Summary of patient-level interventions

Figure 8 sums up the application of antimicrobial stewardship to an individual patient.

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Figure 8 A summary of applying AMS at the patient level.
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A two-column figure. In column A, start with the assessment. Do not start antibiotics in the absence of clinical evidence of bacterial infection. The stages are as follows:

  1. Take thorough drug allergy history
  2. Obtain specimens prior to antibiotic therapy
  3. Initiate antibiotic treatment as soon as possible in patients with severe sepsis or life-threatening infections
  4. Comply with local antimicrobial prescribing guidelines
  5. Document clinical indications for use of antibiotics and dose, route and duration of administration

In column B, you then direct the treatment with a clinical review and reassessment at 48–72 hours. Options include:

  1. Stop the antibiotic
  2. Intravenous or oral switch
  3. Change antibiotic
  4. Continue
  5. Outpatient Parenteral Antibiotic Therapy (OPAT)

You should document all decisions.

Figure 8 A summary of applying AMS at the patient level.

  • Choose the correct statement(s) from the following list. Correct use of antimicrobials is based on following:

    • a. 

    the antimicrobial’s mechanism of activity


    b. 

    whether the effect of the drug on the bacteria is bacteriostatic or bactericidal


    c. 

    the mechanism of resistance to the group of antibiotics


    d. 

    pharmacokinetic parameters


    e. 

    pharmacodynamic parameters.


    The correct answers are a, b, c, d and e.

De-escalation

5.3 Summary of interventions