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How to select the best antibiotics in ICU Dr Mohd Saif Khan

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Hello friends antibiotics are vital medications which are written on the top of a prescription chart in icu decisions are the cornerstone of therapy for severe life threatening infections and sepsis many people find it difficult to choose most appropriate antibiotic from many available options and sometimes due to selection of inappropriate antibiotic patients suffer

Therefore before selecting an antibiotic for your icu patients you must know certain principles certain criteria which i am going to cover in this video there are five criterias the first and foremost criteria is the anatomical location if a patient is suffering from diarrhea for example in which the anatomical location of infection is the intestine the antibiotic

Choice will depend upon the gut pathogens such as salmonella typhi or clostridium difficile similarly in case of brain infections for example acute bacterial meningitis you will require different set of antibiotics directed at a specific type of pathogen which can penetrate the blood-brain barrier also so antibiotic selection will depend upon the anatomical location

For two important reasons first the bacteriology or microbiome will be different in that location and the second reason is the antibiotic penetration to that location a meticulous history and physical local examination will be able to localize probable site of infection knowing the source of infection will also help you in planning a surgical procedure for eradication

Of that source and this is known as source control which is a definitive treatment for many difficult to treat resistant type of infections in icu now the second criteria is the prior culture and sensitivity reports if you know that the patient is coming to you had developed similar infection in the past or if there is a history of previous hospitalization you

Must look at culture reports to see whether organism is resistant to certain antibiotics it will help you to select most appropriate antibiotic to which the organism will be most sensitive and hence the clinical and microbiological success will be maximum now the third criteria i am going to talk about is the prior antibiotic use while you are inquiring about

The previous hospitalization always look at the discharge summary and the prescription charts to get an idea about the antibiotics patient was receiving in the past which is a crucial information to guide your antibiotic selection this itself is the risk factor for possibility of acquiring mrsa or pseudomonas klebsiella and multiple drug resistant organisms now

The fourth criteria is the local epidemiology of antibiotic resistance you must discuss with your clinical microbiologist or infectious disease consultant about the antibiogram of your ico this antibiogram will inform you the types of organisms microbiology lab has isolated and deals sensitivity patterns in different biological samples over a period of time so by

This you will know about with whom you are playing right now the fifth criteria and the last criteria is the safety and cost of comparator drugs sometimes you get an antibiotic sensitivity report in patients previous health records which shows a particular organism is equally sensitive to two previous different antibiotics well in that case the safety and the

Cost of the drug become important criteria to pick the one which is the least toxic and least expensive for example in case of hospital acquired pneumonia you do the ball and the bulk culture shows the step aureus in abundance and this step aurius is sensitive to paper cylinders of bacter and vancomycin both now this patient has high urea creatinine value and

Shows the feature of aki in icu so you may not like to use the vancomycin rather pipracian tesobactum would be a better choice as the nephrotoxic potential of pipral cell entasobactin is lesser compared to vancomycin so so these are the five important criteria to select to choose the antibiotic the most appropriate antibiotic for your iso patients and i hope

That next time when you are prescribing or writing an antibiotic on the prescription chart icu prescription chart you will definitely keep these principles of antibiotic selection in your mind of course later you have to de-escalate the antibiotic based on the fresh culture and sensitivity reports from various biological fluids so that’s all for today thank you so much you

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How to select the best antibiotics in ICU @Dr Mohd Saif Khan By Dr Mohd Saif Khan MD DM (Critical Care Medicine)