3. Voodoo
A patient with fever & deranged LFT, on
Magnex & Tinidazole, shifted to hospital
Started on Cefaxone/Oflox/Ampi/Metro
Switched to Aug/Pip.tazo/O/M
Switched to Clinda/P.t/O & antimalarials
All within 48 hours of admission &
with MP reported negative
4. Facts
50% antibiotics are used inappropriately
Majority of acute diarrhea and acute
bronchitis episodes are not due to bacterial
infection
UGI bleed and seizures are not due to
bacterial infection
Antibiotics do not treat the patient, antibiotics
treat bacterial infection
6. Questions
Is it infection?
Is it bacterial infection?
If yes, take appropriate samples first
What is likely etiologic agent?
What antibiotic?
7. Empiric antibiotic
Choice depends on:
Severity of infection
Susceptibility of presumed bacteria
Patient factors
Drug factors
Cost
11. Antibacterial spectrum of antibiotics
Predominantly Gram positive
Clox, Pen. G, 1st
gen. Ceph., Clindamycin
Vancomycin, Linezolid, Teicoplanin
Only Anaerobes
Metronidazole, Clindamycin
Only Gram negative
Aminoglycosides, Cipro/Oflox, Aztreonam
Broad spectrum
Augmentin, 3rd
gen. Ceph., Pip.tazo, Levoflox, Imipenem,
Meropenem, Chloramphenicol
12. Empiric antibiotics
Severe acute GE: Cipro./Co-trimox.
Acute UTI : Co-trimox./Cipro.
Acute bronchitis : Co-trimox./Doxy./Azithro.
Sepsis: 3rd
Cephalo/Pip.tazo/Meropenem
add Aminoglycoside
IV line infection: Vancomycin/Linezolid
13. Patient factors
h/o allergy
Pregnancy: avoid Aminoglycosides & Doxycycline
Deranged LFT: dose adjustment of Ceftriaxone, Clindamycin,
Metronidazole
Deranged RFT: dose adjustment of Aminoglycosides,
Quinolones, Co-trimox., Vancomycin, all beta-lactams
Deranged RFT: no dose adjustment of Ceftriaxone, Azithro.,
Clinda., Doxy., Metro.
14. Drug factors
Bactericidal: cell-wall active agents e.g. beta-
lactams, aminoglycosides, Vanco.
or DNA active agents e.g. Quinolones
Bacteriostatic: inhibit protein synthesis
e.g.Macrolides, Co-trimox., Doxycycline, Clindamycin
No difference in an immunocompetent host, but
bactericidal agents preferred in an
immunocompromised host or for
meningeal/endocardial/endovascular infections
Aminoglycosides & Quinolones show concentration
dependent killing
18. Better use of Antibiotics
Use when required, i.e. do not use when not required
Empiric antibiotics based on empiric bacteria & local
susceptibility profile
Use only necessary & appropriate combination
Newer doesn’t mean better
Scale up/down based on lab. results
Switch from IV to oral ASAP
Drugs can cause fever & can change hematologic
parameters