Prophylactic antibiotics

[rn undisclosed name]

Where I work we have a pneumonia pathway which is to be followed. At the bottom of the pathway there is a section for a patient who is a pseudomonal risk and they are to receive Zosyn q6h IV and Cipro q12h IV. Pharmacy adjusts doseage and frequency based on kidney function. Patients who are considered a pseudmonal risk are nursing home residents, hx of bronchiectasis, and one other thing I don't remember.

My issue is giving antibiotics prophylactically. This particular patient came in with NOTHING to do with an infection and he had been in the hospital for 8 days and was STILL on these antibiotics even though he had no s/s of infecton. I called pharmacy and they said they were managing it but couldn't tell me what the criteria was for continuing. The only thing I could see that they were managing was the doseage adjustment for kidney function. I was told I could call the doctor and see what she wanted to do so I called and explained the situation and she said to just d/c the antibiotics so I did that.

This all happened on Sunday and I worked yesterday and brought this up to my manager because really I want to be clear on this whole pathway to see if she could find out. She had me call the director of pharmacy since she was the one who started this pathway and was on the committee. So I called her and she said ID should have been on the case to manage this. Well, why should you put ID on for a pt who does not have an infection? Basically I got nowhere she did say she would look into this and get back to me. I never heard back but I plan to pursue this because now I just have to know.

In the meantime the CNS from employee health was there and she is always going through the charts and making sure patients who have pneumonia are on the pneumonia pathway and getting their flu/pneumonia vaccines on discharge. She pointed to one of the ID doc and said that is who to ask. Well I asked and boy did I get an earful about how that is so 1990's and we need to get with the times and how he doesn't agree with the whole pathway and how pseudomonas doesn't really exist anymore and the chances of having it are small, yada, yada.

Am I right to have an objection to this? What do you do at your hospitals regarding this?

[fultzymom]

I don't work in a hospital but I think that this practice is part of the reason that there is growing resistance to ATBs. Where I work we do have a few people on Prophylactic Macrobid one time daily. But this is the people who have chronic UTIs. And there are only like a couple of them (I work in LTC). I agree with you that you should have questioned the med.

[EmmaG, RN]

And then they wonder why MDROs are on the rise...

Good grief. What a stupid, stupid policy.

[flightnurse2b, LPN]

Am I right to have an objection to this? What do you do at your hospitals regarding this?

i think you are totally right to have an objection to it. its just another way to make smarter and more drug resistant organisms, imo. the only prophylaxis we had for ABT was for a patient getting ANY invasive procedure (even including intracath or foley cath) that had a hx of rheumatic fever, artificial hv, mvp, or mr/tr to have ampicillin 2g iv and gentamicin 80mg to prevent SBE.

[lsyorke, RN]

This is why I ha e a problem with "pathways". Not every patient is going to fit that pathway, especially for antibiotic use. Medicine by checklist....not very accurate for treatment.

My experience with them is that a patient ends up on alot more medication than is usually necessary.