How to Prescribe an Antibiotic Berny Baretto (Antibiotic Pharmacist) 11 th February 2011

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.

Chest Infection Recommendation

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 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 1 Try again! Write a prescription for non-severe CAP( not pen- allergic)

Chest Infection Recommendation

Query Non-severe CAP

Crossing off an Antibiotic

Example 2 Uncomplicated Cystitis Please write a prescription for a patient with uncomplicated cystitis

UTI Recommendation

Uncomplicated Cystitis

Crossing off an Antibiotic

Re-prescribing after antibiotic sensitivities appear on CRRS

Example 3 Prescribe Treatment for Sepsis (source unclear) pen allergic option.

Sepsis –Source Unclear Recommendation

Sepsis Source Unclear (pen-allergic)

Example 4 Therapy for moderate Clostridium difficile infection

Clostridium difficile Therapy Recommendation

Clostridium difficile Therapy (moderate)

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.

Varying Doses

Varying Doses (contd)

Special Patient Factors eg Pregnancy

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

Thank you Any Questions ?????