00:00
Now, remember,
this is a whole team sport.
00:03
Healthcare providers,
lab, nurses, pharmacists
were all involved in the process,
and the effort it takes
to get effective treatment.
00:11
We're all looking at that
sensitivity table.
00:13
We want to find one antibiotic
that will take out both organisms.
00:18
So I'm looking for one antibiotic
that marked as susceptible
or sensitive to that drug.
00:26
Alright, and you're ready to take it
to the next level.
00:28
Let's take a look at these
results again.
00:30
And I want you to think through them
like a real practicing nurse.
00:34
I want you to see if you can
identify the options
for effective treatment
based on the sensitivity table
for both organisms.
00:42
First of all, I want you to start
by crossing out the drugs
we would absolutely not give.
00:49
Now pay attention to the letters,
not the numbers.
00:52
Remember, the numbers just represent
the MIC.
00:55
So it doesn't mean
if you see one drug,
they're both effective,
and one is at eight
and one is at 16.
01:01
It doesn't mean the 16 is better.
01:03
So ignore the numbers.
01:05
Just take a look at the letters
R and S.
01:09
So go ahead
take a look at your chart
like a practicing nurse would
and cross through the medications
that we would not use to treat
both of these organisms.
01:20
Okay, good deal.
Did you get that?
Ampicillin is resistant
for organism one.
01:26
It's sensitive to organism two.
01:28
But you should draw a line
through ampicillin
because we wouldn't give it
because it doesn't treat
both organisms.
01:34
The other one is tetracycline.
01:36
You'll see that it's sensitive
for organism one,
but it's resistant for organism two,
just the opposite of ampicillin.
01:43
But you want to draw a line
through that one.
01:47
Now that you found those,
I want you to look for medications
that will treat
both of the organisms.
01:53
Circle those drug names.
01:59
Okay, good deal.
02:00
I hope you found those
over on the right.
02:02
Levofloxacin and Nitrofurantoin.
02:05
Okay, so you found the medications
because look at both columns,
In levofloxacin,
we've got an S for sensitivity
for microorganism one,
and S for sensitive
for organism two.
02:17
Same thing with nitrofurantoin
S for sensitivity,
and organism one
and S for sensitivity
to organism two.
02:26
Alright,
so let's compare these.
02:28
If you get a culture and sensitivity
report back,
looking at this sensitivity table
we have more than one medication
to pick from.
02:35
So let's use the same criteria
we used in the other example.
02:39
Let's look at efficacy.
02:41
Well, we've got both options
that were work
and we know they're both
going to have good efficacy.
02:46
Because we looked
at that information
on the sensitivity table.
02:50
And you can also consult
other clinical resources.
02:53
You can look at UpToDate,
or Epocrates, or First Consult.
02:57
These are programs
that are available
to healthcare practitioners
to follow up and help you make
an informed decision.
03:03
Now keep in mind levofloxacin,
is a fluoroquinolone.
03:07
And that could be used,
but we usually
keep fluoroquinolone
for more serious
types of infections,
rather than acute cystitis,
which is just a bladder infection.
03:17
So unless there's some known
or suspected resistance,
that's not likely
going to be the one
that we're going to choose.
03:24
But let's keep walking through it.
Let's look at cost.
03:27
Well, levofloxacin is going to be
$18 for seven days.
03:30
We're giving roughly
750 milligrams.
03:33
It's going to be almost twice that
for the other medication.
03:37
What about risk for adverse effects?
There is a slight risk of
tendon rupture with levofloxacin.
03:44
But remember,
if it's nitrofurantoin,
we want to avoid that
in the elderly,
because their kidneys are not going
to be working with us enough
to keep a therapeutic level
in the serum, or the blood.
03:55
Resistance can be
per patient history,
and drug availability.
04:00
Both drugs are available.
04:02
So in this case, really the
biggest adverse effect we found
was that we try to reserve
levofloxacin
for other types
of more serious infections.
04:12
So we would likely go with
nitrofurantoin
unless the patient was elderly.