#Antibiotic stewardship

[ask-a-vetblr]

hey! my parents cat was just tentatively diagnosed with asthma. they put him on prednisone to treat it... he got rapidly worse, its been a week and hes hiding and barely eats. the vet said that he probably had a mild respiratory infection beforehand and that the meds exacerbated it. hes on antibiotics and weaning off the prednisone now, fingers crossed he makes it.

my question is: i know with things like dental care you usually get antibiotics beforehand to stop accidental infections from setting in like this, why isnt that more common when going on immunosuppressants? is there a reason why they dont prescribe a round before heavy treatment to prevent whats happening to my kitty? thanks ahead of time! im a bit shaken up by the whole thing and just want to understand a bit better.

gettingvetted here.

Asthma in cats is very common, as are viral upper respiratory infections, especially herpes. The vast majority of viral upper respiratory infections are self-limiting, meaning they come and go on their own, similar to a cold. They don't typically cause changes in lung x-rays or sounds, because again, they are upper respiratory focused (nose/throat). Meanwhile, asthma happens on the level of the lungs. There can certainly be infectious bronchitis cases due to bacteria or viruses that causes asthma symptoms, but 99% of the time asthma symptoms are due to allergic bronchitis (which is the technical term for asthma) which causes thickening and inflammation of the airways on radiographs and result in a wheezing or crackling noise. Thus, in most cases, radiographs and a good stethoscope are all that are necessary to differentiate asthma from an upper respiratory infection. Unless you performed a nasal swab and/or a tracheal swab, which is invasive, difficult, and very expensive, you would never be 100% sure of the origin of airway inflammation. This is not a test we tend to reach for unless we have unsuccessfully treated asthma and/or upper respiratory infections and are attempting to find a more targeted therapy. If it looks and sounds like a run-of-the-mill asthma case, and there is no pneumonia present, there is no need for antibiotics alongside the steroids. Even if it looks and sounds like a run-of-the-mill upper respiratory infection, there is still usually no need for antibiotics, because they will not shorten the course or even relieve the symptoms of a viral disease process and would be considered poor stewardship of antibiotics. We typically only prescribe antibiotics for upper respiratory infections if the animal is at risk for pneumonia and we are trying to prevent that, for example very young kittens, cats with FIV, etc., or in cases where we know for a fact that the infection is due to mycoplasma bacteria, which we would find out via one of those nasal swab tests. In these cases, antibiotics still won't help shorten the course or relieve symptoms; they are simply to prevent pneumonia (or anemia, in the case of mycoplasma).

All of this is to say that your vet was justified in using a steroid to treat asthma, and an underlying condition may have been exacerbated by it. It is very common for cats with URI's to hide and not want to eat. It is also pretty common for cats to get URI's after a stressful scenario such as having an asthma flare and/or going to the vet. They are typically not life threatening unless the cat has one of the immune conditions discussed above. I hope your kitty is feeling better - it’s been a few days since this ask was submitted!

P.S. It's actually falling out of favor to use antibiotics with dental care unless the teeth were/are so severely infected that the jaw is considered to be at risk of fracture from the infection or if there is a noticeable tooth root abscess. A routine dental cleaning and even most extractions do not warrant antibiotics.

[wayfaringmd]

What are the main concerns with constant antibiotic usage? I have an ear infection that came back after using lovofloxacin, and never went away after cefdnir, so I’m now on ciprofloxacin even with a history of tendon problems. (I get really bad hives with penicillin and doxycycline, so those two meds are out of the question). I’m a little concerned though, cause at this point surgery is in the question as well, which means more antibiotics after wards, and I know how unfun c diff is

So c. Diff and other antibiotic associated diarrheas and side effects are definite concerns but also antibiotic resistance. If you’re constantly on antibiotics then the bugs you tend to grow start getting smart and they mount defenses against those antibiotics, eventually requiring stronger and stronger stuff until there’s nothing left to treat you with. Also, with ear infections in particular, they’re often viral, so antibiotics don’t help anyway. This is often interpreted as the patient having a resistant bug when in reality they have a virus that can’t be treated with antibiotics anyway. Newer recommendations are to watch and wait on ear infections because lots of them will resolve spontaneously.

[reportwire]

Experts weigh in on ways to combat growing antibiotic resistance amid COVID-19

Experts weigh in on ways to combat growing antibiotic resistance amid COVID-19

The COVID-19 pandemic has hindered progress in antibiotic stewardship and hospital infections, and antibiotic resistance in the human population is a growing threat.  A decade-old estimate (PDF) from the Centers for Disease Control and Prevention (CDC) pegs annual healthcare costs related to antimicrobial resistance (AMR) at $20 billion, plus $35 billion in costs to society for lost productivity.…

[medconweb]

Ergebnisbericht: Rationaler Anti­biotika­einsatz im ambulanten Sektor – Workshop des RKI vom 28.11.2018 Möglichkeiten der Surveillance des Antibiotikaverbrauchs Konzepte für Fortbildungen zu rationaler Antibiotikatherapie Wirksame Interventionen zur Senkung des Antibiotikaverbrauchs Chancen und Möglichkeiten technischer Anwendungen (z.B. Apps) zum rationalen Antibiotikaeinsatz Download: RKI (PDF, 7.58MB)

[chrlseatn]

@burnthesagc​​​     /    closed  starter  for  sage  blythe

“  i  think  you’re  the  only  person  i  know  in  this  class,  ”  charlie  smiles  as  he  takes  the  seat  next  to  sage,  sliding  his  chair  a  little  closer  to  the  girl.  “  not  that  i’m  complaining.  but  the  pressure’s  on  for  you  to  pick  me  as  your  lab  partner.  ”

[md-admissions]

Morning rant

As thankful as I am for the physicians who provide and take care of transplant patients, as much as I like the patients with transplants themselves, I hate hate hate hate transplant ID as a discipline.

Everyday I feel like I’m talking down perfectly intelligent physicians and surgeons who have been reduced to paranoid medication-prescribing-machines. Cough? Ceftriaxone and azithromycin, the patient must have pneumonia. The patient peed three times not two yesterday? UTI, we should start daptomycin because maybe it’s vancomycin resistant enterococcus. It’s. Ridiculous. I’m not just the ID doctor, I’m like the fucking psychiatrist for these hyper vigilant physicians who already, at baseline, think they’re smarter than everyone and know what’s right. Like the asshole who prescribed ceftriaxone and azithromycin this morning in the renal transplant patient WHO HAS THE FLU LIKE THE FLU SWAB IS POSITIVE YOU CAN’T DO MUCH BETTER.

Meanwhile the patients themselves are usually the most trustworthy and reliable because they’ll tell me “hey I feel better so I started drinking more water today! But I was told I have a UTI?”

Do your friendly ID fellow (me) a favor. Listen to your transplant patients and don’t prescribe an antibiotic just to make yourself feel better.

[wiratomkinder]

“from the creators of 2 strains 1 agar” im losing my GOURD

[iamdrssekandi]

Outpatient Parenteral Therapy. Can a patient receive intravenous medications while commuting?

Outpatient Parenteral Therapy. Can a patient receive intravenous medications while commuting?

Outpatient parenteral therapy is when a patient receives intravenous medications while commuting. They don’t require an admission unless their condition worsens. Outpatient parenteral treatment is becoming a standard of care in many regions globally, but many health care providers and patients may misuse it. It requires constant evaluation and stewardship. Benefits of such therapy include…

[wayfaringmd]

Earn it.

Wayfaring: Well, you definitely have pneumonia. 

Patient: Whatcha gonna give me fer it?

Wayfaring: Levaquin. It’s a heavy duty antibiotic. 

Student: You should feel really special. I’ve been here 7 weeks and this is only like the 4th antibiotic I’ve seen her write!

Wayfaring: Not true! I write them when they’re warranted. I just don’t hand them out like candy.

Patient: Oh yeah. She makes us earn ‘em all right. 

[jppres]

The use of an antibiotic order form in a tertiary hospital: Influence on physicians��� prescribing patterns

The use of an antibiotic order form in a tertiary hospital: Influence on physicians’ prescribing patterns

Article published in the Journal of Pharmacy & Pharmacognosy Research 9(4): 474-483, 2021. Image: Pixabay Original article Duc Chien Vo1, Tuan Anh Mai2, Thu Thao Nguyen3, Dang Thoai Nguyen4, Thi Ha Vo3,4* 1Department of Respiratory Medicine, Nguyen Tri Phuong Hospital, Ho Chi Minh, V-70000, Vietnam. 2Department of Pharmacy, Hanoi Pharmacy University, Ha Noi, 100000, Vietnam. 3Department of…

[narcbrain]

Esketamine as Treatment for Major Depressive Disorder J. John Mann, MD, compares esketamine nasal spray to intravenous administration and describes the drawbacks of the recently authorised remedy process for MDD.

[ask-a-vetblr]

what are your thoughts on convenia? my cat was given a convenia injection today to potentially treat urinary inflammation/infection (still waiting on culture results) since she’s practically impossible to medicate w antibiotics at home. I was completely unaware of convenia horror stories until after she was given it, tho I know those stories are the worst of the worst. just trying to work through my anxiety about her having an adverse reaction. thanks in advance!

gettingvetted here.

Convenia is a great drug and works really well. I use it almost daily in practice. I don't typically use it for urinary issues but it's not wrong to do in a case like yours. I have never heard any horror stories associated with its use.

Sueanoi here,

It is not my first choice but I’m not averse to it.. I usually only use it after bacterial culture confirmed its sensitivity, simply because of its cost. i have not encountered any adverse effect on my patients.

vet-and-wild here.

I’m probably an outlier but I don’t really like it. Because of the timing of peak concentration there are resistance issues. My school was pretty intense about antibiotic stewardship, so they definitely discouraged us from using this. However, I absolutely use it for fractious animals or outdoor cats that the owner sees like twice a week. I’ve even used it in a raccoon. If getting daily meds into an animal is not an option, I’ll go to convenia. But it’s never my first choice. I haven’t necessarily heard horror stories from individual patients though.

[medconweb]

ARVIA „ARS und AVS Integrierte Analyse“ – Ein neues Surveillance-Tool für Krankenhäuser zur Analyse von Antibiotika-Verbrauch und -Resistenz Epidemiologisches Bulletin 6/2019 des RKI

[audible-smiles]

antibiotic stewardship is a great idea for clinicians who want to get yelled at a lot

[pleasedotheneedful]

after a month or two of languishing in anhedonia/apathy on my couch that finally came to a head when I was 15 mins late to my own morning report yesterday, I’m back on my bullshit

this includes lovely medical student board prep feedback and I see nothing has changed:

The answer key emphasizes how amoxicillin-clavulanate is a very inappropriate choice. However, there is no reason offered as to why. Furthermore, quick research on sources such as the AAFP and others do not share the ‘emphasis’ of the statement made in the answer key.

The stem was for a new case of GAS pharyngitis. Let me just emphasize this up front: you should not give amox-clav for first-time cases. I do not give a shit if your attending practices differently. It’s bad antibiotic stewardship. If you use a sledgehammer to put up wall decorations, you’re still going to eventually wear out the hammer.

I dunno what other sources they checked but the AAFP guidelines they’re referring to are from 2001. The AAP published a full GAS pharyngitis update in 2011 that supports my statement.

I used bold emphasis in the explanation because people don’t seem to understand why it’s wrong to jump to amox-clav on this question. Or sometimes they don’t catch that amox-clav is different from amox.

[rainafms]

RAINA VIRANI + CLASSES // @gallaghertasks

𝐒𝐏𝐑𝐈𝐍𝐆 𝟐𝟎𝟐𝟎

GEN 207: how to disappear ( A )

FRE 101: intro to french ( A- )

don’t talk to raina about french, she’s still hurting about what that a- did to her gpa

MED 301: clinical research and statistics ( A+ )

her brain works in numbers that’s all.

MED 302: physical trauma care ( A )

𝐅𝐀𝐋𝐋 𝟐𝟎𝟐𝟎

GEN 206: spies on screen

GEN 208: clandestine operations 

MED 303: antibiotic stewardship

MED 401: social neuroscience

FRE 102: french 2 ( she’s going to get a higher grade this semester, she’s manifesting it )