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Introduction
• Practical Prescribing session
• Why is it important?
• Background
• What must be included in an antibiotic prescription
• Practical examples
• Summary
Prescribing Example
• Please prescribe appropriate therapy for a query non-severe community acquired pneumonia as indicated on the antibiotic policy.
Why is it Important?
• Ensure appropriate use of antibiotics :– Right antibiotic
– Right dose
– Right Route
– Right length of time
• Promotes Good Prescribing Practice
• Adherence to Trust Antibiotic Policy
• Helps to Reduce Incidence of Clostridium difficile Infection
HPA & Dept of Health Guidelines 2009- C.difficile infection :How to deal with the problem
• Reduce use of Broad Spectrum Antibiotics especially:
• Cephalosporins
• Fluoroquinolones
• Clindamycin
• Aminopenicillins
• Carbapenems
Examples of Antibiotics less likely to cause C.diff infection
• Gentamicin
• Penicillin
• Anti-pseudomonal penicillins with or without a beta-lactamase inhibitor.
• vancomycin
Other Guidance
• All consultants need to be responsible for reviewing antibiotic prescriptions on all their ward rounds (as should their juniors)
• Antibiotics should be prescribed only when there is clinical evidence of bacterial infection
• Antibiotics started inappropriately or without sufficient evidence should be stopped
• Follow Antibiotic Policy
What must an Antibiotic Prescription Included
• Length of Course or a Review Date (all i/v antibiotics must be reviewed at 48 hours and reviewed to oral where clinically appropriate)
• Indication
Example 2
• Uncomplicated Cystitis
• Please write a prescription for a patient with uncomplicated cystitis
Prescribing Issues
• Prescribing of Drugs that change frequency (eg teicoplanin)
• How to ensure levels are monitored
• Consider Special Patient Factors eg Renal impairment or Pregnancy.
• I/V Antibiotics –Medusa(Injectable Medicines Guide)
Example 5
• Antibiotic with varying dose eg Teicoplanin dose 600mg bd for 3 doses then 24 hourly i/v.
Summary
• Background & Why appropriate prescribing is important
• Practical Prescribing Session– Allergy status
– Alert status
– Follow antibiotic policy
– Consider Special Patient Factors
– What must be Included eg Indication & course length
– Check sensitivities