Antimicrobials and resistance

• Antimicrobial stewardship: prudent prescribing is not to prescribe as few antibiotics as possible but to identify that small group of patients who really need antibiotic treatment and then explain, reassure, and educate the large group of patients who don’t
• Inappropriate and excessive use of antibiotics, particular broad spectrum, leads to resistance, C. difficile, increased morbidity, mortality, increased cost and reduces quality of life

C diff. and the 4 Cs

• Co-amoxiclav, cephalosporins, clindamycin, ciprofloxin
• Broad spectrum agents alter nomal gut flora
• Clostridioides difficile (CDI) proliferates → causes diarrhoea and spreads
• Avoid if possible

Overcoming issues with antibiotics

Right drug

• Compliance with local antibiotic policies ensures patients get the most effective treatment for their infection
• Check patients don’t have a documented allergy
• Be mindful of microbiology results being available and prompt their review by the team to ensure empirical treatment is appropriate

Right time

• Administration of antibiotics at the recommended dosage interval is an important factor in their effectiveness
• IV antibiotics given within the first hour once sepsis is diagnosed will increase survival

Right duration

• Prolonged duration of antimicrobial treatment is a risk factor for CDI and antimicrobial resistance
• Local antibiotic policies specify recommended duration for each infection type

Right dose