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Antibiotic treatment
PharmDr. Martin Šimíček
FAFP1 Pharmaceutical care I
Seminar, 5. 11. 2018
brain (hospital) eyes, ears
respiratory tract heart (hospital)
GIT
genitourinary tract
most common - respiratory tract infections
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Antibiotics are ordered to:
- irritating cough
- high fever
- increased erythrocyte sedimentation rate
- increased number of leukocytes in the blood
count
- asymptomatic bacteriuria
- finding pathogenic microbe in a swab of the
throat ....
When to give ATB ?
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IMPORTANT:
In the general public but also
among health care professionals,
exists the impression that:
if the patient doesn‘t receive
antibiotics, he is not, especially
when acute disease with unpleasant
symptoms, well-treated.
When to give ATB ?
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Inflammatory airway disease
• ATB prescribing for respiratory tract infections is
75% (from the whole administration)!
X
• Respiratory tract infections are caused by about 200
viruses and only about 5 bacteria.
 Acute rhinitis
 Inflammation of the nasopharynx
 Substantial proportion of acute bronchitis (especially in children)
 Catarrhal inflammation of middle ear
 Facial sinuses
• Evidence-based medicine?
Caused by
respiratory
viruses
Do patients really need ATB?
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• Enzymatic destruction of drug
• Prevention of penetration of
drug
• Alteration of antibiotic or
target site
• Rapid ejection of the drug
Mechanisms of Antibiotic Resistance
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When to administer ATB - bacterial infections
Diagnostic methods:
• C reactive protein (CRP) levels
• Higher sedimentation of Erys
– ♂ 2–5 mm/hod
– ♀ 3–8 mm/hod
• Leukocytosis
• Bacterial cultivation + sensitivity determination
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When to give ATB – bacterial infections
• Determination of C reactive protein (CRP):
• high values ​​are associated with bacterial
infection, > 50mg/l
• low concentrations indicate a viral etiology of
infection <10 mg l
 Test is done by the pediatrician or GP at the office
 Costs around 100 CZE (paid by health insurance)
 What would be the use in PHARMACY?
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CRP test
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Streptococcal infection
 Complicated process
 Fever over 38 ° C
 Shivers
 Magnitude of sore throat
and swallowing
 Hypersalivation
 Painful enlargement of
cervical nodes
Viral infection
 Uncomplicated process,
coupled with signs in the
surrounding regions due to
high communication skills
(sinusitis, otitis, pharyngitis ...)
 Runny nose
 Sneezing
 Cough
 Headache
Division of symptoms and findings of streptococcal
and viral tonsillitis
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Division of symptoms and findings of streptococcal
and viral tonsillitis
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Communication with patient
• Why do patients want ATB for common cold?
• How would you explain to the patient that ATB cannot be
dispensed without prescription?
• Which ATB are OTC?
Do not underestimate the communication part of
dispensing!
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Dispensing minimum
1) Always warn the patient that he is receiving
antibiotics
2) Frequency of use
 On the right time at the right dose
 Not 3 times a day, but every 8 hours, etc.
 Or give specific times (8.00 and 20.00)
 Always write on the box!
 If you miss the dose, take as soon as you
remember (never take double dose)
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3. The time during which patients are taking
antibiotics (how long?)
 Up to using the package, 7 days or until further
control at the doctor, etc. (do not stop halfway)
 Draw attention to the durability of diluted antibiotic
syrups, and their proper storage
 If the antibiotics did not start to with within 48 hours,
NO decreasing of the symptoms, patient should
contact the doctor
Dispensing minimum
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• If condition does
not improve, or even
worsened after
completing the
course of treatment,
consult your doctor
immediately!
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Dispensing minimum
4. Connection with food
 Before eating, after eating, "in case of abdominal pain
eat something small with ATB" ...
 The possible interactions with certain foods, minerals
(bivalent cationts), alcohol (eg, metronidazole, tetracycline
antibiotics).
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Dispensing minimum
5. Warn about possible side effects
 Only those side effects that may occur in the individual.
Do not name all!
 Possible photosensitivity?
 Draw attention to possible allergization, and how to
proceed with its occurrence
 depletion of bacterial mikroflora
 Broad-spectrum antibiotics for prolonged use or when used in
high-risk patient groups –- recommend the way of protection and
regeneration of the intestinal microflora
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Side effects of ATB
• Nausea
• Vomiting
• Constipation x Diarrhoea bacterial μflora
• Headache
• Allergic reactions (beta-lactames)
– rash, itchness, brethlessness
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Dispensing minimum
6. Warn about possible interactions with other
drugs
 Need for individualization. (eg, a young woman contraception,
seniors - statins ....)
7. Regime measures
 Plenty of fluids, bed rest, plenty of sleep, vit. C,
probiotics support immune ...
8. Make sure, if the patient understood
everything correctly
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Once more inform patient that:
• Do not share antiotics with others
or leave them for us in next
similar episode
• Similar symptoms do not mean
the same disease
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Probiotics, etc.
• Probiotics: contain bacterial strains
(Lactobacilus, Bifidobacterium, Streptococcus,
Enterococcus, orSacharomyces) which recolonize
the intestinal wall.
• Usually combination of strains
• Positive effect on specific and non-specific
immunity
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Probiotic use at ATB therapy
• Effects on the prevention and treatment of
gastrointestinal complications
• To be administered in parallel with ATB
• Usually higher doses than in prevention (3x daily,
3rd day, not at the same time)
• Sacharomycces boulardii especially for
long-term antibiotic therapy (predominantly
colonizes only when using Sacharomycces)
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Lacidofil 45 cps
authorized drug (store in refridgerator)
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Choice of probiotic
• According to a given resistence to specific
antibiotic (see in SPC antibiotics).
• Sufficient dose (108_1010 microorganisms)
• Read PIL, at the end of exspiration – lower doses, alive microorganisms!!)
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Choice of probiotic
Various dosage forms
• for children: sachets, capsules, soluble
tablets
• for adults
Antibiotic Spectrum of Activity
• no antibiotic is effective against all microbes !!
• there are microbes resistant for most of ATB groups
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Mechanisms of Antimicrobial Action
• Cell wall formation
• Protein synthesis
• DNA replication
• RNA synthesis
• Synthesis of essential metabolites
• Bacteriostatic x bacteriocide
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Thank you for our attention