抗生素管理工作（英文PPT）Antibiotic Stewardship课件.pptVIP

Antibiotic Stewardship C.G. Wlodaver, M.D. Agenda Basics Specifics Physician/administration acceptance Physician response Measurement/reporting Cost implications Clinical vignettes and user friendly recommendations Goal Condense clinical infectious disease ad absurdum Create mini-ID specialists, by recipe What is Antibiotic Stewardship? A program that encourages judicious (vs injudicious) use of antibiotics Antibiotics are relatively so effective, non-toxic and inexpensive…so easy to use…that they are prone to abuse When the diagnosis is uncertain, antibiotics are often prescribed… Stewardship strives to fine tune antibiotic Rx in regards to Efficacy Toxicity Resistance-induction C. difficile-induction Cost Discontinuation How does it relate to MRSA? Resistance-induction: MRSA and other MDRSs Darwinism Flemming Weinstein, L Native American wisdom Efficacy Some prescribers are still in the MSSA era What are its limitations? It’s difficult/dangerous… to practice clinical infectious diseases with limited information Select cases very carefully Primum non nocere Does it work? Data……………. Recommended by Collaborative Drs. Perl, Bratzler, CW IDSA Practiced regularly How does it work? A pharmacist, par excellence, or someone else… reviews patients on antibiotics and makes recommendations, prn; overseen by ID-trained physician, when available. Training… Physician contacted Telephone call… Notation in chart… Rx change written Pharmacist, verbal order Physician Common InterventionsSome are so evident that they should be automatic Allergy Efficacy Empiric, vs MRSA Based on culture and sensitivity Dosing Cefazolin, q8h Ceftriaxone, q24h Levels Vancomycin… Aminoglycosides… IV-to-po switch Criteria Afebrile WBC normalized Oral bio-availability, e.g. quinolones………. Intact GI tract Patient can often go home on po without further in-hospital observation…….. Redundancy E.g. Unasyn or Zosyn + Flagyl… When to discontinue antibiotics altogether! Asymtomatic UTI Viral