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Antibiotic Policy

Aug 17, 2014

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  • Antibiotic Policy in Medical Care Dr.T.V.Rao MD
  • Discovery Of Penicillin changes the History of Medicine
  • 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
    • 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
  • 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.
  • Frequent, Irrational, and Indiscriminate use increases 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
  • 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 .
    • 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
    • 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
    • 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 Group Monitors
    • 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
    • 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
    • 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
    • A proper specimen collection is most neglected area of Microbiology.
    • Scientific approaches in Sample collection is concern for successful Microbiological evaluations,
  • 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
    • 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.
    • 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
  • Empherical Therapy
    • To many drugs creates complex problems in drug resitance.
    • The clinicians should optimize the duration of empherical treatment.
  • 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 Antibiotic Policy
    • 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
    • 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 with Antibiotic Policy If
    • 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 Antibiotic Policy
    • 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 Antibiotic Policies
        • 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