Antibiotic PolicyinMedical Care : Antibiotic PolicyinMedical Care Kemonce_303@yahoo.com Discovery Of Penicillin changes the History of Medicine : Discovery Of Penicillin changes the History of Medicine Why we Need Antibiotics : Why we Need Antibiotics Nearly One half of the Hospitalized patients receive antimicrobial agents.
Antibiotics are valuable Discoveries of the Modern Medicine.
All current achievements in Medicine are attributed to use of Antibiotics
Life saving in Serious infections. What went wrong with Antibiotic Usage : What went wrong with Antibiotic Usage Treating trivial infections / viral Infections with Antibiotics has become routine affair.
Many use Antibiotics without knowing the Basic principles of Antibiotic therapy.
Many Medical practioners are under pressure for short term solutions.
Commercial interests of Pharmaceutical industry pushing the Antibiotics, more so Broad spectrum and Newer Generation antibiotics. as every Industry has become profit oriented.
Poverty encourages drug resitance due to under utilization of appropriate Antibiotics. Drug usage = Drug resistance : Drug usage = Drug resistance Basis of Antibiotic Resistance : Basis of Antibiotic Resistance The antibiotic resistance is guided by Genomic changes
Spread of R plasmids among the Bacteria
Do remember Antibiotics are used in Animal husbandry apart from Medical use
The discovery of antibiotic resistance was discovered with spread of R plasmids from animal sources
The Human gut forms the interconnecting area in R plasmids transmission leading ultimately to antibiotic resistance Plasmids played a Major Role in spread of Antibiotic resistance. : Plasmids played a Major Role in spread of Antibiotic resistance. Frequent, Irrational, and Indiscriminate use increases Antibiotic resistance, : Frequent, Irrational, and Indiscriminate use increases Antibiotic resistance, Spread of Antibiotic Resistance : Spread of Antibiotic Resistance Indiscrimate use of Antibiotics in Animals and Medical practice
R plasmids spread among co-inhabiting Bacterial flora in Animals ( in gut )
R plasmids may be mainly evolved in Animals spread to Human commensal, - Escherichia coli followed by spread to more important human pathogens Eg Shigella spp. Why we Need Antibiotic Policy : Why we Need Antibiotic Policy Aim of Antibiotic Policy : Aim of Antibiotic Policy Reduce the Antimicrobial resistance
Initiate best efforts in the hospital area as many resistance Bacteria are generated in Hospital areas and in particular critical care areas.
Initiate good hygienic practices so these bacteria do not spread to others
Practice best efforts, these resistance strains do not spill into critically ill patients in the Hospital
To prevent spill into Society, as they present as community associated infections.. Objectives of Antibiotic Policy. : Objectives of Antibiotic Policy. Antibiotics should not be used casually
Policy emphasizes, avoiding the use of powerful Antibiotics in the Initial treatments.
We should create awareness that we are sparing the powerful Broad spectrum Drugs for later treatment
Patient saves Money
Doctors save Lives. Policy Deals with : Policy Deals with We discuss on the Broad basis
Clinicians / Microbiologists / Pharmacists and Nurses do take part.
Policies are framed on demands of the Clinical areas, depending on recent Infection surveillance data contributed from Microbiology Departments. Aims of the Antibiotic Policy : Aims of the Antibiotic Policy Create awarness on Antibiotics as misuse is counterproductive.
More effective treatments in serious Infections.
Reduce Health care associated infections spilling to society and increase of Community associated Infections.
( A growing concern in Devloping world ) Antibiotic working GroupMonitors : Antibiotic working GroupMonitors Formulate Optimal guidelines in Treatment of Infections with minimal risk of Health care associated Infections.
Create a plan for monitoring the Use of Antibiotics across the Hospital Education On Antibiotic policy : Education On Antibiotic policy Acton plan for Education to all concerned clinical staff on Antibiotic prescriptions.
Evaluate the feed back of success and failures of the policy.
Create Infection surveillance Data
Developing facilities in Microbiology departments for auditing data and guidance
Restrictions in prescribing and Antibiotic availability.
A continuous education to Junior Doctors Sample collection : Sample collection Proper specimen collection is combined responsibility of Clinical and Microbiological Departments.
Continuous training of junior staff on sample collection, and is most neglected necessity
A good clinical history is greatly helpful in differentiating community acquired infections from hospital acquired infections. Pitfalls in Specimen collection : Pitfalls in Specimen collection A proper specimen collection is most neglected area of Microbiology.
Scientific approaches in Sample collection is concern for successful Microbiological evaluations, Microbiology Services : Microbiology Services Constant up graduation of Microbiology departments is good investment.
Quality control methods in testing of antibiotic resistance pattern is a top priority. Role of Microbiology Department : Role of Microbiology Department Microbiology departments asses trends in development of antimicrobial resistance.
The results of sensitivity/resistance patterns should be correlated with Antimicrobial agents currently used in the Hospital.
Identify and forecast that nature of relation between antibiotic use and resistance. Better services from Microbiology Departments. : Better services from Microbiology Departments. Basic infrastructure should be updated for detection of MRSA and ESBL producers.
Documentation of all Opportunistic infections. and Hospital infection outbreaks Good Microbiology practices will save the resources and reduces the Antibiotic usage : Good Microbiology practices will save the resources and reduces the Antibiotic usage Empherical Therapy : Empherical Therapy To many drugs creates complex problems in drug resitance.
The clinicians should optimize the duration of empherical treatment. Advantages of Antibiotic Policy : Advantages of Antibiotic Policy Saves the Lives
Reduces the morbidity
Saves Health related costs
Reduces the Antibiotic related toxicity.
Patients are satisfied. Staff Education on AntibioticPolicy : Staff Education on AntibioticPolicy Staff education is most Important principle in success
Draw your own plans according to nature of patients, your past experiences
Induction training for new staff
Continuing Medical Education to both Junior and Senior practioners.
Include nursing staff, pharmacists for the success of the Programme Our Policy is Successful : Our Policy is Successful If the Staff will understand the potential hazards of Antibiotics
Use of Antibiotic guidelines in teaching Under and Post graduate Medical Students,
If we are united we can reduce Hospital generated infections We will succeed withAntibiotic PolicyIf : We will succeed withAntibiotic PolicyIf Both patients and Doctors reduce their expectation on the role of Antibiotics
If the Medical profession realizes our aim is to give Right Drug for Right Bug. Patient Education on AntibioticPolicy : Patient Education on AntibioticPolicy Education of the patients and society is important in Devloping world.
Educate the patients many infections are trival,viral, Do not need Antibiotics
If they understand Unnecessary consumption of Antibiotics kills the Normal flora, and reduces the Immunity and makes them potential victims in future.
A difficult task in Devloping countries. Proved success of AntibioticPolicies : Proved success of AntibioticPolicies Studies Prove
1 Rapid reversal of major clinical problems of resistance to Choramphenicol ,Erythromycin, and Tetracycline in Staphylococcus aureus on withdrawal of antibiotics.
2 Out breaks of Erythromycin resistant Group A Streptococci and Penicillin resistant Pneumococci, can be controlled by major reduction in prescription of Erythromycin and Penicillin.
3 Control of multiple resistant Gram – ve bacteria and role played by reducing the prescription of 3rd generation of Cephalosporins
( I.M.Gould Review of the role of antibiotic policies in the control of antibiotic resistance, Journal of Antimicrobial Chemotherapy 1999 43, 459 – 465. ) Make your conclusions and contribute to Antibiotic Policy : Make your conclusions and contribute to Antibiotic Policy It is true to say that there is no absolute proof of causative association between antibiotic use and resistance, But many authorities believe the association to be virtually certain.
It is pragmatic and essential approach to control of antibiotic resistance with control of antibiotic use.
Make every one a partner in prevention of Antibiotic resistance, and success will follow. How to prove the Success : How to prove the Success Prove your action plans with evidence based success outcomes
Senior practioners should be role models
Prove how rationalism helps, saves money, morbidity and mortality. Why Everyone worried about Antibiotic ( misuse ) Use. : Why Everyone worried about Antibiotic ( misuse ) Use. Drug resistance can reverse Medical progress
The following diseases are already in the list of attaining the drug resistance, and Medical profession will find difficult to cure in future.
3. Sore throat and Ear Infections. Best way to keep the matters in Order : Best way to keep the matters in Order Every Hospital should have a policy which is practicable to their circumstances.
Rigid guidelines without coordination will lead to greater failures
The only way to keep Antimicrobial agents useful is to use them appropriately and Judiciously
(Burke A.Cunha, MD,MACP Antimicrobial Therapy. Medical Clinics of North America NOV 2006) Working together creates Safe Hospitals : Working together creates Safe Hospitals Created for Benefit of Medical and paramedical personal in Developing world : Created for Benefit of Medical and paramedical personal in Developing world Ali Aziabi