BioMed Research International / 2015 / Article / Tab 2

Review Article

Educational Effectiveness, Target, and Content for Prudent Antibiotic Use

Table 2

Educational content on prudent antibiotic prescribing for prescribers.

Topic ConceptLearning outcomes

AntibioticsModes of action of antibiotics(i) Broad- or narrow-spectrum of antibiotics
(ii) Basic principles of pharmacokinetics (PK) and pharmacodynamics (PD) properties of antibiotics
(iii) Antimicrobial susceptibility test
(iv) Basic principles of antibiotics cycling or mixing (antibiotic heterogeneity)
Toxicity(i) Collateral damage of antibiotic use (toxicity)
Costs(i) Lack of development of new antibiotics

Bacterial resistanceMechanism of antimicrobial resistance(i) Acquired resistance-mechanism of antibiotic resistance in pathogenic bacteria
(ii) Intrinsic resistance-mechanism of antibiotic resistance in commensal bacteria (e.g., risk of Clostridium difficile infection or Candida spp. infection)
(iii) Epidemiology of antibiotic resistance
(iv) Importance of the appropriate use of antibiotics to minimize the emergence of resistance

Diagnosis of infectionInfection and inflammation(i) Infection versus inflammation
(ii) Proper use and interpretation of bacterial Gram stain, point-of-case tests (e.g., urine dipstick, streptococcal rapid antigen diagnostic test in tonsillitis), serology, and biomarkers of inflammation (e.g., C-reactive protein (CRP) and procalcitonin)
(iii) Establishment of standardized diagnosis criteria for specific infections (e.g., community-acquired pneumonia, hospital-acquired pneumonia, cystitis, and pyelonephritis)
(iv) Importance of taking microbiological samples for culture before starting antibiotic therapy
Antimicrobial susceptibility testing (AST)(i) Detection of antibiotic resistance (e.g., phenotypic method, PCR-based techniques, mass spectrometry, and microarrays)

Infection prevention and controlClinical microbiology and indication for antimicrobials(i) The nature and classification of pathogenic microorganism
(ii) Clinical situations when not to prescribe an antibiotic
(iii) Viral infections
(iv) The importance of understanding the differences between colonization and infection
(v) The principles and practices of the prevention and control of infection
(vi) Transmission mechanism of pathogenic bacteria in both community and hospital setting
(vii) Definition and indications of directed therapy versus prophylaxis
(viii) Surgical antibiotic prophylaxis: indication, choice, duration, and timing
(ix) The principles and benefit of vaccines
Hygiene(i) The importance of hand hygiene
(ii) Transmission mechanism of pathogenic bacteria in hospital setting
(iii) Prudent use of invasive devices, such as intravenous or urinary catheters, and incision and drainage of abscesses

Prescribing antibioticsEmpiric therapy(i) Not initiating antibiotic treatment in the absence of bacterial infection
(ii) Knowledge of when not to prescribe antibiotics and use alternatives
(iii) Knowledge of when to use a delayed antibiotic prescription
(iv) Choosing the dose and interval of administration based on PK/PD properties of antibiotics
(v) Choosing the route of administration (intravenous versus oral)
(vi) Estimating the duration of treatment
(vii) An understanding of common side effects such as allergy
Targeted therapy using diagnostics(i) Reassessment of the antibiotic prescription
(ii) Streamlining/deescalation based on microbiological results
(iii) Decision to switch agent (narrow/broader spectrum, intravenous/oral)
(iv) Therapeutic drug monitoring to ensure adequate drug levels (e.g., vancomycin)
(v) Stop prescribing antibiotics when Clostridium difficile infection is present
(vi) Reconcile and adjust antibiotics at all transitions and changes in patient’s condition
(vii) An awareness of trade and generic names of prescribed antibiotics to avoid possible harm to patients
Antimicrobial stewardship program(i) Prudent antibiotic prescribing according to national/local practice guidelines
(ii) Avoiding the unnecessary use of broad-spectrum antibiotics
(iii) Documentation of antibiotic prescription in clinical chart or in patient’s clinical records: indication, route, dose, duration, and review/stop date of antibiotics

Communication skillsDiscussion technique with patients(i) Knowledge of when not to prescribe antibiotics and how to negotiate this with patients

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