How to Prescribe an AntibioticBerny Baretto (Antibiotic Pharmacist)

11th 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 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 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 ?????