Antimicrobials patient education

Identify and apply five major principles of patient education and monitoring response to antimicrobial therapy. 

Patient education, deescalation of antimicrobial therapy based on culture results, monitoring for clinical response and... 

After selection and initiation of antimicrobial regimen, there are a number of additional patient care and monitoring considerations that should be addressed to improve the likelihood of a successful outcome. Patient education, deescalation of antimicrobial therapy based on culture results, monitoring for clinical response and adverse effects, and appropriate duration of therapy are important. 

Provide patient education with regard to appropriate use of antimicrobials (e.g., dose, interval), adverse effects, and drug interactions (which may play a role in therapy failure and increased toxicity). 

Patient education with emphasis on goals, realistic expectations, and dangers of overtreatment is important to optimize therapeutic outcomes. Treatment regimens are targeted to types of lesions and acne severity. Mild acne usually is managed with topical retinoids alone or with topical antimicrobials, salicylic acid, or azelaic acid. Moderate acne may be managed with topical retinoids in combination with oral antibiotics, and if indicated, benzoyl peroxide. Severe acne is often managed with oral isotretinoin. 

Significant deficiencies in the security and control of samples have been well documented. " " In fact, it has been estimated that just over half of samples actually reach patients. Samples may be used by prescribers and staff, or they may be diverted. Personal use of drug samples by physicians and other healthcare providers raises ethical concerns and is not without risk." Limaye and Paauw described three medical residents who self-prescribed antimicrobials and were subsequently diagnosed with Clostridium difficile infection." Tong and Lien reported self-medication with samples and distribution of samples to nonphysicians by almost 60% of pharmaceutical representatives surveyed at a Canadian family practice office. A contributing factor to some of these issues is that institutional or facility sample policy and procedures are often absent, or compliance is poor. One institution found only 10% compliance when the inventory of samples was compared with the required written documentation. Even after an educational program in which the policy was explained to the house staff, a second audit found only 26% compliance. " Poor compliance with policy and procedure may jeopardize patient safety, as well as put the institution at risk for JCAHO recommendations or Board of Pharmacy penalties. 

More research needs to be performed to better understand consumers typical intervention points after contact with the environment. Unlike the healthcare setting, in which healthcare workers contact contaminated sources such as a patients and should wash their hands, consumers generally wash their hands only when they perceive them as being dirty. Consumers need to be better educated about how they can contact bacteria and when they should wash their hands. Many consumers may not wash their hands frequently enough to significantly reduce risk of bacterial transfer or infection. Increased use of antimicrobial products with persistent activity could reduce risk of contamination especially in situations where frequent handwashing is not practical or the use of alternative forms such as hand sanitizers allow for washing away from sinks. 

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