Any thoughts on overcoverage with antibiotics... eg. will you be penalized for treating a cellulitis with zosyn + vanco... the ultimate combo!! of course this is an overstatement but I do plan on overtreating rather than undertreating as there is NO WAY I can remember all the proper therapies... and I'd rather the patient not die. Any broad sweeping mnemonics to help with proper coverage? Eg. go-to drugs that work for a lot of situations. Thanks!
We may not lose score if we use higher antibiotics. But we will definitely lose score if lower antibiotic than that indicated is used. Examples : There are very poor management and giuve zero score : Using ciprofloxacin in pneumonia, using moxifloxacin in UTI, not using double gram negatives like quinolone and zosyn in hospital acquired pneumonia, not using indicated regimen in complicated pelvic inflammatory disease. In these conditions, they are really testing appropriate use of antibiotic. Sub optimal or poor antibiotic gets very low score.
Simple Guidelines for antibiotic management of Sepsis/ Infections on a CCS case
1)Pseudomembranous colitis/ C.Difficle Diarrhea : Metronidazole p.o. If resistant, use vanco p.o ( do not use I.V vanco not effective) c.difficle
2) Meningtitis, empiric : Bugs are S.pneumonia, H.influenzae, N.meningitidis, E.coli. Choice : Vanco+Ceftriaxone. If listeria suspected, add Ampicillin. Give Dexametasone prior to antibiotics In ages < 1month or > 50 years - think of Listeria Meningitis
3) Urinary tract infections : Bugs are E.coli, proteus Enterococci - use Quinolone, ceftriaxone, extended spectrum beta lactums, if enterococci is present - use ampicillin or vancomycin.
4) Intra abdominal infections ( diverticulitis etc) : Enteric gram ve rods ( E.coli), Anerobes (B.fragilis) - Use good anerobic coverage : Cipro+flagyl if uncomplicated, Pip/tazo, Ertapenem, Imipenem if complicated. Do not use cephalosporin alone ( add metronidazole if using it)
5) Community acquired pneumonia : Bugs are S.pneumoniae, Legionella, mycoplasma, H.influenzae - Use Third generation cephalosporin + macrolide or Newer Quinolone for inpatient therapy. For OP therapy, quinolone newer or macrolide
6) Early Hospital Acquired Pneumonia ( < 5 days) : Bugs : Gram negative rods non resistant ( e.coli, proteus, klebsiella), S.pneumonia, H.influenzae, legionella - use PIP/TAZO, Unasyn, Cefepime or newer quinolone
7) Late Hospital Acquired Pneumonia ( > 5days) - Bugs are Resistant gram ves (ESBL), Pseudomonas, MRSA - Use anti-pseudomonal drugs PIP/TAZO + quinolone, Cefepime, Imipenem, Vancomycin (if MRSA suspected)
