Curriculum standards

• Antimicrobial agents:
  • antibacterial
  • antifungal
  • antimycobacterial
  • antiparasitic
  • antiviral
• Classification of antimicrobial agents

Adjunct therapeutic modalities for management of infections

• Addressing underlying anatomical, physiological, and psychosocial risks for acquisition, persistence, or recurrence of infection
• Immune-modulating therapeutic agents, such as:
  • glucocorticoids
  • granulocyte colony-stimulating factor
  • normal immunoglobulin in:
    • necrotising fasciitis
    • Streptococcus pyogenes
    • toxic shock syndrome
• Novel and emerging therapies, such as phage therapy
• Products to modulate the microbiome (e.g. faecal microbiota transplantation)
• Surgery for source control

Pharmacological principles of antimicrobials

• Adverse effects:
  • allergy, such as:
    • cross-reactivity
    • de-labelling implications
    • types of reactions
  • class-related and drug-specific contraindications
  • dose-related versus idiosyncratic drug adverse effects
• Agents that require monitoring, and the monitoring process, including baseline assessment
• Biofilm and impacts upon antimicrobial exposure
• Drug-drug interactions
• Failure
• Formulations
• Mechanisms of action and resistance, such as:
  • antimicrobial spectrum
  • pharmacodynamics concepts, such as:
    • post-antibiotic effect
    • site of action within microbe
• Pharmacodynamics
• Pharmacokinetics, such as:
  • antimicrobial agents in normal and diseased states, including critical illness
  • bioavailability
  • concepts both generally and in relation to antimicrobial usage, such as:
    • absorption
    • distribution
    • excretion
    • metabolism
  • drug exposure at different sites of infection
  • optimal dose adjustments, such as in kidney and hepatic impairment, and extremes of body weight
  • targets for antimicrobial efficacy, and the impacts of antimicrobial dosing to optimise treatment outcomes, such as time versus concentration-based killing
• Pregnancy and lactation risk assessment
• Principles and indications for chemoprophylaxis and surgical prophylaxis
• Resistance:
  • general mechanisms, such as:
    • chromosomal, plasmid, and transposon
    • class
    • cross
    • inducible and constitutive
  • specific mechanisms for key bacteria, such as carbapenemase-producing Enterobacterales (CPE), extended-spectrum beta-lactamases (ESBLs), and methicillin-resistant Staphylococcus aureus (MRSA), and implications for targeted and empiric therapy
• Therapeutic drug monitoring for the safe and effective use of antimicrobial therapy

• Antitoxins and immune globulin in treatment of infection
• Contraindications of antimicrobials, such as:
  • allergy
  • drug and food interactions
• Evidence-based dose and duration of antimicrobial agents
• Feasibility and availability
• Indications and evidence base for antimicrobial use
• Prescription of antimicrobial agents in a safe and effective manner, considering their positive and negative effects in individual patients and the community
• Principles of home therapy with antibiotics, such as:
  • choice of antibiotic appropriate stability
  • dosing
  • infections and circumstances amenable to hospital in the home and contraindications, such as medical and social
  • monitoring
  • outpatient parenteral antibiotic therapy
  • patient selection issues
  • vascular access and pumps
• Principles of initiating antimicrobial therapy, such as:
  • choice of empiric therapy for syndromes
  • discussing rationale for choice
  • host factors, such as:
    • age
    • body mass index
    • kidney and hepatic function
    • pregnancy
  • importance of completing investigations prior to initiating antimicrobial therapy
  • intravenous versus oral antimicrobial therapy
  • timing of immediate empiric therapy versus post-microbiological diagnosis
• Rationale for use of multi-agent therapy, such as:
  • prevention of resistance
  • spectrum of cover for empiric regimen based on local antibiograms
  • synergy

• Prophylaxis and treatment of infections to prevent disruptive effects on host normal flora, which may lead to:
  • Candida spp. infection
  • Clostridium difficile infection
  • development and spread of resistant microbial strains
• Surgical and other types of antimicrobial prophylaxis, such as:
  • appropriate durations and dosing
  • impact on surgical-site infections
  • post-operative prescribing

• Advice for patients on common adverse effects and role (if any) of probiotics
• Consequences of antimicrobial therapy

Antimicrobial stewardship

• Audit
• Antimicrobial development
• Antimicrobial resistance
• Broad spectrum to narrow spectrum de-escalation
• De-labelling allergies
• Desensitisation
• Epidemiology of antimicrobial resistance, such as:
  • contributing factors
  • incidence
  • local resistance – own community and hospital, including concept and understanding of antibiograms prevalence
  • national and global variability of resistance and implications for travellers, including those who have been admitted to healthcare facilities overseas
• Implications of antimicrobial resistance at various levels:
  • community
  • healthcare setting
  • patient
• Intravenous to oral switch
• Metrics for measuring efficacy of an antimicrobial stewardship program
• Organisation and implementation of antimicrobial stewardship programs at the hospital level, based on the requirements set out in Standard 3 of the Australian Commission on Safety and Quality in Health Care (Preventing and Controlling Infections Standard) and the Ngā Paerewa Health and Disability Services Standard
• Recognition of benefits associated with antimicrobial stewardship programs and the components of these programs
• Restricted agents

Treatment of specific infections

• Antimicrobial therapy for implant infections
• Chemoprophylaxis
• Diagnostic tests for implant-associated infections
• Empirical and targeted antimicrobial therapy for surgical site infections, as well as indications for surgical retreatment
• Surgical treatment of implant infections