Antibiotic Selection: Narrow vs. Broad Spectrum (Nursing)

00:01 Hi, welcome to our video on Antibiotic Selection.

00:04 Okay, now, don't be underwhelmed by that first title because this is something really cool that you get to be a part of.

00:12 This is a role that nurses play that is so amazing in helping our patients get better.

00:18 See, I want you to start thinking about this question, but I don't expect you to answer it; how does a health care provider select the best antibiotic? See, that's the whole point of this video, is I want you to walk through the process, so even in your clinical rotations, you can be involved in that process.

00:36 So, hold on to that thought on how a health care provider can select the best antibiotic, and we'll answer that by the end of this video.

00:44 Okay, so let's get started.

00:45 There's a couple pieces of information you need to have as we're walking through this.

00:49 First of all, I want you to understand the difference between narrow and broad spectrum.

00:55 A narrow-spectrum antibiotic acts against a really limited group of bacteria.

01:01 So, therefore, a broad-spectrum antibiotic acts against a larger group of bacteria.

01:06 Now, take a look at the graphics, these are pretty cool.

01:09 See, the narrow-spectrum antibiotic has, really, a very simple, straightforward, same type of bacteria that it goes against.

01:17 But look at the broad spectrum.

01:19 You've got all different kinds of bacteria that it works against.

01:23 Now we're going to talk about why it's better to use either a narrow or a broad spectrum as we keep walking through the process of the role you'll play as a healthcare provider, team member, on how we find the best antibiotic for your patient.

01:37 So here's your first question. What do you think? Do you think our goal should be to keep a patient on the broadest spectrum antibiotic or the narrowest spectrum antibiotic, and why? So, take a minute, and jot your answer down in the margin of your notes.

01:55 Now, I'm going to ask you one more question.

01:58 What test could we use to determine if the patient was on an effective antibiotic? Again, just write your thoughts in the notes.

02:07 Okay, now, don't worry. We're going to actually talk about the answers to these questions.

02:12 So, the first question, do you think our goal should be to keep the patient on the broadest spectrum antibiotic or the narrowest spectrum antibiotic? The answer is we want them on the narrowest spectrum antibiotic, and why? Because we want to do everything we can to limit the possibility of the bugs developing resistance to our drugs.

02:33 So it's really important that you can get your patient on the narrowest spectrum antibiotic that will still wipe out their infection as quickly as possible.

02:42 Now, what test we could use to determine if the patient was on an effective antibiotic, hat's a culture, and even a culture and sensitivity test would tell us that.

02:52 All right, so let's talk about what that is.

02:54 Let's start digging into what a culture and sensitivity report would look like.

02:58 So let's say you're the nurse for this patient who's receiving clindamycin.

03:02 Clindamycin is an antibiotic.

03:04 So the clindamycin is used to treat organism number 2.

03:08 Okay, so look at the report that you have in your downloadable notes and follow over organism 2. Do you see the name -- Based on this culture and sensitivity report, what is the name for organism 2? Okay, if you see the name as MRSA, M-R-S-A, you got the correct answer. You already know now how to read the type of organism on a culture and sensitivity report.

03:33 Congratulations. That's a really cool that you're already at that step.

03:36 Now, here's the really important part.

03:39 Is clindamycin an effective antibiotic for this organism, and why or why not? So by looking at this report, you can tell the answer to that question.

03:50 So pause for just a minute. Take your time.

03:53 Look at clindamycin and you determine -- Pretend that you're this patient's nurse, and you determine if that antibiotic is effective for them or not.

04:03 Ready? Remember, the name of this organism is MRSA and is clindamycin an effective antibiotic? Well, you look at clindamycin and you follow it over on the chart, you'll see an R there.

04:18 Well, we know, from the previous videos, that an R means resistant.

04:22 If you haven't got to see that video yet, then keep in mind, R means resistant, S means sensitive.

04:29 That means -- R means the bug is resistant to that drug, S means the bug is sensitive to that antibiotic and will be killed by it.

04:37 So is clindamycin a good choice? Is it the best choice or even an effective choice for this patient who has methicillin resistant Staphylococcus aureus or MRSA? The answer is no.

04:53 So, whether you got that or not, don't get worried about that.

04:56 Now you know how to look at a chart.

04:58 When you look at a culture and sensitivity test, you'll see that you have -- Look, this patient has 2 organisms.

05:04 You'll see the name of the organism on the chart.

05:06 You'll also see a listing of antibiotics, which you see there, clindamycin happens to be the one this patient is taking.

05:12 But we see -- oh my, it's got an R by it, meaning it won't treat this bug.

05:19 So what's our next step as a nurse? Contact the healthcare provider.

05:23 "Hello, Dr. So and So. My name is Rhonda. I'm taking care of your patient in 5 East.

05:27 I just wanted to let you know that the culture and sensitivity report came back.

05:31 The patient is taking clindamycin, and the report showed that it's resistant to this drug." That's our role. That's when things get really fun, because then you get to talk to the health- care provider, and together, you come up with a next best step for your patient.

05:46 So, now, let's talk about mechanisms of action.

05:49 Now, this might not seem extremely exciting to you, but it's just a way that we organize the medications, the antibiotics.

05:56 So there's lots of different mechanisms. They can inhibit bacterial cell walls synthesis.

06:02 They can increase the cell membrane permeability.

06:05 Yeah, that's not good, because then they -- they explode.

06:08 They can cause a lethal -- that means a deadly inhibition of bacterial proteins.

06:13 They can cause a non-lethal inhibition of bacterial protein synthesis.

06:16 They can inhibit bacterial synthesis. They can be antimetabolites, or they can suppress viral replication.

06:22 So, I know that's 7.

06:25 Those are 7 of the predominant mechanisms of action of these antibiotics.

06:29 We're going to look at 4, so I'm going to wheel that down for you, from 7 to 4 of the most common mechanisms of action that you'll see.

06:38 Now, on the other slide, you'll see that I give you examples of antibiotics from each 1 of those mechanisms of action.

06:45 This is just a way to categorize and to give you a system to, kind of, see how the antibiotics work, okay? There's other ways that you can organize antibiotics, but we're going to roll with this system for the video.

06:57 So let's look at the 4 most common.

07:01 First, they interfere with cell wall synthesis.

07:04 Second, could be a group of antibiotics that interfere with protein synthesis.

07:09 Third, they interfere with DNA replication, or fourth, they're acting as a metabolite, that messes with some critical metabolic reactions inside the bacterial cell.

07:21 So those are the 4 most common ones that you'll see.