antibiotic control thursday 1/17/07. antibiotic use antibiotic resistance how can we change / reduce...
Post on 22-Dec-2015
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Antibiotic use
Antibiotic resistance
How can we change / reduce
Ab use???
Will it reduce Ab resistance???
Suggested Ab use strategies for controlling resistance:
• Ab restriction / Infectious Disease consultants
• Combination therapies
• Cycling
• “Hit hard and early” – abbreviated Ab treatments
• PK/PD – mutant prevention concentration
• Judicious Ab educational interventions
Antibiotic restrictionMacrolide restriction in Finland / Seppala et al. NEJM 1997
Total consumption of macrolides by outpatients in Finland
Frequency of Ery-R GAS isolates from throat + pus in Finland
Macrolide restriction in Finland / Bergman et al. CID2004
• Azithromycin and other macrolide consumption in Finland
• Ery-R in GAS isolates in Finland
Combination therapies
• What are the conditions under which this will work?
• It is effective in preventing antibiotic resistance for TB, HIV, but for any of the bacteria we discussed?
• Not shown effective for other bacteria.
Antibiotic cycling
• Two or more antibiotic classes are alternated on a time scale of months – years.
Squeezing the balloon…
Abbreviated antibiotic treatments
• For many infections still as effective as ‘standard treatments’ (UTI/ OM/pneumoniae?/ rt. Endocarditis)
• But less Ab pressure.
Using PK/PD to reduce resistance emergence
• Time dependent killing (T>MIC)
• Concentration dependent killing (AUC/MIC or Cmax/MIC)
• MPC (mutant prevention concentration) - flouroquinolones
Educational interventions to implement judicious Ab use
• To decrease misuse and abuse of antibiotics (estimated as >50% prescriptions to outpatients).