dr. nuala o'connor, gp elmwood medical practice
DESCRIPTION
Tackling Antibiotic Resistance - The GP's roleTRANSCRIPT
Tackling Antibiotic Resistance -The GP’s Role
Why should all of you be worried ?
What can you do ?
DR Nuala O Connor ICGP Lead HCAI AMR Health Care Associated Infections and Antimicrobial Drug Resistance National Primary Care Conference Kilkenny November 2014
“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” BBC WORLD NEWS
“WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health” APRIL 2014
E.coli resistant to 3rd generation
Cephalosporins
2002 2012
Overall consumption of antibiotics is less/ use more narrow spectrum than broad spectrum
Antimicrobial resistance trends:Bloodstream infections in Ireland: 2002-2012
Data source: HPSC/EARS-Net
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pro
po
rtio
n r
esi
stan
ce
Year
Meticillin-Resistant Staph. aureus
Vancomycin-Resistant Enterococcus faecium
Penicillin-Resistant Strep. pneumoniae
Erythromycin-Resistant S. pneumoniae
Cephalosporin-Resistant E. coli
Quinolone-Resistant E. coli
Multiple-Resistant E. coli
4
25,ooo deaths from multi-drug resistant organisms each year in Europe
“SUPERBUGS “
HCAI from resistant bacteria-Difficult to treat, prolonged illness, hospital stays, risk of death
Why has this problem of Antibiotic resistance emerged?Multifactorial
Increasing complexity of healthcare
Ageing population
Concerns about ‘missing sepsis’
Overuse of broad spectrum agents
Failure to de-escalate from broad spectrum to narrow spectrum Not sending specimens to lab
Not acting on lab reports
Overly lengthy treatment courses
Lack of awareness about the issue of resistance among HCW
Lack of patients awareness about the issue of resistance
Patient compliance issues
Time pressure
Patient pressure
High antimicrobial use in veterinary sector
Lack of regulation of antimicrobial dispensing in some countries
Poor sanitation in developing world
How can general practioners help?What’s different about countries with low
rates AMR
• Overall consumption of antibiotics is less.
• Greece and Cyprus use 3 times more antibiotics per head of population than Netherlands
• Use more narrow spectrum Antibiotics than broad spectrum.
Primary Care Antibiotic Consumption Rates
Ireland DDD’sYear Rate2003 20.342004 20.192005 20.502006 21.092007 22.032008 21.002009 20.232010 19.752011 22.552012 22.802013 23.66
Primary Care Antibiotic Consumption Rates
80 % of antibiotics Community
Antimicrobial Use % Prevalence HALTIreland V Europe
If you are resident in an Irish nursing home, you are more than twice as likley to be on an antibiotic than in any other European Country
Majority prescribed within LTCF by GPs and directly-employed doctors
39% prophylaxis
Demystify Antibiotic Stewardship Ensuring you prescribe the right antibiotic for the patient in front of you at the right time with the right dose duration and route for the condition you are treating causing the least amount of harm to that patient and future patients
Every time we consider prescribing GP’s need to ask themselves …….
Is this antibiotic really necessary ?
If you decide to prescribe ask the following questions ?
What do I tend to prescribe for a particular condition?
Is it the right drug for this condition ?
Is it the right dose for the patient sitting in front of me ?
How long do I tend to prescribe it for?
What investigations, if any, do I use to support my decisions?
Do I know about the Irish primary care prescribing guidelines and am I using them?
Narrow versus broad-spectrum
GP’s need to think more scientifically – what are you treating ?
Penicillin V for strep throat Co amoxiclav for strep throat
Nausea vomiting , diarrhoea ,rashes Toxicity from prolonged use – nitrofurantoin for UTI
prophylaxis and pneumotoxicity Toxicity from idiosyncratic reactions –liver failure with co
amoxiclav Toxicity when dose not reduced or incorrect antibiotic
used for patients with chronic kidney disease Interaction with other medicines – statins and macrolides C. diff overgrowth leading to serious infection after few
doses of antibiotic Serious Allergic reactions
Am I keeping my patients Safe from Antibiotic Side-effects
Every time we consider prescribing GP’s need to ask themselves …….
Have I consulted the antibiotic guidelines recently? www.antibioticprescribing.ie
16
1. Community Resistance Data Tool
2.Antibiotic prescriber feedback
mechanism for all Patients
Gp owns the Data -used for Quality
Improvement
Collaboration between iPCRN, ICGP,
Primary Care Directorate, Patient
Quality and Safety , HCAI AMR
Clinical Care Programme
Improve patient care
Audit requirements for medical
council
talk to your GP or pharmacist or visit www.hse.ie
Taking antibioticsfor colds and flu?
There’s no point.
A cold or flu is caused by avirus and antibiotics do notwork on viruses.
Public Antibiotic Awareness CampaignExplain why we need to need to preserve this
precious resource
Antibiotics can kill bacteria. They have no effect on viruses
such as head cold, flu, chickenpox. They will not reduce a fever They will not relieve pain. Rest, fluids and TLC important
part of recovery from all infections.
Do they know how to take them correctly?
What to look for
What can you do ?
When to seek help ?
www.underthweather.ie
Things you can do now to help reduce Antimicrobial Drug resistance
Do not prescribe antibiotics unless there is a definite clinical indication to do so
Prescribe first line recommended antimicrobials – 5 antibiotics
Co-amoxiclav is not a first-line drug for the common conditions encountered in General Practice
Prescribe phenoxymethylpenecillinfor tonsillitis unless the patient is truly allergic to penicillin.
Restrict macrolides to patient with true penicillin allergy or definite clinical indication e.g mycoplasma
Review any patients in LTCF on prophylactic treatment for UTI
Develop simple antibiotic prescribing policy for your practice and for nursing home residents based on www.antibioticprescribing.ie
Possible idea for audit requirement's 2014/2015 cycle
Mutltifactorial
Global Strageties
National Strageties
Healthcare workers
Professional Respsonsibility
Public recognise they role they
must play
Stop the spread of infections Promote immunisation Encourage appropriate use of antibiotics in humans and agriculture Support development of new antimicrobial agents WHAT CAN WE DO ?
Some signs of improvement 2014
Community Antibiotic Consumption first half 2014 Use of co amoxiclav
Keeping Antibiotics Safe And Effective For Future Generations …
Dept of Health
HSE
Pharmacists
Surgeons
Dept of Agriculture
gp
Vets
Patients
Physicians
..it’s everyone's
responsibility