Rrational use of antibiotics

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Rational Use of Antibiotics Sumaiya Nahid M. PharmThesis

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Antibiotics: Antibiotics are antibacterial substances produced by various species of microorganisms bacteria fungi and actinomycetes that suppress the growth of other microorganisms. Is an antibiotic necessary - Only useful for the treatment of bacterial infections. Antimicrobial agents are among the most commonly used and misused of all drugs. The Three Most Common Situations For Antibiotic Abuse. These are 1. Fever 2. Sore Throat 3. Diarrhoea.

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Irrational Use : "Antibiotics have been given for everything from headaches to ingrown toenails they are swallowed sucked injected and smeared they are painted on cuts dumped into wounds fed to the chickens and pigs and spread on the floors of the hospital wards." -Dr. Richard Novick Reason for irrationality: 1. Lack of confidence 2. Peer pressure 3. Patient pressure 4. Company pressure

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Hazards from Irrational use: 1. Ineffective Unsafe treatment. 2. Increased drug resistance 3. Prolongation of the illness 4. Distress harm to patient 5. Increased Adverse effect 6. Increased morbidity mortality 7. Loss of patient confidence to doctor We must exercise considerable restraint in prescribing antibacterials and restrict the use of antibacterials to only certain definite indications.

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Definition of rational use of medicines "Patients receive medications appropriate to their clinical needs in doses that meet their own individual requirements for an adequate period of time and at the lowest cost to them and their community." WHO 1985. The Misuse Of Miracle Should Be Averted

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• GENERAL PRINCIPLES IN THE RATIONAL USE OF ANTIBIOTICS Prescribing an antibiotic comprises several phases: i perception of need - is an antibiotic necessary ii choice of antibiotic - what is the most appropriate antibiotic a The aetiological agent b The patient c The antibiotic iii choice of regimen : what dose route frequency and duration are needed a Parenteral or oral b Duration of treatment iv monitoring efficacy : is the treatment effective

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WHO advocates 12 key interventions to promote more rational use: 1. Establishment of a multidisciplinary national body to coordinate policies on medicine use 2. Use of clinical guidelines 3. Development and use of national essential medicines list 4. Establishment of drug and therapeutics committees in districts and hospitals 5. Inclusion of problem-based pharmacotherapy training in undergraduate curricula 6. Continuing in-service medical education as a licensure requirement 7. Supervision audit and feedback 8. Use of independent information on medicines 9. Public education about medicines 10. Avoidance of perverse financial incentives 11. Use of appropriate and enforced regulation 12. Sufficient government expenditure to ensure availability of medicines and staff.

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Factors should be considered while prescribing an antibacterial agent:  Site of infection E.g. Infections above the diaphragm: Upper respiratory tract infections like pharyngitis tonsillitis sinusitis otitis epiglottitis can be treated with drugs like Penicillins Cephalosporins and Macrolides.  Type of infection E.g. For extensive severe deep seated chronic and intracellular infections higher and more frequent dose longer duration of therapy combinations lipophilic drugs may have to be used.  Severity of infection In life threatening and rapidly fatal such as bacteremia / pyemia / sepsis syndrome etc. case only intravenous route to ensure adequate blood levels.  Isolate and its sensitivity Ideal management of any significant bacterial infection requires culture and sensitivity study of the specimen.

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 Source of infection Community acquired infections are less likely to be resistant whereas hospital acquired infections are likely to be resistant and more difficult to treat e.g. Pseudomonas MRSA etc..  Host factors Age of the patient immune status pregnancy and lactation associated conditions like renal failure hepatic failure epilepsy etc. should be considered in choosing the antibacterial agent.  Age Infants: Chloramphenicol can cause grey baby syndrome and sulfa can cause kernicterus are contraindicated. Elderly: In the elderly achlorhydria may affect absorption of antibacterial agents. Drug elimination is slower requiring dose adjustments. Ototoxicity of aminoglycosides may be increased in the aged.

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Indications for antibacterial therapy 1. Definitive therapy:  Bacterial infections only A narrow spectrum least toxic easy-to-administer and cheap drug should be prescribed. 2. Empirical therapy: Restricted to critical cases when time is inadequate for identification and isolation of the bacteria. Eg: Septicemic shock/ sepsis syndrome immunocompromised patients with severe systemic infection. 3. Prophylactic therapy: administered to susceptible patients to prevent specific infections that can cause definite detrimental effect. Eg: Antitubercular prophylaxis Anti rheumatic prophylaxis

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