PRUDENTIAL

USE OF ANTIBIOTIC
IN CHILDREN
BLOK 27 2016
Component of Treatment
 General principles of
the treatment of infecBon

AnBmicrobial agents are among the most commonly

prescribed drugs.

The major impact on control of most bacterial infecBons

Concerns that unnecessary use is compromising their

benecial eect
Basic principle of prescribing anBbioBc

Benet value for paBent

Highly suggested bacterial infeciotn

AnBbioBc selecBon
Class, dose, route, interval, duraBon
PK/PD
Adverse reacBon
 Clinical asessment
Clinical evaluaBon should dene the anatomical locaBon and
severity of the infecBve process.

Although such diseases may be caused by wide variety of

organisms, the range of pathogens are usually limited.

The paWern of suscepBbility reasonably predictable.

Permits a raBonal selecBon of chemotherapy in the iniBal

management of such infecBons
 Step 1
Clinical asassment
The anatomical loca0ons
The most likely pathogen Most suitable choice of drug

Determined by accurate physical examina0on

Invasive to the Bssue or blood
Supercial (skin, mucosa)
stream

Determine the route of administra0on of the drug

Topical Intramuscular/ intravenous
Accurate physical examinaBon is necessary to idenBfy the
locaBon of infecBon and to dene anBbioBc prescripBon
 Step 2 Look for other
issues
Epidemiological aspects
Age, sex, occupaBon Over seas travel

Pre-exis0ng medical problems

Valvular heart disease,
ProstheBc devices: V-P shunt
underlying malignant disease

Invading pathogen may be part of hosts ora

Trauma, surgical incision Deciency of circulaBng PMN
 Factors to assist anBbioBc selecBon
indica0on PK/PD that are
for associated with a
an0microbial Most common parBcular
organism causing AnBbioBc anBbioBc
agent the infecBon & spectrum of the
the local chosen empirical
suscepBbility agent
paWern
Cost
eec)veness
Monotherapy
of an)bioitc
or combinaiton Host factor that selec)on
might aect Adverse reaBon
therapy
Criteria in anBbioiBc selecBon
Broad or
narrow
spectrum

Epmpiric or BacteriostaBc
deniBve or bactericid

Moo or
IV or oral
combined
AnBbioBc classes & agents

AnBbioBcs are commonly classied

based on

@ chemical structure
and
@mechanism of acBon
 Bacterial Basics

Bacteria aspects anBbioBc target

Bacterial
BiosyntheBc DNA
cell
processes replicaBon
envelope

12
AnBbioBc classes
 Narrow and broad spectrum
an)bio)cs
Narrow Broad spectrum
Aim to specic bacteri Unknown eBlogy
conrm Emprirical
PotenBal serious bacterial
infecBon
MulBple anBbioitc
Narrow and broad spectrum
--> expire??
LocaBon, eBology, and
suscepBbility

 Mono vs CombinaBon
Mono or combinaBon
Monotherapy : One anBbioBc
CombinaBon : two or more anBbioBcs
 AnBbioBc combinaBon
Empiric therapy of potenBal serious infecBon
Mulitple causaBve agent
Reduce toxicity and resistency
Sinergy or addiBve
Unappropriate antagonist, adverse reacBon
>>, cost >>
Common anBbioBc combinaBon

Double - -lactam & -lactam &

lactam aminoglycoside quinolon
 AnBbioBc administraBon
Preered easy
Oral and cost-
eecBve

When do we give
i.v iv?
 When give iv?

Severe illness Advantage

Reach desirable soon Oral (-)

Reach therapeuBc level ContraindicaBon for

sooner oral
 Empirical therapy
based on clinical DeniBve therapy
diagnosBc and suspected Based on posiBve result
microorganism of culture & sensiBvity
Drug of choice and test
alternaBve drugs

Clinical indicaBon : treatment of the

disease and eBology organisms
Site of infecBon (penetraBon of drugs)
Dosages of anBbioBc
Renal impairment
AdministraBon
 Probable
Flowchart of bacterail
infection treatment
Bacteri
al
Recover
infecB
on

Narrow Empiric therapy

spectrum Culture
an0io0c

Pathogen
Deni0ve
iden0ca0o
therapy
n
 Laboaratory assesment
Few infecBve condiBon present a typical picture with a
deniBve clinical & microbiological diagnosis without lab.
exam

Whenever possible a clinical diagnosis should be supported

by laboratory conrmaBon.

Strong clinical suspected, therapy should be given as soon as

possible; while lab assessment should be taken

Serological test is important to anBgen detecBon

Treatment evaluaBon
 AnBbioBc therapy failure
Inaccurate dose
Inaccurate anBbioBc selecBon
NecroBc inammaBon area
Other infecBon source
Wrong diagnosis
Fight smarter not harder
AnBbioBc stewardship
The CDC Campaign to Prevent An0microbial Resistance in
Healthcare seHngs: 4 Strategies of the Campaign
Thank you