Stiuations in which antibiotics are prescribed: Broadly, antibiotics are used in three scenarios 1.

Empiric - occurs when a patient is treated for an infection before specific culture information has been reported or obtained. This is the most common scenario in which antibiotics are prescribed and therefore highlights the need for accurate empiric antibiotic prescribing. 2. Targeted - occurs when a patient has a pathogen indentified in the microbiology laboratory and antibiotics are prescribed to "target" the pathogen identified. Antibiotic chosen is frequently based on antibiotic susceptibility results 3. Prophylactic - to prevent an infection occurring. For example, certain types of surgical procedures (e.g. colonic resection) require administration of one dose of antibiotics at induction of anaesthesia in order to prevent infection occurring as a result of the surgical procedure. This is determined in the microbiology laboratory by performing susceptibility testing on an organism identified in the laboratory collected from a clinical sample from the patient. Susceptibility testing attempts to predict the likely success or failure of an antibiotic when administered to a patient to treat a particular infection How to determine if organism is susceptible or resistant to an antibiotic? This can be done by either disc diffusion or determining the minimum inhibitory concentration. 1. Disc diffusion is performed by plating the test isolate onto a culture plate; cellulose discs with a standard amount of different antibiotics are placed onto the agar plate. During overnight incubation the antibiotic diffuses into agar from the discs and the zone sizes reflect susceptibility or resistance to a particular antibiotic. This method is the most commonly used and cost effective means of determining antibiotic susceptibility.

2. Minimum inhibitory concentration (MIC), which can be done by agar or broth dilution, refers to the lowest concentration of an antibiotic required to inhibit the growth of a bacterium. Used in the setting of life threatening infections (e.g. infective endocarditis) or where results of disc diffusion are not clear in order to determine specific susceptibility data.

Similar to tetracycline antibiotics. Retains activity versus many streptococci.g. In Ireland more than 60% of E. 4. e.patients with signs of systemic illness and who require admission to hospital may require intravenous antibiotic therapy 2. aureus or MRSA). amoxicillin) . majority of causes of soft tissue infection such as cellulitis are caused by gram positive pathogens (such as Streptococcus pyogenes) so antibiotics prescribed for these infections should target these pathogens Commonly used penicillin. cephradine) are effective mostly versus Gram-positive pathogens. flucloxacillin) .These include the following 1. Likely pathogens involved. Second generation cephalosporins (e.g. Penicillin G . coli isolates resistant to amoxicillin as elevated rates will affect empiric antibiotic prescribing for urinary tract infections (>50% urinary tract infections caused by E.g. 3.g. macrolides can target the so called "atypical" pathogens (e.g. How cephalosporin categorized : Cephalosporin antibiotics. 2. Mycoplasma . are commonly divided into different generations.original penicillin compound which has a narrow spectrum of activity because of beta-lactamase (enzyme which breaks down beta lactam ring structure of penicillins) and other resistance mechanisms produced by bacteria. How ill is the patient . cefotaxime) have excellent Gram-negative activity but reduced gram-positive (particularly S. Likely source of infection as different organisms affect different sites of the body and differing antibiotics have variable tissue penetration (e.g.g. which like penicillin have a beta lactam ring structure.g.semi-synthetic penicillins which are resistant to the beta lactamase produced by the majority of Staphylococcus aureus and are the treatment of choice in infections caused by these pathogens.s ? These include. 1.g. coli). glycopeptides: These bactericidal cell wall synthesis inhibitors. Anti staphylococcal penicillins (e. of which vancomycin is the most commonly prescribed. Local patterns of resistance . Aminopenicillins (e. 3. not all antibiotics cross the blood brain barrier for the treatment of bacterial meningitis). 4. Beta lactam/beta lactamase inhibitor combinations e. coli are amoxicillin resistant and therefore amoxicillin is no longer recommended as empiric treatment of urinary tract infections in Ireland. are used to treat resistant gram positive infections (e. treatement of infections caused by methicillin resistant S.g. Third generation cephalosporins (e. Co-amoxiclav (amoxicillin plus clavulinc acid) and Piperacillin-tazobactam (piperacillin plus tazobactam).e. First generation cephalosporins (e. Addition of beta lactamase inhibitors to these penicillins allows these antibiotics to be effective against most of strains of bacteria which produce beta lactamses. percentage of E. aureus) activity. cefuroxime) retain activity versus Gram-positive pathogens but have increased activity versus gram-negative pathogens.g. macrolides: These bacteriostatic antibiotics have a wide range of activity.addition of side chain in penicillin G resulting in increased activity versus gram-negative bacteria but still susceptible to betalactamses.

local irritation at site of injection can result in secondary infection . These include Hypersensitivity .with other medications patient receiving.for example liver toxicity can occur with macrolides. which can be a side effect of almost all antibiotics. Of note approximately 10% of patients who develop a hypersensitivity reaction to penicillin will also develop a reaction to cephalosporins Altered normal flora .can result in for example candidiasis or antibiotic associated colitis e. Clostridium difficile infection. is particularly associated with the use of second and third generation cephalosporins.with consequences both to the patient and wider community Chemical .. Coxiella spp. Beta lactams such as penicillin have the greatest potential to produce hypersensitivity.ranging from mild skin reactions to angioedema. rifampicin and warfarin can interact altering effects of both medications Tissue/ organ specificity . Clostridium difficile infection.g.. Chlamydia spp. Side effects of antibiotics use : At least 5% of patients develop side effects due to antibiotic therapy. e.) for which beta lactam antibiotics are ineffective due to the absence of a cell wall target in these pathogens or bacterial intracellular replication. nephrotoxicity occurring with aminoglycosides Antibiotic Resistance . quinolones and clindamycin Drug Interactions .g.spp.

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