Antibiotic Selection: Prophylactic vs. Empiric Therapy (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Now we want to talk about the difference between prophylactic versus empiric therapy, and we're talking about when we use antibiotics.

    00:09 Prophylactic therapy means I'm about to undergo a situation where I'm at risk for infection.

    00:15 So, maybe I'm going to surgery.

    00:17 Well, surgery puts me at risk for infection because you're going to make some significant breaks in my skin, right? So, anytime you puncture my skin, I'm at risk for infection.

    00:28 So, I know that, going to surgery, I'm going to put my patient at increased risk for infection, so I give them an antibiotic before they ever have surgery.

    00:36 Now, there's really tight timeframes.

    00:38 When you're caring for a patient in the hospital and they're going for surgery, your hospital will have a protocol that tells you X number of minutes of time when they want the patient to have that antibiotic before the surgeon cuts.

    00:51 So they try to keep that time, get the perfect window so the drug treatment will be the most effective, and that's a really important part of your pre-surgery checklist.

    01:00 So, check with your hospital policy and procedures and they'll be very clear at the timing of an antibiotic before surgery.

    01:07 So, that's 1 use of prophylactic antibiotic therapy. Also, dental procedures.

    01:12 If we know that someone is going to have a dental procedure and there's an infection there or they have some previous risk factors, like some known heart disease, they'll prophylactically put them on antibiotic therapy.

    01:24 So prophylactic antibiotic therapy, the patient doesn't have a known infection, but we're going to put their body under some type of stress: surgery or a dental procedure and it puts them at risk for infection, and that's why it's called prophylactic.

    01:41 The other one is -- term is empiric therapy.

    01:45 Now, in empiric therapy, the patient has a definite infection, okay? They have an infection, but we don't have culture reports back.

    01:53 So, we're going to give it our best clinical educated guess before we get more complete information.

    02:00 So, prophylactic, you don't have an infection, but we know that we're going to put you at risk for infection, so we'll pre-medicate you prophylactically with an antibiotic.

    02:10 Empiric therapy says, "Oh, you've got an infection, we just don't have the culture and sensitivity report back yet because those take a period of days to come back and give us complete information.

    02:22 So that's why we're going to give it our best clinical educated guess." Now, really, we do have some pretty good guesses, and it's usually community based.

    02:31 Let me give you an example. If I was in the ER taking care of patients and they come in with pneumonia, we call that community acquired pneumonia.

    02:39 They didn't get it in the hospital, they came to us from the community with pneumonia.

    02:43 We have a pretty good feel, as healthcare practitioners, of what are the most common bugs in our community.

    02:49 It'll be different community to community, but we know what the predominant bugs are in our community.

    02:55 And so, we're going to treat it with a pretty broad spectrum antibiotic that will knock out the majority of the bugs that we know that we've seen lately in pneumonia cases. And so, we're going to give them a broad spectrum antibiotic, give us our best shot at knocking out that infection.

    03:11 We're going to get a culture and sensitivity, and as soon as that comes back, we're going to want to get them on a much more narrow spectrum antibiotic that will deal with that pneumonia, but we want them on a narrow spectrum antibiotics so that we can minimize the risk for, what? Yep, I heard you, you got it.

    03:28 We want to minimize the risk for resistance.

    03:31 Okay, so, prophylactic, it's preventative.

    03:35 You don't have an infection yet.

    03:37 But we're going to put you in a situation where you're at risk for an infection, so then we give you an antibiotic beforehand, like surgery or a dental procedure.

    03:46 Empiric, I'm sorry to say you have an infection.

    03:50 We just don't know for sure what it is, but we're pretty good at guessing, based on what we've seen with other people in our community.

    03:56 So, we're going to give you a broad spectrum antibiotic until your culture and sensitivity reports come back, and then we're going to get you on a narrower spectrum antibiotic.

    04:05 And the whole reason is because I want to diminish the risk of microbial resistance.

    04:10 Okay, so you're doing really well at keeping up with us and knowing what we're going through.

    04:15 Now, let's talk about how, as a nurse, can I evaluate the effectiveness of a antibiotic therapy? Because this isn't just the responsibility of the health care provider, the nurse practitioner, or the nurse.

    04:27 You get to play a really big role in this.

    04:30 So what you should be looking for -- Okay, and if that wasn't enough of a selling point for you, this is also a huge part of pharmacology on the NCLEX because they're going to test your knowledge and your ability to address the effectiveness of any medication.

    04:44 Well, the effectiveness of antibiotic therapy has to be that the signs of the infection should be resolving.

    04:49 So you should be looking for things like decreased pain, less redness, less drainage, the white cell count is going back to normal.

    04:57 Look for all those signs of infection to be resolving.

    05:01 Now, you want to look at the culture and sensitivity report as soon as you can.

    05:06 So, your goal here is to take a look at that lab report.

    05:09 Don't just wait for the health care provider to come around and make rounds.

    05:13 You need to be proactive, be watching for that report, know when it's supposed to come back and take a look at it.

    05:18 Make sure the organism that has been identified in your patient is the S word, susceptible and not resistant to the antibiotic that they're on.

    05:29 It's a really cool thing if you review the reports, so when your healthcare provider hits the unit for rounds, you can greet them and say, "Hello Dr. So and So," or if you're talking to the nurse practitioner, or the physician's assistant, you can let them know, "Hey, good morning, I've taken care of your patient, Mr. So and So.

    05:46 I just want to let you know I reviewed the culture and sensitivity reports, and that we're on the right antibiotic. Looks like things are resolving." When you do those simple things, you start to build a reputation and a relationship with the healthcare providers.

    06:00 You will have a much better collaborative experience with them, and you'll be able to advocate for your patients in a really effective way.

    06:08 So, the more you stay on top of things and are prepared to give pertinent clinical information to the health care provider, when they're around, it's really going to help both your experience and definitely help your patient experience.

    06:20 So, remember, if the patient's drug is not sensitive to that medication that they're on, you want to notify the healthcare provider very quickly because time is infection.

    06:30 The longer we let a bug go untreated, the worse the chances for infection can be.

    06:35 Now, the worst case scenario for any infection is sepsis, and sepsis puts the patient at risk for death.

    06:42 So that's why not every infection, obviously, ends up that way, but we always want to make sure that we try and get that infection as quickly as possible.

    06:50 So, we're coming back to the question that we started with; how does a health care provider select the best antibiotic? Now you know, so I want you to pause the video, take a look at your notes and answer this question.

    07:08 Okay, good work on working through that question.

    07:12 You'll see the answer written in your notes there, and thank you for watching our video.

    07:16 And I want each of you to feel confident when you're practicing in your professional nursing practice, that you're a valuable member of the team that helps each patient get the most effective antibiotic for their plan of care.

    About the Lecture

    The lecture Antibiotic Selection: Prophylactic vs. Empiric Therapy (Nursing) by Rhonda Lawes, PhD, RN is from the course Anti-Infective Drugs in Nursing.

    Included Quiz Questions

    1. A client who will undergo abdominal surgery
    2. A client with a urinary tract infection
    3. A client with recurrent fever
    4. A client with pus at the incision site
    1. A client with pus draining at the incision site
    2. A client who will undergo exploratory laparotomy
    3. A client scheduled for tumor removal
    4. A client who will undergo heart transplant
    1. Decreased pain
    2. Erythema
    3. Swelling
    4. Leukocytosis
    1. Determine the presence of an infection.
    2. Perform a culture and sensitivity test.
    3. Determine if the client is immunocompromised.
    4. Consider the client's age.
    5. Select a broad-spectrum antibiotic as often as possible.

    Author of lecture Antibiotic Selection: Prophylactic vs. Empiric Therapy (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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