Antibiotics And Diabetes 2-6-17 Pornprasert
2/15/2017Antibiotics and DiabetesChristina Pornprasert, PharmDPopulation Health Clinical PharmacistHartford Healthcare Integrated Care PartnersAssistant Clinical ProfessorUniversity of Connecticut School of PharmacyFebruary 16, 2017Objectives Review considerations for initiating antibiotic therapy in diabeticfoot infections Identify antibiotics that increase risk for blood sugar swings Identify antidiabetic medications that increase risk for infections Recognize drug interactions between antibiotics and antidiabeticmedications21
2/15/2017Link between High Blood Glucose and Infection Risk Increased susceptibility to infections Hyperglycemia elevates dicarbonyls (methylglyoxal and glyoxal) inhibition of beta-defensins More adversely affected after acquiring infections3Infections in Patients with Diabetes Skin and Soft Tissue InfectionsOsteomyelitisUrinary Tract InfectionsEar, Nose, Throat42
2/15/2017Diabetic Foot Infections5Diabetic Foot Infections: Assess for infection 2 clinical signs of inflammation or purulence Severity– Mild (superficial, limited in size/depth)– Moderate (deeper or more extensive) Abscess, osteomyelitis, septic arthritis, fasciitis– Severe (systemic signs or metabolic perturbations)63
2/15/2017Diabetic Foot Infections: Risk Factors Wound with positive probe-to-bone (PTB) testUlceration 30 daysHx of recurrent foot ulcersTraumatic foot woundPeripheral vascular disease in affected limbPrevious lower extremity amputationLoss of protective sensationRenal insufficiencyHx of walking barefoot7Diabetic Foot Infections: Assess for treatment Clinically uninfected wounds: do not collect culture Infected wounds: culture prior to starting antibiotic therapy**Avoid prescribing antibiotics for clinically uninfected wounds**84
2/15/2017Diabetic Foot Infections: Questions to Consider Is there clinical evidence of infection? For clinically infected wounds:– Is there high risk of MRSA?– Has patient received antibiotics (abx) in the past?– Are there risk factors for Pseudomonas infection?– What is the infection severity status?9Diabetic Foot Infections: Antibiotic TherapyMild to moderate infection withno recent abx treatmentTarget gram-positive cocci,especially StaphylococciSevere infectionBroad-spectrum empiric therapyRisk factors for PseudomonasaeruginosaEmpiric therapy directed atPseudomonas aeruginosaPrior hx of MRSA infection, localprevalence of MRSAcolonization/infection high, orclinically severe infectionEmpiric therapy directed at MRSA105
2/15/2017Diabetic Foot Infections: Mild11Diabetic Foot Infections: Moderate or Severe126
2/15/2017Diabetic Foot Infections: Moderate or Severe13Diabetic Foot Infections: Moderate or Severe147
2/15/2017Diabetic Foot Infections: Duration of Therapy Mild infection: 1-2 weeks Moderate/severe infection: 2-3 weeks15Antibiotics and Blood Sugar Swings168
2/15/201717 Classes– Fluoroquinolones moxifloxacin, levofloxacin, ciprofloxacin– Second-generation cephalosporins cefuroxime, cefaclor, cefprozil– Macrolides clarithromycin, azithromycin189
2/15/2017 ED visits or hospitalizations for dysglycemia within 30 days ofstarting antibiotic therapy Dysglycemia– HYPOglycemia: ICD-9 codes with IV dextrose Rx’s– HYPERglycemia: ICD-9 codes with insulin Rx’s19Absolute Risk of Hypoglycemia and Hyperglycemia per1,000 es- Moxifloxacin- Levofloxacin- Ciprofloxacin2010
2/15/2017 Highest risk of hypoglycemia:– Moxifloxacin levofloxacin ciprofloxacin Consider the higher risk when treating diabetic patients withfluoroquinolones, especially moxifloxacin21Antidiabetic Medications and Risk of InfectionDipeptidyl pepti
Osteomyelitis Urinary Tract Infections Ear, Nose, Throat 4. 2/15/2017 3 Diabetic Foot Infections 5 Diabetic Foot Infections: Assess for infection 2 clinical signs of inflammation or purulence Severity – Mild (superficial, limited in size/depth)
Bruce W. Bode, MD, FACE Atlanta Diabetes Associates Atlanta, Georgia American Diabetes Association. Facts and Figures. Available at: http://www.diabetes.org/ada/facts.asp. Accessed January 18, 2000. Diagnosed Type 1 Diabetes 0.5 - 1.0 Million Diagnosed Type 2 Diabetes 10.3 Million Undiagnosed Diabetes 5.4 Million Prevalence of Diabetes in the US 3
Clinical Diabetes. 2017 Jan; 35(1)51-54. Speight J, Conn J, Dunning T, Skinner TC, Diabetes Australia. Diabetes Australia position statement. A new language for diabetes: improving communications with and about people with diabetes. Diabetes Res Clin Pract 2012 Sep; 97(3): 425- 31.
Type 2 Diabetes Type 2 diabetes, which used to be called adult-onset diabetes, can affect people at any age, even children. However, type 2 diabetes develops most often in middle-aged and older people. People who are overweight and inactive are also more likely to develop type 2 diabetes. Type 2 diabetes usually begins with insulin resistance—a
Diabetes in the United States More than 29 million people in the U.S. have diabetes 8.1 million people with diabetes are undiagnosed 9.3% of the U.S. population 1.7 million Americans aged 20 years or older were newly diagnosed with diabetes in 2010 Every 19 seconds, someone is diagnosed with diabetes
TABLE 57-3. Proposed Classification System for Diabetes in Pregnancy Gestational diabetes: diabetes diagnosed during pregnancy that is not clearly overt (type 1 or type 2) diabetes Type 1 Diabetes: Diabetes resulting from β-cell destruction, usually leading to absolute insulin deficiency a. Without vascular complications b.
4. Antibiotics with good anaerobic coverage p.7 5. The PK/PD concept p.8 6. Renal/Hepatic adjustments of antibiotics p.10 7. Therapeutic Drug Monitoring of antibiotics in SGH p.16 8. IV-to-Oral Switch Protocol p.17 9. Surgical Antibiotic Prophylaxis p.19 10. Bits and Pieces from Microbiology Laboratory p.20 11. Do’s and Don’ts In Antibiotic .
Get well soon without antibiotics Product Code: 284682 If a cold is making you feel under the weather, antibiotics aren't going to help Product Code: 290982 Remember, antibiotics won't help your defences against a cold (poster) Product Code: 290981 Unfortunately no amount of antibiotics will ge
1. Only prescribe antibiotics for bacterial infections if: Symptoms are significant or severe There is a high risk of complications The infection is not resolving or is unlikely to resolve 2. Use first-line antibiotics first 3. Reserve broad spectrum antibiotics for indicated conditions only The following information is a consensus guide.
