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Empiric antibiotic therapy

Empiric antibiotic therapy. Prof Ruth Nduati Department of Paediatrics and Child health University of nairobi. Evidence based treatment of infections to prevent anti microbial resistance. Evidence based treatment (culture result). Empiric treatment. Why empiric therapy?.

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Empiric antibiotic therapy

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  1. Empiric antibiotic therapy Prof Ruth Nduati Department of Paediatrics and Child health University of nairobi

  2. Evidence based treatment of infections to prevent anti microbial resistance Evidence based treatment (culture result) Empiric treatment

  3. Why empiric therapy?

  4. Infections are common • Antimicrobial resistance is a problem • Genuine resistance • Inappropriate selection • Inadequate dosing • Amount • duration

  5. Identification of specific organisms • Microbial resistance • Many variables • Sample collection • Sample handling • Culture – media • Resistance panel • Over calling resistance

  6. Steps in selecting the empiric protocol SEVERITY OF ILLNESS Does the child have co-morbid conditions – malnutrition, cardiac disease, neutropenia

  7. Selecting an empiric protocol

  8. Selecting an empiric protocol

  9. Health care associated Pneumonia

  10. Health care associated Pneumonia

  11. Doses of many antibiotic vary with age of child

  12. Age and weight adjusted dosing Cefalosporins and Penicillins generally don’t need age adjusted dosing

  13. Selection and Dosing of many antibiotic varies with severity of illness

  14. Assess for danger signs Example IMCI danger sign list • Inability to drink or breastfeed • Vomiting everything • History of convulsions in current illness • Lethargy or altered consciousness • Seizures now Other • Features of septic shock – cold extremities, cap refill, petichae, multi-organ dysfunction • Oxygen saturation

  15. - DAIDS Tables • Standardized approach to grading severity of disease. • Tables developed to support multi-cente clinical trials • Useful tool for decision making • Grade adverse event/symptom/sign into 5 categories • Grade 1 mild event • Grade 2 moderate event • Grade 3 severe event • Grade 4 potentially life-threatening event • Grade 5 death

  16. Example of severity of infection adjustments

  17. Example of severity of infection adjustments

  18. Example of severity of infection adjustments

  19. Careful selection of empiric treatment protocol is key to preventing anti microbial resistance Empiric treatment DISEASE Specific treatment

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