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Antibiotic Policy Antibiotic Policy in in Medical Care Medical Care Dr.T.V.Rao MD Dr.T.V.Rao MD

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Antibiotic PolicyAntibiotic Policyinin

Medical CareMedical Care

Dr.T.V.Rao MDDr.T.V.Rao MD

Discovery Of Penicillin changes Discovery Of Penicillin changes the History of Medicinethe History of Medicine

Why we Need AntibioticsWhy we Need Antibiotics

Nearly One half of the Hospitalized Nearly One half of the Hospitalized patients receive antimicrobial agents.patients receive antimicrobial agents.

Antibiotics are valuable Discoveries of Antibiotics are valuable Discoveries of the Modern Medicine.the Modern Medicine.

All current achievements in Medicine All current achievements in Medicine are attributed to use of Antibioticsare attributed to use of Antibiotics

Life saving in Serious infections.Life saving in Serious infections.

What went wrong with What went wrong with Antibiotic UsageAntibiotic Usage

Treating Treating trivial infectionstrivial infections / / viral Infectionsviral Infections with Antibiotics with Antibiotics has become routine affair.has become routine affair.

Many use Antibiotics without knowing the Basic principles Many use Antibiotics without knowing the Basic principles of Antibiotic therapy.of Antibiotic therapy.

Many Medical practioners are under pressure for short Many Medical practioners are under pressure for short term solutions.term solutions.

Commercial interests of Commercial interests of Pharmaceutical industryPharmaceutical industry pushing pushing the Antibiotics, more so Broad spectrum and Newer the Antibiotics, more so Broad spectrum and Newer Generation antibiotics. as every Industry has become profit Generation antibiotics. as every Industry has become profit oriented.oriented.

Poverty encourages drug resitance due to Poverty encourages drug resitance due to under utilization of appropriate Antibiotics.under utilization of appropriate Antibiotics.

Drug usage = Drug Drug usage = Drug resistanceresistance

Basis of Antibiotic Basis of Antibiotic ResistanceResistance

The antibiotic resistance is guided by Genomic The antibiotic resistance is guided by Genomic changes changes

Spread of R plasmids among the BacteriaSpread of R plasmids among the Bacteria

Do remember Antibiotics are used in Animal Do remember Antibiotics are used in Animal husbandry apart from Medical usehusbandry apart from Medical use

The discovery of antibiotic resistance was The discovery of antibiotic resistance was discovered with spread of R plasmids from animal discovered with spread of R plasmids from animal sourcessources

The Human gut forms the interconnecting area in R The Human gut forms the interconnecting area in R plasmids transmission leading ultimately to plasmids transmission leading ultimately to antibiotic resistanceantibiotic resistance

Plasmids played a Major Role Plasmids played a Major Role in spread of Antibiotic in spread of Antibiotic

resistance.resistance.

Frequent, Irrational, and Frequent, Irrational, and Indiscriminate use increases Indiscriminate use increases

Antibiotic resistance,Antibiotic resistance,

Spread of Antibiotic Spread of Antibiotic ResistanceResistance

Indiscrimate use of Antibiotics in Animals Indiscrimate use of Antibiotics in Animals and Medical practiceand Medical practice

R plasmids spread among co-inhabiting R plasmids spread among co-inhabiting Bacterial flora in Animals ( in gut )Bacterial flora in Animals ( in gut )

R plasmids may be mainly evolved in R plasmids may be mainly evolved in Animals spread to Human commensal, - Animals spread to Human commensal, - Escherichia coli followed by spread to Escherichia coli followed by spread to more important human pathogens Eg more important human pathogens Eg Shigella spp.Shigella spp.

Why we Need Why we Need Antibiotic Antibiotic

PolicyPolicy

Aim of Antibiotic PolicyAim of Antibiotic Policy

Reduce the Antimicrobial resistanceReduce the Antimicrobial resistance Initiate best efforts in the hospital area as Initiate best efforts in the hospital area as

many resistance Bacteria are generated in many resistance Bacteria are generated in Hospital areas and in particular critical care Hospital areas and in particular critical care areas.areas.

Initiate good hygienic practices so these Initiate good hygienic practices so these bacteria do not spread to othersbacteria do not spread to others

Practice best efforts, these resistance strains Practice best efforts, these resistance strains do not spill into critically ill patients in the do not spill into critically ill patients in the HospitalHospital

To prevent spill into Society, as they present To prevent spill into Society, as they present as community associated infections..as community associated infections..

Objectives of Antibiotic Objectives of Antibiotic PolicyPolicy..

Antibiotics should not be used casuallyAntibiotics should not be used casually Policy emphasizes, avoiding the use of Policy emphasizes, avoiding the use of

powerful Antibiotics in the Initial treatments.powerful Antibiotics in the Initial treatments. We should create awareness that we are We should create awareness that we are

sparing the powerful Broad spectrum Drugs sparing the powerful Broad spectrum Drugs for later treatmentfor later treatment

Patient saves Money Patient saves Money Doctors save LivesDoctors save Lives..

Policy Deals withPolicy Deals with

We discuss on the Broad basisWe discuss on the Broad basis Clinicians / Microbiologists / Clinicians / Microbiologists /

Pharmacists and Nurses do take Pharmacists and Nurses do take partpart..

Policies are framed on demands of the Policies are framed on demands of the Clinical areas, depending on recent Clinical areas, depending on recent Infection surveillance data contributed Infection surveillance data contributed from Microbiology Departments.from Microbiology Departments.

Aims of the Antibiotic Aims of the Antibiotic PolicyPolicy

Create awarness on Antibiotics as misuse is Create awarness on Antibiotics as misuse is counterproductive.counterproductive.

More effective treatments in serious More effective treatments in serious Infections.Infections.

Reduce Health care associated infections Reduce Health care associated infections spilling to society and increase of spilling to society and increase of Community associated Infections.Community associated Infections.

( A growing concern in Devloping world )( A growing concern in Devloping world )

Antibiotic working GroupAntibiotic working GroupMonitorsMonitors

Formulate Optimal guidelines in Formulate Optimal guidelines in Treatment of Infections with minimal Treatment of Infections with minimal risk of Health care associated risk of Health care associated Infections.Infections.

Create a plan for monitoring the Create a plan for monitoring the Use of Antibiotics across the Use of Antibiotics across the

HospitalHospital

Education On Antibiotic Education On Antibiotic policypolicy

Acton plan for Education to all concerned Acton plan for Education to all concerned clinical staff on Antibiotic prescriptions.clinical staff on Antibiotic prescriptions.

Evaluate the feed back of success and Evaluate the feed back of success and failures of the policy.failures of the policy.

Create Infection surveillance DataCreate Infection surveillance Data Developing facilities in Microbiology Developing facilities in Microbiology

departments for auditing data and guidancedepartments for auditing data and guidance Restrictions in prescribing and Antibiotic Restrictions in prescribing and Antibiotic

availability.availability. A continuous education to Junior DoctorsA continuous education to Junior Doctors

Sample collectionSample collection

Proper specimen collection is combined Proper specimen collection is combined responsibility of Clinical and Microbiological responsibility of Clinical and Microbiological Departments.Departments.

Continuous training of junior staff on sample Continuous training of junior staff on sample collection, and is most neglected necessitycollection, and is most neglected necessity

A good clinical history is greatly helpful in A good clinical history is greatly helpful in differentiating community acquired infections differentiating community acquired infections from hospital acquired infections.from hospital acquired infections.

Pitfalls in Specimen Pitfalls in Specimen collectioncollection

A proper specimen A proper specimen collection is most collection is most neglected area of neglected area of Microbiology.Microbiology.

Scientific Scientific approaches in approaches in Sample collection is Sample collection is concern for concern for successful successful Microbiological Microbiological evaluations,evaluations,

Microbiology ServicesMicrobiology Services

Constant up Constant up graduation of graduation of Microbiology Microbiology departments is departments is good investment.good investment.

Quality control Quality control methods in testing methods in testing of antibiotic of antibiotic resistance pattern resistance pattern is a top priority.is a top priority.

Role of Microbiology Role of Microbiology DepartmentDepartment

Microbiology departments asses trends in Microbiology departments asses trends in development of antimicrobial resistance.development of antimicrobial resistance.

The results of sensitivity/resistance The results of sensitivity/resistance patterns should be correlated with patterns should be correlated with Antimicrobial agents currently used in Antimicrobial agents currently used in the Hospital.the Hospital.

Identify and forecast that nature of Identify and forecast that nature of relation between antibiotic use and relation between antibiotic use and resistance.resistance.

Better services from Better services from Microbiology Departments.Microbiology Departments.

Basic infrastructure Basic infrastructure should be updated for should be updated for detection of detection of MRSAMRSA and and ESBL ESBL producers.producers.

Documentation of all Documentation of all OpportunisticOpportunistic infections.infections. and and Hospital Hospital infection infection outbreaksoutbreaks

Good Microbiology practices Good Microbiology practices will save the resources and will save the resources and

reduces the Antibiotic usagereduces the Antibiotic usage

Empherical TherapyEmpherical Therapy

To many drugs To many drugs creates complex creates complex problems in drug problems in drug resitance.resitance.

The clinicians The clinicians should optimize the should optimize the duration of duration of empherical empherical treatment.treatment.

Advantages of Antibiotic Advantages of Antibiotic PolicyPolicy

Saves the LivesSaves the Lives Reduces the morbidityReduces the morbidity Saves Health related costsSaves Health related costs Reduces the Antibiotic related Reduces the Antibiotic related

toxicity.toxicity. Patients are satisfied.Patients are satisfied.

Staff Education on Staff Education on AntibioticAntibiotic

PolicyPolicy

Staff education is most Important principle Staff education is most Important principle in successin success

Draw your own plans according to nature Draw your own plans according to nature of patients, your past experiencesof patients, your past experiences

Induction training for new staffInduction training for new staff Continuing Medical Education to both Continuing Medical Education to both

Junior and Senior practioners.Junior and Senior practioners. Include nursing staff, pharmacists for the Include nursing staff, pharmacists for the

success of the Programmesuccess of the Programme

Our Policy is SuccessfulOur Policy is Successful

If the Staff will understand the potential If the Staff will understand the potential hazards of Antibioticshazards of Antibiotics

Use of Antibiotic guidelines in teaching Use of Antibiotic guidelines in teaching Under and Post graduate Medical Students,Under and Post graduate Medical Students,

If we are united we can reduce Hospital If we are united we can reduce Hospital generated infectionsgenerated infections

We will succeed withWe will succeed withAntibiotic PolicyAntibiotic Policy

IfIf

Both patients and Doctors reduce Both patients and Doctors reduce their expectation on the role of their expectation on the role of AntibioticsAntibiotics

If the Medical profession realizes our If the Medical profession realizes our aim is to give aim is to give Right Drug for Right Right Drug for Right Bug.Bug.

Patient Education on AntibioticPatient Education on AntibioticPolicy Policy

Education of the patients and society is Education of the patients and society is important in Devloping world.important in Devloping world.

Educate the patients many infections are Educate the patients many infections are trival,viral, Do not need Antibioticstrival,viral, Do not need Antibiotics

If they understand Unnecessary If they understand Unnecessary consumption of Antibiotics kills the Normal consumption of Antibiotics kills the Normal flora, and reduces the Immunity and flora, and reduces the Immunity and makes them potential victims in future.makes them potential victims in future.

A difficult task in Devloping countriesA difficult task in Devloping countries..

Proved success of AntibioticProved success of AntibioticPoliciesPolicies

Studies ProveStudies Prove

1 Rapid reversal of major clinical problems of resistance to 1 Rapid reversal of major clinical problems of resistance to Choramphenicol ,Erythromycin, and Tetracycline in Choramphenicol ,Erythromycin, and Tetracycline in Staphylococcus aureus on withdrawal of antibiotics.Staphylococcus aureus on withdrawal of antibiotics.

2 Out breaks of Erythromycin resistant 2 Out breaks of Erythromycin resistant Group A Group A StreptococciStreptococci and and Penicillin resistant PneumococciPenicillin resistant Pneumococci, , can be controlled by major reduction in prescription of can be controlled by major reduction in prescription of Erythromycin and Penicillin.Erythromycin and Penicillin.

3 Control of multiple resistant Gram – ve bacteria and role 3 Control of multiple resistant Gram – ve bacteria and role played by reducing the prescription of 3played by reducing the prescription of 3rdrd generation of generation of CephalosporinsCephalosporins

.. ( ( I.M.Gould Review of the role of antibiotic policies in the control of antibiotic resistance, Journal of I.M.Gould Review of the role of antibiotic policies in the control of antibiotic resistance, Journal of

Antimicrobial Chemotherapy 1999 43, 459 – 465. )Antimicrobial Chemotherapy 1999 43, 459 – 465. )

Make your conclusions and Make your conclusions and contribute to Antibiotic Policycontribute to Antibiotic Policy

It is true to say that there is no absolute It is true to say that there is no absolute proof of causative association between proof of causative association between antibiotic use and resistance, But many antibiotic use and resistance, But many authorities believe the association to be authorities believe the association to be virtually certain.virtually certain.

It is pragmatic and essential approach to It is pragmatic and essential approach to control of antibiotic resistance with control control of antibiotic resistance with control of antibiotic use.of antibiotic use.

Make every one a partner in prevention of Make every one a partner in prevention of Antibiotic resistance, and success will follow.Antibiotic resistance, and success will follow.

How to prove the SuccessHow to prove the Success

Prove your action plans with Prove your action plans with evidence based success outcomesevidence based success outcomes

Senior practioners should be role Senior practioners should be role modelsmodels

Prove how rationalism helps, saves Prove how rationalism helps, saves money, morbidity and mortality.money, morbidity and mortality.

Why Everyone worried Why Everyone worried about Antibiotic ( misuse ) about Antibiotic ( misuse )

Use.Use.

Drug resistance can reverse Medical progressDrug resistance can reverse Medical progress

The following diseases are already in the list of The following diseases are already in the list of attaining the drug resistance, and Medical attaining the drug resistance, and Medical profession will find difficult to cure in future.profession will find difficult to cure in future.

1. Tuberculosis1. Tuberculosis 2. Malaria2. Malaria 3. Sore throat and Ear Infections3. Sore throat and Ear Infections..

Best way to keep the Best way to keep the matters in Ordermatters in Order

Every Hospital should have a policy which is Every Hospital should have a policy which is practicable to their circumstances.practicable to their circumstances.

Rigid guidelines without coordination will lead to Rigid guidelines without coordination will lead to greater failuresgreater failures

The only way to keep Antimicrobial agents useful The only way to keep Antimicrobial agents useful is to use them appropriately and Judiciouslyis to use them appropriately and Judiciously

((Burke A.Cunha, MD,MACP Antimicrobial Therapy. Medical Clinics of Burke A.Cunha, MD,MACP Antimicrobial Therapy. Medical Clinics of North America NOV 2006)North America NOV 2006)

Working together creates Safe Working together creates Safe HospitalsHospitals

Created for Benefit of Medical Created for Benefit of Medical and paramedical personal in and paramedical personal in

Developing worldDeveloping world

Dr.T.V.Rao MDDr.T.V.Rao MD

Email ;Email ; [email protected]