Download PIAS-KT Educational Outreach

UTI & Pneumonia
Translating Knowledge into Practice
PIAS-KT Study
Sukhjinder Sidhu
Sean Gorman
Richard Slavik
Tasha Ramsey
Sarah Murray
Nicole Bruchet
Attendance
• Please email Brenda Flood
([email protected]) if you
attended this session
• Please email Brenda Flood
([email protected]) if you view
this presentation online at a later date
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• YOU SURPASSED OUR PROJECTED
PARTICIPATION RATE FOR THE PRE-QUIZ!
• STAY TUNED FOR A POST-QUIZ THAT WILL BE
SENT OUT IN MID-MARCH
• THANK YOU TO TASHA RAMSEY FOR HER
EXPERT REVIEW OF THIS PRESENTATION
Speaker Disclosure
• The speakers have no actual or potential
conflicts of interest to disclose
Outline
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PIAS-KT Study Overview
Local Opinion Leaders
Prevalence and Impact of UTIs & Pneumonia
Antimicrobial Stewardship
Key Pharmacist Interventions for UTIs & Pneumonia
DTP Tracker Data for UTIs & Pneumonia
UTIs & Pneumonia Therapeutics
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–
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When to treat with antibiotics and When Not to treat?
What antibiotics to initiate and Why?
When, How, and Why to de-escalate antibiotics?
How long to treat with antibiotics?
Objectives
• To review the pharmaceutical care of patients
with UTIs & Pneumonia including:
– Key pharmacist interventions
– Indications for antibiotic therapy
– Initial empiric antibiotic therapy recommendations
– Antibiotic de-escalation strategies
– IV to PO step-down considerations
– Duration of antibiotic therapy
PIAS-KT Study Overview
PRE phase
Knowledge
Quiz
Jan 17-30, 2014
Intervention
POST phase
Behavior
DTP/DSEM DTP
KPI/DSEM KPI
Jul 1-Dec 31,2013
Behavioral
Change
Strategies
Jan 30 – Mar 14,
2014
Knowledge
Behavior
Quiz
DTP/DSEM DTP
KPI/DSEM KPI
Mar 17-28, 2014
1. Audit & Feedback
2. Local opinion leaders
3. Educational meetings
4. Educational outreach
5. Printed education materials
6. Reminders
Jan 1-Jun 30, 2014
Local Opinion Leaders
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KGH – Dawn Robb
RIH – Kim Winters
PRH/SOH – Orysya Fetterly
VJH – Chelsea Argent
SLH/OMH – Ian Petterson
KBH/KLH – Michael Conci
EKH/GDH – Darren Feere
Prevalence & Impact of UTIs
Prevalence
– Approximately 4,000,000 UTIs/year in Canada
– Affects 20% of women between 15-29 yo
– Number 1 healthcare-associated infection
– 16th most common non-surgical reason for IH admission
Impact
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–
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660 cases and 3200 acute bed-days at IH
Hospital-acquired UTIs associated with extra day of hospitalization
Up to 25% of patients with UTI receive inappropriate therapy
Up to 50% of patients with asymptomatic catheter-associated
bacteriuria are treated with antibiotics (which is inappropriate)
Mayo Clin Proc 2007;82:181-5.; Can J Infect Dis Med Microbiol 2005;16:166-70.
Prevalence & Impact of Pneumonia
Prevalence
– Approximately 170,000 cases of CAP each year in Canada
– HAP/VAP is 2nd most common nosocomial infection in Canada
– 5th most common non-surgical reason for IH admission
Impact
–
–
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1300 cases and 7000 acute bed-days at IH each year
CAP is the leading infectious cause of death
Up to 15% of patients with CAP receive inadequate therapy
Up to 75% of patients with HAP/VAP receive inadequate therapy
Clin Infect Dis 2005;41:1709-16.; Postgrad Med 2010;122:130-141.
Antimicrobial Stewardship Definition
• An activity (or activities) that includes
– Appropriate antibiotic selection
– Appropriate antibiotic dosing
– Appropriate antibiotic route selection
– Appropriate antibiotic duration of therapy
Clin Infect Dis 2007;44:159-77.
Antimicrobial Stewardship Goals
• Optimize clinical outcomes by ensuring effective
antimicrobial therapy
• Minimize collateral damage from antimicrobials
– Antimicrobial resistance
– Antimicrobial toxicity
– Costs of inappropriate antimicrobial use
– Superinfections (e.g. Clostridium difficile)
Clin Infect Dis 2007;44:159-77.
Clinical Pharmacists’ Role in
Antimicrobial Stewardship
PHARMACEUTICAL
CARE
ANTIMICROBIAL
STEWARDSHIP
Urinary Tract Infection
Key Pharmacist Interventions
1. Initiate appropriate antibiotics for symptomatic UTI
2. Discontinue empiric antibiotics started for UTI that are not
indicated
3. De-escalate antibiotics for UTI based on C&S data and
clinical response
4. Perform IV to PO step-down of antibiotics for UTI
5. Promote appropriate duration of antibiotic therapy for UTI
IH UTI Key Pharmacist Interventions, April 21, 2011
Pneumonia
Key Pharmacist Interventions
1.
Initiate appropriate antibiotics for pneumonia
2.
Discontinue empiric antibiotics started for pneumonia that are not
indicated
3.
De-escalate antibiotics for pneumonia based on C&S data and
clinical response
4.
Perform IV to PO step-down of antibiotics for pneumonia
5.
Promote appropriate duration of antibiotic therapy for pneumonia
IH Pneumonia Key Pharmacist Interventions, April 21, 2011
Project Alignment
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CPhA “Blue Print” for Pharmacy Practice
CSHP “Vision 2015”
Canadian Clinical Pharmacy KPI Collaborative
Accreditation Canada
MOHS KRAs and CCM groups
IH SET goals, objectives
IH Pharmacy Clinical Priorities
DTP Tracker Data - UTI
• UTI ranks #6 in disease prevalence for all Rx interventions
• UTI ranks #3 in disease prevalence for 8 DSEM interventions
• UTI ranks #2 in disease prevalence for key pharmacist
interventions
DTP Tracker Data - UTI
• AIMS study showed a statistically significant, clinically
important increase after DSEMs
– DSEM DTP/total DTP (27.9% to 31.9%, p<0.05)
– KPI/total DTP (21.7% to 25.8%, p<0.05)
• In UTI subgroup, AIMS failed to show a statistically
significant benefit
– DSEM DTP/total DTP (3.91% to 3.93%, p=NS)
– KPI/total DTP (3.82% to 4.61%, p=NS)
DTP Tracker Data - Pneumonia
• Pneumonia ranks #3 in disease prevalence for all Rx
interventions
• Pneumonia ranks #2 in disease prevalence for 8 DSEM
interventions
• Pneumonia ranks #3 in disease prevalence for key
pharmacist interventions
DTP Tracker Data - Pneumonia
• In Pneumonia subgroup, AIMS failed to show a
statistically significant benefit
– DSEM DTP/total DTP (4.75% to 4.90%, p=NS)
• However, in Pneumonia subgroup, AIMS demonstrated a
statistically significant REDUCTION
– KPI/total DTP (5.07% to 3.94%, p=0.016)
Pharmaceutical Care of UTI and Pneumonia
UTI Pharmaceutical Care
Outline
• When and When Not to treat with antibiotics?
• What antibiotics to initiate and Why?
• When, How, and Why to de-escalate antibiotics?
• How long to treat with antibiotics?
What Makes a UTI ‘Complicated’?
• Patients with structural or functional
abnormalities of the genitourinary tract
– Obstruction
– Instrumentation (including catheters)
– Impaired voiding
– Metabolic abnormalities
– Immunocompromised
– Men
Can J Infect Dis Med Microbiol 2005;16:349-60.
UTI
“Why should antibiotics be initiated?”
•  duration of symptoms
•  abscesses, metastatic infection, septic shock, AKI
Clin Infect Dis 2005;40:643-54.
UTI
“When should antibiotics be initiated?”
– Clinical manifestations of cystitis
• Dysuria, frequency, urgency, suprapubic pain, hematuria
– Clinical manifestations of pyelonephritis
• Above symptoms together with fever (>38°C), chills, flank
pain, costovertebral angle tenderness, and nausea/vomiting
– Asymptomatic bacteriuria in pregnancy
Cystitis at IH
“When should antibiotics be initiated?”
“If clinically feasible, initiation of antimicrobial
therapy should be delayed until results of urine
culture are available”
Can J Infect Dis Med Microbiol 2005;16:349-60.
UTI at Interior Health
“What antibiotics should be initiated and why?”
Organisms Associated with Urinary Tract Infections
Infection 2007;35:150-3. (Calgary Data 2004-5)
UTI at Interior Health
“What antibiotics should be initiated and why?”
PO options
IV options
Antibiotic
Susceptibility (%)*
Collateral
Damage Risk
Nitrofurantoin
94-98
Low
Cefixime
92-94
Probable
Amox/Clav
84-90
Probable
TMP/SMX
80-83
Possible
Ciprofloxacin
78-85
Probable
Ceftriaxone
94-97
Probable
Gentamicin
94-96
Possible
Pip/Tazo
94-97
Probable
Ampicillin
61-68
Probable
*E. coli Susceptibilities at IH 2012
UTI at Interior Health
“What antibiotics should be initiated and why?”
*Enterococcus Susceptibilities at IH 2012
UTI at Interior Health
“What antibiotics should be initiated and why?”
• Risk Factors for Antibiotic Resistant UTIs
– Abx exposure (especially to TMP/SMX or FQ) in past 3 months
– Travel to endemic area
– Previous multi-drug resistant UTI
Clin Infect Dis 2005;40:643-54.
UTI at Interior Health
“What antibiotics should be initiated and why?”
• Oral Antibiotic Selection
– Oral antibiotics are first line for cystitis
– Oral antibiotics are first line for uncomplicated
pyelonephritis (not acutely ill)
• IV Antibiotic Selection
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Unable to tolerate oral therapy (nausea/vomiting/ileus)
Impaired GI absorption
Hemodynamic instability (acutely ill)
Infecting organism resistant to available oral options
Clin Infect Dis 2005;40:643-54., Can J Infect Dis Med Microbiol 2005;16:349-60.
Complicated Cystitis at IH
“What antibiotics should be initiated?”
“Oral antimicrobial therapy is appropriate for
most episodes”
Can J Infect Dis Med Microbiol 2005;16:349-60.
Uncomplicated Cystitis at IH
“What antibiotics should be initiated?”
Recommendations for Empiric Therapy
1. Nitrofurantoin 100 mg PO BID x 5 days (CrCl ≥ 40 mL/min)
2. Trimethoprim/Sulfamethoxazole i DS PO BID x 3 days
• Cefixime 400 mg PO Daily x 3 days
• Amoxicillin/Clavulanate 875 mg PO BID x 3 days
• Amoxicillin/Clavulanate 500 mg PO TID x 3 days
Complicated Cystitis at IH
“What antibiotics should be initiated?”
Recommended Empiric Oral Options
1st Line
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Cefixime 400 mg PO Daily x 7-14 days
Amoxicillin/Clavulanate 875 mg PO BID x 7-14 days
Amoxicillin/Clavulanate 500 mg PO TID x 7-14 days
Trimethoprim/Sulfamethoxazole i DS PO BID x 7-14 days
2nd Line (high prevalence resistance)
• Ciprofloxacin 500 mg PO BID x 7-14 days
Complicated Cystitis at IH
“What antibiotics should be initiated?”
Recommended Empiric IV Options
• Ampicillin + Gentamicin
• Ampicillin + Ceftriaxone
• Piperacillin/Tazobactam +/- Gentamicin
Uncomplicated Pyelonephritis at IH
“What antibiotics should be initiated and why?”
Recommend Empiric Oral Therapy
• Same as for uncomplicated cystitis EXCEPT:
– No nitrofurantoin
– Longer duration of therapy (7-14 days)
Uncomplicated Pyelonephritis at IH
“What antibiotics should be initiated and why?”
Recommended Empiric IV Therapy
for Acutely Ill Patients
• Gentamicin 5-7 mg/kg/day IV OR
• Ceftriaxone 1-2G IV daily
Complicated Pyelonephritis at IH
“What antibiotics should be initiated and why?”
Recommended Empiric Oral Options
• Same as for complicated cystitis
1st Line
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Cefixime 400 mg PO Daily x 7-14 days
Amoxicillin/Clavulanate 875 mg PO BID x 7-14 days
Amoxicillin/Clavulanate 500 mg PO TID x 7-14 days
Trimethoprim/Sulfamethoxazole i DS PO BID x 7-14 days
2nd Line (high prevalence resistance)
• Ciprofloxacin 500 mg PO BID x 7-14 days
Complicated Pyelonephritis at IH
“What antibiotics should be initiated and why?”
Recommended Empiric IV Options
• Same as for complicated cystitis
– Ampicillin + Gentamicin
– Ampicillin + Ceftriaxone
– Piperacillin/Tazobactam +/- Gentamicin
Asymptomatic Bacteriuria in Pregnancy
“What antibiotics should be initiated and why?”
Recommended Antibiotic Therapy
• Wait for results of screening urine C&S
• Select narrowest spectrum agent that is safe in pregnancy
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Amoxicillin/Clavulanate
Amoxicillin
Cefixime
Cephalexin
Nitrofurantoin (avoid in 3rd trimester)
TMP/SMX (avoid in 1st and 3rd trimesters)
UTI Therapeutics
“What is antibiotic de-escalation and
why is it important?”
• Antibiotic De-escalation
– Replace empiric broad-spectrum regimen with a
more narrow spectrum regimen
– Organism identified with susceptibilities
– Intended to reduce collateral damage
– De-escalation for UTIs is under-performed
Infection 2013;41:211-14.
UTI Therapeutics
“When and How should antibiotics be
de-escalated?”
• When to de-escalate
– Once urine C&S known
– No other suspected infections
– No patient-limiting factors (e.g. allergy)
Infection 2013;41:211-14.
UTI Therapeutics
“When and How should antibiotics be
de-escalated?”
• How to de-escalate
– Broad spectrum to narrowest spectrum
– Narrowest spectrum with  collateral damage risk
Examples
Empiric
Step-Down
Ciprofloxacin
Amoxicillin
Cefixime
Cephalexin
Ceftriaxone
TMP/SMX
Pip/Tazo
Amoxicillin/Clav
Ceftriaxone
Cefixime
Infection 2013;41:211-14.
UTI Therapeutics
“How should antibiotics be de-escalated?”
• IV to PO Step-Down
– Tolerates oral intake
– No factors affecting absorption
– Hemodynamically stable
– If acutely ill pyelonephritis and considering PO βlactam, patient should receive at least 1 dose of
Ceftriaxone OR Aminoglycoside
Infection 2013;41:211-14.
Interior Health IV to PO
Step-Down Policy
• Pharmacists Have IV-PO Step-Down Authority
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–
–
–
–
Applies to Ciprofloxacin/Moxifloxacin
Duration IV antibiotics: ≥ 48 hours
Tolerating other PO medications, fluids, or foods x 12 hours
No potential problems with absorption
Clinically stable (stable BP, resolving fever/afebrile, adequate urine
output, absence of encephalopathy, WBC normal or normalizing)
• Exclusions
• Febrile neutropenia, gram negative bacteremia, CNS infections, septic
shock, severe cellulitis
InsideNet – Pharmacist managed IV to PO conversion program (2006)
UTI Therapeutics
“How long to treat with antibiotics?”
• Uncomplicated cystitis
– 3-7 days (5-7 days for nitrofurantoin)
• Complicated cystitis
– 7-14 days
• Pyelonephritis
– 7-14 days
Candida-Associated Cystitis
• Indications for treatment
– Symptomatic cystitis
– Asymptomatic, but high risk (neutropenia,
planned urologic manipulation)
• Recommended treatment
– Fluconazole 200-400 mg PO daily x 14 days
– Amphotericin 0.3-0.6 mg/kg IV x 7 days (2nd line)
Clin Infect Dis 2009;48:503-35.
Pneumonia Pharmaceutical Care
Outline
• When and When Not to treat with antibiotics?
• What antibiotics to initiate and Why?
• When, How, and Why to de-escalate antibiotics?
• How long to treat with antibiotics?
IH Pneumonia DSEM
Pneumonia
When and Why Antibiotic Treatment?
• Physician/NP Diagnosis
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Varies depending on outpatient/inpatient
Chest x-ray infiltrates PLUS
Fever, purulent secretions, elevated WBC
Other clinical manifestations: dyspnea, pleuritic chest pain
• Consequences of Pneumonia
– Reduced survival
– Increased risk of ICU admission
– Prolonged length of hospitalization
Clin Infect Dis 2007;44:sS.; Pneumonia DSEM 2008.
Community-Acquired Pneumonia
• Patients not hospitalized in previous 14 days
Clin Infect Dis 2000;31:383-421.
Community-Acquired Pneumonia
“What antibiotics should be initiated and why?”
Microbiologic Etiology
Patient Setting
Outpatients
Organisms
Mycoplasma pneumoniae, Streptococcus
pneumoniae, Haemophilus influenzae
Inpatients
(non-ICU)
Streptococcus pneumoniae, Mycoplasma
pneumoniae, Chlamydia pneumoniae, Haemophilus
influenzae, other gram (-) bacilli, Staphylococcus
aureus
Inpatients
(ICU)
Streptococcus pneumoniae, various gram (-) bacilli,
Legionella pneumophilia, Staphylococcus aureus
Clin Infect Dis 2000;31:347-82.
Community-Acquired Pneumonia
Risk Factors for AROs
Drug-Resistant
Pneumococci
MRSA
Pseudomonas
aeruginosa
Age > 65 yrs
Dialysis
Structural Lung Dz
Abx exposure 90 d*
Hospitalization
Corticosteroids (> 10
mg Prednisone/day)
Alcoholism
ICU Admission
Immunosuppression
Prior/Prolonged Abx
> 7 days Broad Abx in
past month
Comorbidities
Previous colonization
Malnutrition
Exposed to child in daycare
*β-Lactam, Fluoroquinolone, Macrolide
Can J Infect Dis Med Microbiol 2008;19:19-53., Clin Infect Dis 2007;44:(Suppl 2):S27-72.
Community-Acquired Pneumonia
“What antibiotics should be initiated and why?”
Antibiotic
Susceptibility (%)
Cost/day
S. pneumo
H. flu
Atypicals
Ceftriaxone
99-100
99-100
Ø
$2.62
Amox/Clav
99-100
92-97
Ø
$0.72
Amoxicillin
99-100
73-80*
Ø
$0.18-0.36
Moxifloxacin
99
√
√
$4.00 (PO)
$17.50 (IV)
Doxycycline
81-89
88-92
√
$0.18
Azithromycin
74-89
NR
√
$1.28 (PO)
$8.32 (IV)
NR
91-95
Ø
$1.84-3.68 (PO)
$31.56 (IV)
Cefuroxime
*Ampicillin Susceptibility
Susceptibilities at IH 2012
Community-Acquired Pneumonia
“What antibiotics should be initiated?”
Recommendations for Empiric Therapy in Hospital
• General Ward
1. Moxifloxacin 400 mg PO/IV daily
2. Ceftriaxone 2 g IV daily + Azithromycin 500 mg IV daily
• ICU
1. Ceftriaxone 2 g IV daily + Azithromycin 500 mg IV daily
2. Ceftriaxone 2 g IV daily + Moxifloxacin 400 mg IV daily
Clin Infect Dis 2007;44:(Suppl 2):S27-72.
Approach to De-Escalation
Suspected CAP
Empiric Antibiotics
C&S Available?
NO
Significant
Improvement after
48-96 hr?
• De-escalate
• Max 7 Days
Significant
Improvement after
48-96 hr?
NO
YES
•
•
•
•
•
YES
NO
Review Abx
Review Dose
Re-culture
Complication?
Consider non-infection
YES
• De-escalate
using C&S
• Max 7 days
Intensive Care Med 2014;40:92-5.
Community-Acquired Pneumonia
“Pathogen-Directed Therapy”
Organism
Preferred
Alternatives
S. pneumoniae;
MIC < 2 mg/L
Pen G, amoxicillin
Macrolide, cephalosporins,
clindamycin, doxycline,
respiratory fluoroquinolone
S. pneumonia;
MIC ≥ 2 mg/L
3rd generation cephalosporin,
fluoroquinolone
Vancomycin, linezolid,
amoxicillin >3 g/day if MIC ≤ 4
mg/L
H. influenzae
(no betalactamase)
Amoxicillin
Fluoroquinolone, doxycycline,
azithromycin, clarithromycin
H. Influenza
(beta-lactamase)
2nd or 3rd generation
cephalosporin, amoxicillinclavulanate
Fluoroquinolone, doxycycline,
azithromycin, clarithromycin
Enterobacteriacea 3rd generation cephalosporin,
e
carbapenem
P. aeruginosa
Antipseudomonal beta-lactam
Beta-lactam/beta-lactamase
inhibitor, fluoroquinolone
Clin Infect Dis 2007;44:(Suppl 2):S27-72.
Aminoglycoside PLUS cipro or
Community-Acquired Pneumonia
“IV to PO Step-down Criteria”
• Normal functioning GI tract AND
• Able to ingest medications AND
• Improving clinically AND
• Clinical stability
– T < 37.8 0C
– HR < 100 bpm
– RR < 24 breaths/min
– SBP > 90 mm Hg
– Arterial O2 sat > 90%
– Normal mental status
Clin Infect Dis 2007;44:(Suppl 2):S27-72.
Interior Health IV to PO
Step-Down Policy
• Pharmacists Have IV-PO Step-Down Authority
–
–
–
–
–
Applies to Ciprofloxacin/Moxifloxacin
Duration IV antibiotics: ≥ 48 hours
Tolerating other PO medications, fluids, or foods x 12 hours
No potential problems with absorption
Clinically stable (stable BP, resolving fever/afebrile, adequate urine
output, absence of encephalopathy, WBC normal or normalizing)
• Exclusions
• Febrile neutropenia, gram negative bacteremia, CNS infections, septic
shock, severe cellulitis
InsideNet – Pharmacist managed IV to PO conversion program (2006)
Community-Acquired Pneumonia
“How long to treat?”
• Minimum treatment duration 7 days AND
• Afebrile (T ≤ 37.8 x 48-72 h) AND
• ≤ 1 sign of CAP-related clinical instability
•
•
•
•
•
•
•
T ≥ 37.8
HR ≥ 100 beats/min
RR ≥ 24 breaths/min
SBP ≤ 90 mmHg
SaO2 ≤ 90% or PaO2 ≤ 60 mm Hg on room air
Inability to maintain oral intake
Abnormal mental status
• Azithromycin 500 mg IV daily x 3 days (with ceftriaxone)
Clin Infect Dis 2007;44:(Suppl 2):S27-72.
Hospital-Acquired/
Ventilator-Associated Pneumonia
• HAP
– Pneumonia that occurs > 48 hours after admission
• VAP
– Pneumonia arising > 48 hours after intubation
Clin Infect Dis 2000;31:383-421.
HAP/VAP
“What antibiotics should be initiated and why?”
Microbiologic Etiology
Patient Setting
Organisms
S. pneumoniae, MSSA, H. influenzae, E. coli,
Early HAP (≤ 4 days) Klebsiella spp., Enterobacter spp., Proteus spp.,
Serrratia spp
Late HAP (> 4 days)
VAP
All of the above PLUS:
MRSA, P. aeruginosa
All of the above PLUS:
Late (> 4 days on ventilator):
MRSA, P. aeruginosa, Acinetobacter spp.,
Stenotrophomonas spp.
HAP/VAP
“What antibiotics should be initiated and why?”
Susceptibility (%)
Antibiotic
E. coli
Klebsiella
spp.
Enterobacter
P.
aeruginosa
Ceftriaxone
94-97
95-99
NR
R
Moxifloxacin
NR
NR
NR
NR
Piperacillin/
Tazobactam
94-97
95-99
NR
91-95
Amoxicillin/
Clavulanate
84-90
82-96
R
R
Meropenem
100
99-100
98-100
96-98
Ciprofloxacin
78-85
92-99
95-100
80-89
Gentamicin
94-96
97-100
99-100
82-89
Ceftazidime
NR
NR
NR
94-96
Susceptibilities at IH 2012
HAP/VAP
“What antibiotics should be initiated and why?”
MDR Bacteria Risk Factors
HAP/VAP
“What antibiotics should be initiated and why?”
Infect Dis Clin N Am 2004;18:939-962.
RSS 2012
HAP/VAP
“What antibiotics should be initiated and why?”
Reasonable IH Strategy
Early HAP/VAP, and
no risks for MDR bugs
Ceftriaxone
Late HAP/VAP, or
risks for MDR bugs
Piperacillin-tazobactam
Piperacillin-tazobactam
Ciprofloxacin (?)
Moxifloxacin
Meropenem*
+/- aminoglycoside (PA)
+/- vancomycin (?)
RSS 2012
Approach to De-Escalation
Am J Respir Crit Care Med 2005;171:388-416.
RSS 2012
Pneumonia Therapeutics
“How long to treat with antibiotics?”
Shorter Duration of Therapy
Potential Benefits
•
•
•
•
•
 Overall antibiotic use
 Resistance rates
 Super-infection
 Drug costs
 Adverse events
Potential Risks
•  Treatment failures
•  Relapse rates
•  Re-infection rates
•  Complications
J Clin Pharmacol Therap 2003;28:123-129.
RSS 2012
HAP/VAP
“How long to treat?”
Diagnosis*
Duration
HAP/VAP
(not caused by MRSA/NLFGNR**)
7-8 days
HAP/VAP
(caused by MRSA/NLFGNR)
14-15 days
*Uncomplicated Pneumonia
**Non-lactose fermenting Gram negative rods
Am J Respir Crit Care Med 2005;171:388-416.
Session Review
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•
•
•
•
•
•
•
•
PIAS-KT overview
Local Opinion Leaders
UTIs/Pneumonia are highly prevalent and impactful
Pharmaceutical care of patients with infections naturally
includes antimicrobial stewardship activities
UTI/Pneumonia KPIs are antimicrobial stewardship activities
When to initiate antibiotics for UTI/Pneumonia
What antibiotic to initiate for UTI/Pneumonia
When and how to de-escalate antibiotics for UTI/Pneumonia
How long to treat with antibiotics for UTI/Pneumonia
Attendance
• Please email Brenda Flood
([email protected]) if you
attended this session
• Please email Brenda Flood
([email protected]) if you view
this presentation online at a later date
Questions?
TMP/SMX Resistance
Clinical Cure Uncomplicated Cystitis
Ann Intern Med 2001:135:41-50