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Principles of Antimicrobial Therapy and Stewardship
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1
Question
What is the primary purpose of timely antibiotic therapy in bacterial infections?
Answer
Early correct treatment reduces toxicity and improves outcomes
2
Question
What is meant by selection pressure in antibiotic use?
Answer
Environmental conditions favoring survival of resistant bacteria over susceptible ones
3
Question
What is a common adverse consequence of antibiotic therapy on gut microbiota?
Answer
Clostridioides difficile overgrowth causing diarrhea/infection
4
Question
Why is it important to pass the first antibiotic dose promptly after admission in septic patients?
Answer
Delays can worsen prognosis and increase mortality risk
5
Question
What does endophthalmitis require in terms of clinical management?
Answer
Ophthalmologic emergency with rapid antibiotic therapy and source control
6
Question
What does the diagram described in the image illustrate regarding antibiotics and bacteria?
Answer
Natural selection leading from susceptible to resistant bacterial populations under antibiotic pressure
7
Question
Why is using the narrowest effective antibiotic important in treating infections?
Answer
To reduce toxicity and limit selective pressure
8
Question
What is meant by inoculum size in infections and how does it affect therapy?
Answer
High inoculum requires combination therapy or synergistic dosing to control infection
9
Question
How does antibiotic exposure drive selection of resistant bacteria?
Answer
Survivors with resistance proliferate, forming a resistant inoculum
10
Question
What is the relationship between antibiotic spectrum and selection pressure for resistance?
Answer
Appropriate spectrum minimizes resistance selection pressure by not unnecessarily affecting flora
11
Question
Why can Clostridioides difficile infection follow antibiotic use?
Answer
Disruption of normal microbiota allows C. difficile overgrowth and infection
12
Question
What happens if endocarditis is treated with antibiotics alone without addressing the bacterial burden?
Answer
Risk of complications due to persistent bacteremia and embolic events
13
Question
What considerations should guide antibiotic choice beyond the pathogen, such as the infection focus?
Answer
Site-specific distribution, penetration to focus, and physiopathology of the disease
14
Question
Why is dosing and timing critical in urinary tract infections?
Answer
To ensure drug concentration at the site of infection and effective bacterial kill
15
Question
What is the role of culture and sensitivity in guiding antibiotic therapy for infections?
Answer
Identifies susceptible organisms and informs targeted therapy (65-70% sensitivity typical)
16
Question
What is a key consideration when treating endocarditis with antibiotics alone?
Answer
Complications and mortality risk from high bacterial load and embolic events.
17
Question
Why is focusing on the infection site important for antibiotic choice?
Answer
Patient outcomes depend on achieving adequate drug concentrations at the focus.
18
Question
What is a typical rationale for longer antibiotic courses in osteomyelitis?
Answer
Bone circulation is difficult to penetrate; treatment often lasts 4-6 weeks.
19
Question
What should be done for abscesses in antibiotic therapy?
Answer
Drain the abscess; antibiotics have limited entry into the purulent cavity.
20
Question
How do chronic kidney disease and liver disease affect antibiotic therapy?
Answer
Dose adjustments are required due to altered pharmacokinetics and clearance.
21
Question
In urinary tract infections, what clinical elements are essential before therapy?
Answer
Compatible clinical syndrome plus culture results.
22
Question
What is the reported sensitivity range for culture results in guiding therapy?
Answer
Culture sensitivity around 65-70% is acceptable.
23
Question
What is a three-gen cephalosporin primarily active against?
Answer
Actively targets gram-negative bacilli.
24
Question
What is the driving philosophy in infection management?
Answer
Aim to beat the infection early; delay increases microbial load and disease progression.
25
Question
How has antimicrobial resistance trend differed over time?
Answer
AMR is a growing problem in hospitals and now outpatient settings.
26
Question
What is the projected global mortality due to antimicrobial resistance by 2050?
Answer
Over 10 million deaths per year.
27
Question
What are PROA programs in antimicrobial stewardship?
Answer
Regulation programs to optimize antibiotic use; laws in Chile since 2023.
28
Question
What is a fundamental goal of antimicrobial optimization?
Answer
Maximize killing of pathogens while minimizing toxicity, resistance, and costs.
29
Question
What physiological changes can occur in critically ill patients that affect dosing?
Answer
Increased interstitial fluid and edema increase volume of distribution for hydrophilic drugs.
30
Question
How do vasoactive drugs influence antibiotic absorption in the gut?
Answer
Splanchnic vasoconstriction decreases intestinal absorption.