In this video I describe a systematic method of choosing antibiotic depending on different factors called the 5 rights which are the right patient, the right drug, the right dose, the right route and the right duration

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###### the right patient
in the patient factor of this method you need to confirm the presence of infection in your patient through three ways, the first is if your patient have fever because the hallmark of all bacterial infections is fever except if your patient is immunocompromised WBC less than 5000 then they would not have fever but patient having fever doesn’t always mean infection;; the second way is that you do complete blood count to your patient and look for white blood cell count 500010000 if elevated then infection more likely, neutrophils 60%70% if elevated then bacterial infection is more likely, lymphocytes 30% if elevated then viral infection or tuberculosis more likely, eosinophils 410% if elevated then allergic reaction or parasitic infection more likely, basophils less than 1% if elevated then blood cancer more likely;;; the third way is by doing specific test and that depends if patient have cough you send them for throat swab or chest x rays, if patient have urinary symptoms like urgency, frequency etc you send them for general urine exam and so on ;;;; and by that you confirm your patient having fever and you move to the next step which is

###### the right drug
When choosing the right drug we need to consider three things: type of infective organism, patient factors and tissue penetration:
1 type of infective organism: ideally you want to know the infective organism by taking infective material CSF, blood, urine, throat swab ... and send it for laboratory for culture and sensitivity and then you give the antibiotic according to the sensitivity test you done but sometimes you give antibiotic without knowing the infective organism and that is what we call empirical therapy and we only give empirical therapy in acutely ill patients because the culture and sensitivity takes up to 3 days and you can’t wait that long so you give empirical therapy, we also give empirical therapy in patients who are immunocompromised WBC less than 5000 and we give empirical therapy in patients who have meningitis "symptoms are triad of severe headache, photo sensitivity and neck rigidity" so we give pencillin to these patients empirically and we take CSF specimen and send it to lab for C/S;;; when selecting empirical therapy drug you want to take into consideration the site of infection and patients history (previous infections, age, recent travel history, recent antimicrobial therapy, immune status whether infection is hospital or community acquired) into consideration so you give antibiotics that cover the expected organisms and hopefully it is right
2 Patient factors: some antibiotics can’t be used in some age groups like neonates can’t be given chloramphenicol or sulfonamides, chloramphenicol cause grey baby syndrome, sulfonamides cause kernicterus; children can’t be given tetracyclines and fluoroquinolones, tetracyclines cause abnormal teeth formation "dental enamel hypoplasia", fluoroquinolones cause articular damage; old age can’t be given aminoglycosides because of severe nephrotoxicity and ototoxicity; pregnant patient can’t be given aminoglycosides because of congenital deafness, also pregnant can’t take fluroquinolones because it pass placenta and cause articular damage; immunocompromised patients better take bactericidal drugs, bacteriostatic don’t work well because immune system is compromised in these patients; people with renal or liver dysfunction need dose adjustment and monitoring to avoid toxicity...


Video Timestamps:
Intro: (0:00)
Approach to antibiotics selection: (0:51)
The right patient: (2:11)
The right drugs: (8:30)
Type of infective organism in choosing right drug: (9:19)
Patient factors in choosing right drug: (18:25)
Tissue penetration in choosing right drug: (22:30)
The right dose: (26:50)
The right route: (30:22)
The right duration: (31:04)

How to select the right antibiotic
Antibiotic Selection
The five rights of antibiotic selection