Working as an Infectious Diseases Clinical Pharmacy Specialist

Minimizing the Impact through Antimicrobial Stewardship

Antibiotic Resistance is a Public Health Crisis

At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy.

I will consider the welfare of humanity and relief of human suffering my primary concerns.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve.

I will keep abreast of developments and maintain professional competency in my profession of pharmacy.

I will maintain the highest principles of moral, ethical, and legal conduct.

I will embrace and advocate change in the profession of pharmacy that improves patient care.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

Mission: Protect, promote and advance the health and safety of our nation.◦ Rapid and effective response to public health needs

◦ Leadership and excellence in public health practices

◦ Advancement of public health science

Corps officers are involved in ◦ disease control and prevention

◦ biomedical research

◦ regulation of food and drugs

◦ mental health and drug abuse

◦ health care delivery

The origins of the Public Health Service are to be found with sailors and medical care.

July 16, 1798 – 5th Congress passed an Act, signed by President John Adams◦ “to provide for the accommodation of sick and disabled seamen.”

Today: more than 6,500 active-duty officers working to create a global world free of preventable disease, sickness, and suffering.◦ CDC

◦ NIH

◦ IHS

◦ NOAA

◦ FDA

◦ CMS

◦ BOP

General Biology

Botany

Cell Biology

Invertebrates

Parasitology

Virology

Microbiology

Immunology

Anatomy & Physiology

Pathophysiology

Genetics

IBM Austin TexasSport’s AuthorityBiology & Chemistry TutorDispute resolution & mediationImmunology Lab Technician

American Association of Colleges of Pharmacy (AACP.org)◦ Calculus, Statistics, Physics with lab◦ General biology with lab◦ Human anatomy & physiology◦ Microbiology with lab◦ Upper division bioliogy (ex Molecular)◦ General Chem with lab, organic chem with lab◦ Biochemistry◦ Reading & writing for college or equivalen◦ Public speaking◦ Liberal arts / Humanities◦ Economics◦ Human Behavior (social,behavioral, psych)

Sante Fe – Policy & advocacy

DC – AAIP

VA – ambulatory care

ID

Homeless Shelter

Clinics & volunteering with health fairs

Reservation

PIMC

Walgreen’s

IHS

Cardiovascular risk reduction

Retail Outpatient Consultant MTM Inpatient Midlevel Pharmaceutical

Industry Research Radiopharmacy Toxicology Academia

Clinical Pharmacy◦ HIV◦ ID◦ Diabetes◦ Cardiovascular◦ Oncology◦ Pediatrics◦ Psych◦ Home Health◦ Critical Care◦ Emergency

Travel Medicine

Broad-spectrum

Once daily

Oral and IV

Works by inhibiting

topoisomerase II, IV◦ Enzyme needed to

separate replicating

DNA

◦ Blocks cell division

Resistance◦ Efflux pumps

◦ Plasmid-mediated

resistance genes for

proteins that block

binding

◦ Mutations in DNA

gyrase

More than 2 million people are infected by drug-resistant germs each year

23,000 die of their infections The biggest killer is C. difficile Up to half the antibiotic Rx written are

unnecessary. These unneeded antibiotics are

making the superbug problem worse. There are not any new antibiotics

immediately in development that will kill these.

Older antibiotics with toxic side effects are the last line defense.

NBC NEWS Sept 16, 2013

MDR Acinetobacter

Drug-resistant Campylobacter

Fluconazole-resistant Candida

ESBLs

VRE

MDR Pseudomonas

Drug-resistant Non-typhoidal Salmonella

Drug-resistant Shigella

CRE

MRSA

VRSA

Drug-resistant Strep pneumoniae

Erythromycin-resistant Group A Strep

Clindamycin-resistant Group B Strep

Drug-resistant TB

Abx resistant TB

Mycobacterial efflux pump promotes intracellular survival and may mediate tolerance to antimicrobials

Verapamil – drug for heart disease

C3HeB/FeJ mice model of TB – lung lesions like humans◦ Infected with aerosol M. tuberculosis

◦ Given standard anti-TB treatment (RIPE) + Verapamil

◦ Lung colony-forming units progressively decreased and lower than standard treatment at 2, 4, 8, & 12 weeks

◦ All mice culture negative at 4 months with verapamil

◦ Lower 3-month relapse

J Respir Crit Care Med 2013 Sep 1

Treat infection not

colonization

Use the most effective

drug, dose with the

shortest duration

Minimize unnecessary

broad-spectrum

antibiotic exposure

Minimize the spread of

resistant bugs

Education

Guidelines

Daily monitoring

Restriction

Microbiology

interpretation

Rapid diagnostics

Thaddus D. Wilkerson, Pharm.D., BCPS

tdwilkerson@anthc.org

(907) 729-2155