Rational antibiotic therapy

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  • Rational antibiotic therapy
It's 1:40 AM, you are a doctor on duty in the Emergency Room, you are awaiting arrival of Emergency Medical Service with a patient in severe condition any minute. Suddenly, a new patient enters the full waiting room. Charles Pear (age 63) complains of fever, chill and shivering. He also feels weak. What are you going to do?

Patient shows sighs of inflammatory process, so I decide to start antibiotics empirically.

Wrong answer

Empirical use of antibiotics without detailled examination increases the risk of antibiotic resistance.


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After taking a case history and physical examination, I advise the patient to go home, to take Panadol (effective drug: acetaminophen) to decrease the fever and to visit his GP for further examination next morning.

Wrong answer

This process is too risky for the patient.


Back

I take a case history, physically examine the patient and then I make blood collections.

Wrong answer

It would be better to make blood collections at the beginning. We save the time.


Back

I tell a nurse to make blood collections. Then I take a case history and continue with physical examination.

Correct answer

By collecting blood at the beginning we save time. Generally taken blood samples are: ionts (Na+, K+, Ca2+, Mg2+, Cl-, phosphates), FBC, clotting, liver enzymes (AST, ALT, GMT, ALP), BUN (urea, creatinin), CRP. Optional samples can be added: D-dimers, troponins, NT-proBNP, fibrinogen, lactate.


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GP=general practitioner×
 
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