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Antimicrobial therapy

Introduction to antimicrobial therapy: 

An antimicrobial agent is a chemotherapeutic agent that is used to treat infectious diseases caused by microbes. The antimicrobial agents encompass pharmaceutical agents that include antibacterial, antiparasitic antiviral and antifungal drugs. Some of the important determinants that need to be taken into account before the administration of any antimicrobial agents are characteristics of the host including demographic characters, pre-existing illness, and immunity; accuracy in diagnosis, understanding pharmacotherapeutic features of drug, the cost-effectiveness of the drug. Antimicrobial stewardship in therapeutic programs deals with the appropriate use of any antimicrobial drug with effective ways of administration to the patient that maximizes the clinical cure or prevention and reduces the unwanted side effects, resistance, and cost that may be caused due to the drug.  (Leekha et al., 2011) The present case study focusses on the cause of superinfection of C. difficile in the patient due to the use of antimicrobials and its treatment, the role of certain antibiotics such as Aminoglycosides and Gentamycin, urinary problems faced by the patient post catheterization and nursing care plan of treatment to resolve the issue. Lessons learned from the case study will be addressed along with the actions that can be taken in clinical practice. In the end, a self-assessment of the case study is done to evaluate and reflect the situation for evolving better strategies of clinical practice.

Superinfection of C. difficile due to antimicrobial use and nursing care plan to contain the infection:

In the present case study, Edward Hunter is an 89 years old patient suffering from end-stage pulmonary fibrosis and hypoxemia. He had been admitted under the care of the community nursing team for treatment of his breathlessness. Two days ago, the patient had developed body chills with bloody, jelly-like production of sputum. Culture and sensitivity examination of sputum revealed Streptococcus pneumonia and Klebsiella pneumonia and was diagnosed with hospital-acquired pneumonia. Previously for the chest infection, he had been treated with antibiotics Amoxycillin 500 mg and Clarithromycin 500 mg thrice and twice a day respectively. Post-treatment with macrolide Clarithromycin the patient developed diarrhea. Stool examination tested positive for Clostridium difficile. 

1. difficile is the most common cause of nosocomial infectious diarrhea in the United States. (Kuntz et.al, 2011) About 14, 000 deaths occur in the United States due to Clostridium difficile infection. (Santiago et. al, 2015) Clostridium difficile is a bacteria that causes infection of the large bowel and causes colitis. In the intestinal tract, there is a presence of many useful bacterias that prevents infection. Exposure to antibiotics is the most important risk factor for C. difficile infection among them macrolide is one of the categories of antibiotics that can cause the infection. Deshpande et.al, 2013) Administration of these antibiotics kill these useful bacterias and allow the C. difficile to grow and produce toxins that can potentially damage the cell lining of the intestinal wall. (Kelly & Lamont, 2015). Nursing care plans include assisting the patient for maintaining extra hygiene, using bed pans, replacement of bed linens, replacement of incontinence material, preventing and treating injuries related to moistures and maintaining hydration and administering fluids in case of dehydration. (Elseviers et.al, 2015) Also reducing the broad-spectrum antimicrobial use minimizes the resistance of the microorganisms against the drug.

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