SlideShare a Scribd company logo
1 of 57
Download to read offline
Antibiotics : Use and overuse
KM Murali
MD (Med), DM (Neph), DNB (Neph), F Neph (Canada)
Consultant Nephrologist
MIMS, Kozhikode
First world war
Second world war
Cold war
Man
vs
Microbe
Timeless war
Spread of “jewish poison”
Antibiotics use and overuse
Antibiotics use and overuse
Anton V Leeuwenhock : “animalcules”
1674 AD
Louis Pasteur: “germ theory of disease”
1857
1822 - 1895
Gram Staining
Gram Positive
Staphylococci
Coagulase + ve
Coagulase - ve
Streptococci
Enterococci
Gram +ve bacilli
Gram +ve anaerobes
Gram Positive Gram Negative
Enterobacteriaceae
Eschericiae
Klebsiellae Proteaceae
Pseudomonas
Vibrio
Hemophilus
Others
Gram Staining
Staphylococci
Coagulase + ve
Coagulase - ve
Streptococci
Enterococci
Gram +ve bacilli
Gram +ve anaerobes
Antibiotics use and overuse
The “antibiotic surge”
• Penicillin 1941
• Streptomycin 1944
• Tetracycline 1948
• Erythromycin 1952
• Vancomycin 1958
• Methicillin 1959
• Gentamicin 1962
“...... It’s time to close the book on infectious
diseases, the war against pestilence is over”
William Stewart, Surgeon General
Message to US Congress, 1969
Antibacterial weaponry
Penicillins Fluoroquinolones
Cephalosporins Macrolides
Monobactams Sulfonamides
Carbopenams Streptogramins
Aminoglycosides Oxazolidinediones
Glycopeptides Others
+
DNA
DNA-RNA polymerase
Cell wall
Cell membrane
Protein synthesis
Folate synthesis
PABA
DHFA
THFA
Penicillin and beta-lactam ring
• The prototype Penicillin G
• Acid resistant Penicillin V
• Penicillinase resistant Methicillin, Oxacillin
• “Broad Spectrum” Amoxicillin, Ampicillin
• “Antipseudomonas” Azlocillin, piperacillin
• Combinations Augmentin, Timentin
• (+ β-lactamase inhibitor)
The big penicillin family
Penicillin vs Cephalosporin
Penicillin vs Cephalosporin vs Carbapenams
Penicillin vs Aztreonam
Penicillin vs Vancomycin
Antibiotics use and overuse
Antibiotics use and overuse
Antibiotics use and overuse
Antibiotics use and overuse
“Excessive use of penicillin
can lead to its resistance”
- Sir Alexander Fleming (1941)
Preliminary reports of resistance
• Penicillin 1941  1942
• Streptomycin 1944  1946
• Tetracycline 1948  1952
• Erythromycin 1952  1955
• Vancomycin 1958  1990
• Methicillin 1959  1968
• Gentamicin 1962  1975
• Ciprofloxacin 1988  1989
Staphylococcus aureus PCN resistance
0
5
10
15
20
25
30
1990 1992 1994 1996 1998 2000
Year
Non ICU
ICU
Enterococcus Vancomycin resistance
0
5
10
15
20
25
30
35
40
OverallPercentResistance
PCN ERY CLINDA TET TMP-SMX
1994-1995
1997-1998
1999-2000
Streptococcus antibiotic resistance
RESISTANCE : Survival of the fittest
Revertant
Resistant
Compensatory
mutations
Passages
Antibiotics use and overuse
Categories of resistance
Acquired
Staphylococci
Streptococci
Gram –ve cocci
Enterobacteriaceae
Intrinsic
Pseudomonas
Enterococci
Categories of acquired resistance
• Mutational
• Single drug
• Low level resistance
• Surpassable
Transferable
Often multiple drugs
High level resistance
Unsurpassable
• Enzymatic inactivation of drug
Biochemical basis of drug resistance
Beta – lactamase opens penicillin ring
Beta - lactamase
Penicillinase
Oxacilinase
Cephalosporinase
Carbenicilinase
Carbapenamase
ESBL
Beta – lactamase inhibitors
• Flucloxacillin
• Clavulanate
• Sulbactam
• Tazobactam
• Enzymatic inactivation of drug
• Alteration of drug target
Biochemical basis of drug resistance
• Penicillin binding proteins (PBPs)
– Streptococcus pneumoniae (penicillin)
– Staphylococcus aureus (MRSA, nafcillin; mecA gene)
• Ribosomal binding site (23S rRNA)
– Streptococcus pneumoniae, Helicobacter pylori (macrolides)
• DNA gyrase
– Gram negative bacteria (quinolones)
• Cell wall precursor targets
– Vancomycin resistant enterococci (VRE)
Alteration of Drug Target
Vancomycin resistance in enterococcus
• Enzymatic inactivation of drug
• Alteration of drug target
• Changes in drug uptake or efflux
Biochemical basis of drug resistance
The toughest enemy: Pseudomonas
Pseudomonas: Efflux pump
Conspiracy: Sharing of intelligence
Pseudomonas
Enterobacteriacea
Campylobacter
Staphylococci
Enterococci
Streptococci
Man vs Microbe : Are we lost ??
• We are not winning
• But let us not lose
• Let us not overuse antibiotics
Physician practices in antibiotic use
• 2/3 of outpatient antibiotic use is avoidable
• 40% inpatient antibiotic selection incorrect
• Costly antibiotics being overused
Ground realities in Indian scenario
• Poor awareness about sample collection
• Poor microbiological infrastructure
• Low yield of blood culture
• Low yield of anaerobic bacteriae
• Lack of faith in laboratory reports
EMPIRICAL ANTIBIOTIC THERAPY
IS DIRECTED AGAINST THE MOST
PROBABLE PATHOGEN……………..
NOT AGAINST ALL PATHOGENS !!!
BUT THEN CULTURES SHOULD FOLLOW
Empirical initiation of therapy
Empirical completion of therapy
ICU Antibiotic cocktail
• One for gram positive
• One for gram negative
• One for anaerobe
• One for ‘atypical’
• One for the master and one for the dame !!
Practical solutions
• Prevention of infection
• Give only essential treatment
• Monitoring policies
Preventing infections
• Universal precautions
• Hand washing
• Avoid non-essential lines and tubes
• Isolation of patients infected with muti-
drug resistant pathogens
Essential treatment
• Use the right antibiotic
• Avoid broad spectrum antibiotic
• Use the right dose
• Use for the right time
Monitoring policies
• Infection control surveillance
• Bacteriological surveillance
• Prescription surveillance
Thank you

More Related Content

What's hot

ANTIBIOTIC RESISTANCE
ANTIBIOTIC RESISTANCEANTIBIOTIC RESISTANCE
ANTIBIOTIC RESISTANCERashidKwdr2
 
Antibiotic resistance I Mechanism I Types I Contributing factors.
Antibiotic resistance I Mechanism I Types I Contributing factors.Antibiotic resistance I Mechanism I Types I Contributing factors.
Antibiotic resistance I Mechanism I Types I Contributing factors.kausarneha
 
Antimicrobial resistance
Antimicrobial resistanceAntimicrobial resistance
Antimicrobial resistanceszahir2018
 
0VERVIEW OF ANTIBIOTIC RESISTANCE 111.pptx
0VERVIEW OF ANTIBIOTIC RESISTANCE 111.pptx0VERVIEW OF ANTIBIOTIC RESISTANCE 111.pptx
0VERVIEW OF ANTIBIOTIC RESISTANCE 111.pptxKrishnaSupalkar
 
Antimicrobial resistance
Antimicrobial resistanceAntimicrobial resistance
Antimicrobial resistance-
 
Antibiotic resistance
Antibiotic resistanceAntibiotic resistance
Antibiotic resistancesuhailk11
 
Misuse of Antibiotic | Antibiotics helpful or harmful ?
Misuse of Antibiotic | Antibiotics helpful or harmful ? Misuse of Antibiotic | Antibiotics helpful or harmful ?
Misuse of Antibiotic | Antibiotics helpful or harmful ? Dr. Rajat Sachdeva
 
Antibiotic resistance mechanisms
Antibiotic resistance mechanismsAntibiotic resistance mechanisms
Antibiotic resistance mechanismsdrakmane
 
Overuse & Misuse of Antibiotics
Overuse & Misuse of AntibioticsOveruse & Misuse of Antibiotics
Overuse & Misuse of AntibioticsDr. Rajat Sachdeva
 
General Principles of Antimicrobial Selection - 2018
General Principles of Antimicrobial Selection - 2018General Principles of Antimicrobial Selection - 2018
General Principles of Antimicrobial Selection - 2018Arwa M. Amin
 
Antimicrobial resistance
Antimicrobial resistanceAntimicrobial resistance
Antimicrobial resistanceNAIF AL SAGLAN
 
Molecular mechanisms of antimicrobial resistance in bacteria
Molecular mechanisms of antimicrobial resistance in bacteria Molecular mechanisms of antimicrobial resistance in bacteria
Molecular mechanisms of antimicrobial resistance in bacteria Jobir Nadhi
 

What's hot (20)

ANTIBIOTIC RESISTANCE
ANTIBIOTIC RESISTANCEANTIBIOTIC RESISTANCE
ANTIBIOTIC RESISTANCE
 
Antibiotics Resistance
Antibiotics ResistanceAntibiotics Resistance
Antibiotics Resistance
 
Antibiotic resistance I Mechanism I Types I Contributing factors.
Antibiotic resistance I Mechanism I Types I Contributing factors.Antibiotic resistance I Mechanism I Types I Contributing factors.
Antibiotic resistance I Mechanism I Types I Contributing factors.
 
Antimicrobial resistance
Antimicrobial resistanceAntimicrobial resistance
Antimicrobial resistance
 
0VERVIEW OF ANTIBIOTIC RESISTANCE 111.pptx
0VERVIEW OF ANTIBIOTIC RESISTANCE 111.pptx0VERVIEW OF ANTIBIOTIC RESISTANCE 111.pptx
0VERVIEW OF ANTIBIOTIC RESISTANCE 111.pptx
 
Antibiotic resistance
Antibiotic resistanceAntibiotic resistance
Antibiotic resistance
 
Antimicrobial resistance
Antimicrobial resistanceAntimicrobial resistance
Antimicrobial resistance
 
Antibiotic resistance
Antibiotic resistanceAntibiotic resistance
Antibiotic resistance
 
Antibiotics resistance lecture
Antibiotics resistance lectureAntibiotics resistance lecture
Antibiotics resistance lecture
 
Antimicrobials
AntimicrobialsAntimicrobials
Antimicrobials
 
Misuse of Antibiotic | Antibiotics helpful or harmful ?
Misuse of Antibiotic | Antibiotics helpful or harmful ? Misuse of Antibiotic | Antibiotics helpful or harmful ?
Misuse of Antibiotic | Antibiotics helpful or harmful ?
 
Antibiotic resistance mechanisms
Antibiotic resistance mechanismsAntibiotic resistance mechanisms
Antibiotic resistance mechanisms
 
Overuse & Misuse of Antibiotics
Overuse & Misuse of AntibioticsOveruse & Misuse of Antibiotics
Overuse & Misuse of Antibiotics
 
General Principles of Antimicrobial Selection - 2018
General Principles of Antimicrobial Selection - 2018General Principles of Antimicrobial Selection - 2018
General Principles of Antimicrobial Selection - 2018
 
Antimicrobial resistance
Antimicrobial resistanceAntimicrobial resistance
Antimicrobial resistance
 
Antibiotics
Antibiotics Antibiotics
Antibiotics
 
Antibiotic resistance
Antibiotic resistanceAntibiotic resistance
Antibiotic resistance
 
Molecular mechanisms of antimicrobial resistance in bacteria
Molecular mechanisms of antimicrobial resistance in bacteria Molecular mechanisms of antimicrobial resistance in bacteria
Molecular mechanisms of antimicrobial resistance in bacteria
 
Antibiotic resistance
Antibiotic resistanceAntibiotic resistance
Antibiotic resistance
 
WHY WE MISUSE ANTIBIOTICS
WHY WE MISUSE ANTIBIOTICS WHY WE MISUSE ANTIBIOTICS
WHY WE MISUSE ANTIBIOTICS
 

Similar to Antibiotics use and overuse

Molecular Epidemiology of Mycobacterium tuberculosis-Barry Kreiswirth PhD
Molecular Epidemiology of Mycobacterium tuberculosis-Barry Kreiswirth PhDMolecular Epidemiology of Mycobacterium tuberculosis-Barry Kreiswirth PhD
Molecular Epidemiology of Mycobacterium tuberculosis-Barry Kreiswirth PhDEastern Pennsylvania Branch ASM
 
Pharmacology of Antibiotics
Pharmacology of  AntibioticsPharmacology of  Antibiotics
Pharmacology of AntibioticsAmr Rafat
 
antibiotic principles.ppt
antibiotic principles.pptantibiotic principles.ppt
antibiotic principles.pptJigar Mehta
 
ANTIMICROBIAL RESISTANCE
ANTIMICROBIAL RESISTANCEANTIMICROBIAL RESISTANCE
ANTIMICROBIAL RESISTANCEKushal Saha
 
Antibiotic resistance a global concern part ii
Antibiotic resistance  a global concern part iiAntibiotic resistance  a global concern part ii
Antibiotic resistance a global concern part iiRohan Jagdale
 
Dr. Shelley Rankin - One Health Antibiotic Stewardship State of Science - Wha...
Dr. Shelley Rankin - One Health Antibiotic Stewardship State of Science - Wha...Dr. Shelley Rankin - One Health Antibiotic Stewardship State of Science - Wha...
Dr. Shelley Rankin - One Health Antibiotic Stewardship State of Science - Wha...John Blue
 
Princeton presentation
Princeton presentationPrinceton presentation
Princeton presentationLauren Cowley
 
Antibiotic resistance dr sachin
Antibiotic resistance dr sachinAntibiotic resistance dr sachin
Antibiotic resistance dr sachinSachin Verma
 
Antibiotics DR. JAMA chep 1.pptx
Antibiotics DR. JAMA chep 1.pptxAntibiotics DR. JAMA chep 1.pptx
Antibiotics DR. JAMA chep 1.pptxNadiirMahamoud
 
Antimicrobial Drugs_Genaral consideartions.pptx
Antimicrobial Drugs_Genaral consideartions.pptxAntimicrobial Drugs_Genaral consideartions.pptx
Antimicrobial Drugs_Genaral consideartions.pptxsapnabohra2
 
Superbug selection and associated clinical and non clinical
Superbug selection and associated clinical and non clinicalSuperbug selection and associated clinical and non clinical
Superbug selection and associated clinical and non clinicalKarthik Kumaragurubaran
 
Antibiotics in oral and maxillofacial surgery
Antibiotics in oral and maxillofacial surgeryAntibiotics in oral and maxillofacial surgery
Antibiotics in oral and maxillofacial surgeryFiras Kassab
 
Drugs against bugs - antibiotics in the ICU
Drugs against bugs - antibiotics in the ICUDrugs against bugs - antibiotics in the ICU
Drugs against bugs - antibiotics in the ICUAndrew Ferguson
 
Clinical Mycology U F Medical Students 12 05 07 Final2
Clinical Mycology  U F Medical Students 12 05 07 Final2Clinical Mycology  U F Medical Students 12 05 07 Final2
Clinical Mycology U F Medical Students 12 05 07 Final2raj kumar
 
Introduction to Microbiology.pptx
Introduction to Microbiology.pptxIntroduction to Microbiology.pptx
Introduction to Microbiology.pptxssuser504dda
 

Similar to Antibiotics use and overuse (20)

antibiotic resistance
antibiotic resistance antibiotic resistance
antibiotic resistance
 
Molecular Epidemiology of Mycobacterium tuberculosis-Barry Kreiswirth PhD
Molecular Epidemiology of Mycobacterium tuberculosis-Barry Kreiswirth PhDMolecular Epidemiology of Mycobacterium tuberculosis-Barry Kreiswirth PhD
Molecular Epidemiology of Mycobacterium tuberculosis-Barry Kreiswirth PhD
 
Pharmacology of Antibiotics
Pharmacology of  AntibioticsPharmacology of  Antibiotics
Pharmacology of Antibiotics
 
antibiotic principles.ppt
antibiotic principles.pptantibiotic principles.ppt
antibiotic principles.ppt
 
ANTIMICROBIAL RESISTANCE
ANTIMICROBIAL RESISTANCEANTIMICROBIAL RESISTANCE
ANTIMICROBIAL RESISTANCE
 
Antibiotic resistance a global concern part ii
Antibiotic resistance  a global concern part iiAntibiotic resistance  a global concern part ii
Antibiotic resistance a global concern part ii
 
Dr. Shelley Rankin - One Health Antibiotic Stewardship State of Science - Wha...
Dr. Shelley Rankin - One Health Antibiotic Stewardship State of Science - Wha...Dr. Shelley Rankin - One Health Antibiotic Stewardship State of Science - Wha...
Dr. Shelley Rankin - One Health Antibiotic Stewardship State of Science - Wha...
 
Princeton presentation
Princeton presentationPrinceton presentation
Princeton presentation
 
Antibiotic resistance dr sachin
Antibiotic resistance dr sachinAntibiotic resistance dr sachin
Antibiotic resistance dr sachin
 
Antibiotics DR. JAMA chep 1.pptx
Antibiotics DR. JAMA chep 1.pptxAntibiotics DR. JAMA chep 1.pptx
Antibiotics DR. JAMA chep 1.pptx
 
Antimicrobial Drugs_Genaral consideartions.pptx
Antimicrobial Drugs_Genaral consideartions.pptxAntimicrobial Drugs_Genaral consideartions.pptx
Antimicrobial Drugs_Genaral consideartions.pptx
 
Superbug selection and associated clinical and non clinical
Superbug selection and associated clinical and non clinicalSuperbug selection and associated clinical and non clinical
Superbug selection and associated clinical and non clinical
 
Drugs Used in infectious Disease_Antibiotics
Drugs Used in infectious Disease_AntibioticsDrugs Used in infectious Disease_Antibiotics
Drugs Used in infectious Disease_Antibiotics
 
Anibiotics_.ppt
Anibiotics_.pptAnibiotics_.ppt
Anibiotics_.ppt
 
Malarial Drug
Malarial DrugMalarial Drug
Malarial Drug
 
Antibiotics in oral and maxillofacial surgery
Antibiotics in oral and maxillofacial surgeryAntibiotics in oral and maxillofacial surgery
Antibiotics in oral and maxillofacial surgery
 
Drugs against bugs - antibiotics in the ICU
Drugs against bugs - antibiotics in the ICUDrugs against bugs - antibiotics in the ICU
Drugs against bugs - antibiotics in the ICU
 
Clinical Mycology U F Medical Students 12 05 07 Final2
Clinical Mycology  U F Medical Students 12 05 07 Final2Clinical Mycology  U F Medical Students 12 05 07 Final2
Clinical Mycology U F Medical Students 12 05 07 Final2
 
Introduction to Microbiology.pptx
Introduction to Microbiology.pptxIntroduction to Microbiology.pptx
Introduction to Microbiology.pptx
 
Antibacterial agents jp
Antibacterial agents jpAntibacterial agents jp
Antibacterial agents jp
 

More from Chandan N

Universal & transmission precaution
Universal & transmission precautionUniversal & transmission precaution
Universal & transmission precautionChandan N
 
Coronory angiography
Coronory angiographyCoronory angiography
Coronory angiographyChandan N
 
Anasthesia during cpb
Anasthesia during cpbAnasthesia during cpb
Anasthesia during cpbChandan N
 
Reducing stroke in AF
Reducing stroke in AFReducing stroke in AF
Reducing stroke in AFChandan N
 
Antiplatelet and arterial thrombosis
Antiplatelet and arterial thrombosisAntiplatelet and arterial thrombosis
Antiplatelet and arterial thrombosisChandan N
 
Anticoagulant in DVT and APE
Anticoagulant in DVT and APEAnticoagulant in DVT and APE
Anticoagulant in DVT and APEChandan N
 
Renal failure
Renal failureRenal failure
Renal failureChandan N
 
Non hodgkins lymphoma
Non hodgkins lymphomaNon hodgkins lymphoma
Non hodgkins lymphomaChandan N
 
Non hodgkins lymphoma
Non hodgkins lymphomaNon hodgkins lymphoma
Non hodgkins lymphomaChandan N
 
Final housestaff opportunistic infections lecture
Final housestaff opportunistic infections lectureFinal housestaff opportunistic infections lecture
Final housestaff opportunistic infections lectureChandan N
 
Diabetes in pregnancy
Diabetes in pregnancyDiabetes in pregnancy
Diabetes in pregnancyChandan N
 
Control and prevention_of_influenza
Control and prevention_of_influenzaControl and prevention_of_influenza
Control and prevention_of_influenzaChandan N
 
Chronic renal failure
Chronic renal failureChronic renal failure
Chronic renal failureChandan N
 
Advances in hiv treatment
Advances in hiv treatmentAdvances in hiv treatment
Advances in hiv treatmentChandan N
 
Acute renal failure
Acute renal failureAcute renal failure
Acute renal failureChandan N
 
Abnormal puerperium
Abnormal puerperiumAbnormal puerperium
Abnormal puerperiumChandan N
 

More from Chandan N (20)

Universal & transmission precaution
Universal & transmission precautionUniversal & transmission precaution
Universal & transmission precaution
 
Coronory angiography
Coronory angiographyCoronory angiography
Coronory angiography
 
Anasthesia during cpb
Anasthesia during cpbAnasthesia during cpb
Anasthesia during cpb
 
Reducing stroke in AF
Reducing stroke in AFReducing stroke in AF
Reducing stroke in AF
 
Antiplatelet and arterial thrombosis
Antiplatelet and arterial thrombosisAntiplatelet and arterial thrombosis
Antiplatelet and arterial thrombosis
 
Anticoagulant in DVT and APE
Anticoagulant in DVT and APEAnticoagulant in DVT and APE
Anticoagulant in DVT and APE
 
Acute mi
Acute miAcute mi
Acute mi
 
Renal failure
Renal failureRenal failure
Renal failure
 
Nutrition
NutritionNutrition
Nutrition
 
Non hodgkins lymphoma
Non hodgkins lymphomaNon hodgkins lymphoma
Non hodgkins lymphoma
 
Non hodgkins lymphoma
Non hodgkins lymphomaNon hodgkins lymphoma
Non hodgkins lymphoma
 
ckd
ckdckd
ckd
 
Nhl
NhlNhl
Nhl
 
Final housestaff opportunistic infections lecture
Final housestaff opportunistic infections lectureFinal housestaff opportunistic infections lecture
Final housestaff opportunistic infections lecture
 
Diabetes in pregnancy
Diabetes in pregnancyDiabetes in pregnancy
Diabetes in pregnancy
 
Control and prevention_of_influenza
Control and prevention_of_influenzaControl and prevention_of_influenza
Control and prevention_of_influenza
 
Chronic renal failure
Chronic renal failureChronic renal failure
Chronic renal failure
 
Advances in hiv treatment
Advances in hiv treatmentAdvances in hiv treatment
Advances in hiv treatment
 
Acute renal failure
Acute renal failureAcute renal failure
Acute renal failure
 
Abnormal puerperium
Abnormal puerperiumAbnormal puerperium
Abnormal puerperium
 

Recently uploaded

Explaining "pathology" in digital pathology
Explaining "pathology" in digital pathologyExplaining "pathology" in digital pathology
Explaining "pathology" in digital pathologyYves Sucaet
 
Ayurveda research in Hypothyroidism, P
Ayurveda  research  in Hypothyroidism, PAyurveda  research  in Hypothyroidism, P
Ayurveda research in Hypothyroidism, PDr.Shalu Jain
 
HERPES SIMPLEX VIRUS 12032019 TUESDAY pptx
HERPES SIMPLEX VIRUS 12032019 TUESDAY  pptxHERPES SIMPLEX VIRUS 12032019 TUESDAY  pptx
HERPES SIMPLEX VIRUS 12032019 TUESDAY pptxPulkitMittal54
 
Neurological Evaluation of Acute Ischemic stroke in Emergency Room
Neurological Evaluation of Acute Ischemic stroke in Emergency RoomNeurological Evaluation of Acute Ischemic stroke in Emergency Room
Neurological Evaluation of Acute Ischemic stroke in Emergency RoomSudhir Kumar
 
Substance use disorder (drug addict ), Addiction
Substance use disorder (drug addict ), AddictionSubstance use disorder (drug addict ), Addiction
Substance use disorder (drug addict ), AddictionZeinabEmad3
 
SGK VIÊM KHỚP DẠNG THẤP YHN .pdf
SGK VIÊM KHỚP DẠNG THẤP YHN              .pdfSGK VIÊM KHỚP DẠNG THẤP YHN              .pdf
SGK VIÊM KHỚP DẠNG THẤP YHN .pdfHongBiThi1
 
Thyroid function tests for MBBS, LAB. MED & BDS.pptx
Thyroid function tests for MBBS, LAB. MED & BDS.pptxThyroid function tests for MBBS, LAB. MED & BDS.pptx
Thyroid function tests for MBBS, LAB. MED & BDS.pptxRajendra Dev Bhatt
 
clean rooms and its classification .pptx
clean rooms and its classification .pptxclean rooms and its classification .pptx
clean rooms and its classification .pptxushakiranmai4
 
Routine Medicine Laboratory Testing _ CÁC XÉT NGHIỆM THƯỜNG QUY ÁP DỤNG TRON...
Routine Medicine Laboratory Testing  _ CÁC XÉT NGHIỆM THƯỜNG QUY ÁP DỤNG TRON...Routine Medicine Laboratory Testing  _ CÁC XÉT NGHIỆM THƯỜNG QUY ÁP DỤNG TRON...
Routine Medicine Laboratory Testing _ CÁC XÉT NGHIỆM THƯỜNG QUY ÁP DỤNG TRON...DUY NGUYEN PHUC
 
Laryngeal papillomatosis .pdf ENT BY QUICKMEDTALK
Laryngeal papillomatosis .pdf ENT BY QUICKMEDTALKLaryngeal papillomatosis .pdf ENT BY QUICKMEDTALK
Laryngeal papillomatosis .pdf ENT BY QUICKMEDTALKQuick MedTalk
 
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptxANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptxsiddharthroy26587
 
Derma Pharmaceutical Franchise Company - Solace Biotech Limited
Derma Pharmaceutical Franchise Company - Solace Biotech LimitedDerma Pharmaceutical Franchise Company - Solace Biotech Limited
Derma Pharmaceutical Franchise Company - Solace Biotech LimitedSBL DIGITAL
 
NECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptx
NECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptxNECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptx
NECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptxSizan Thapa
 
Brief introduction to information ecosystem x public health.pptx
Brief introduction to information ecosystem x public health.pptxBrief introduction to information ecosystem x public health.pptx
Brief introduction to information ecosystem x public health.pptxTina Purnat
 
Ovarian tumors Lecture notes for MBBS.pptx
Ovarian tumors Lecture notes for MBBS.pptxOvarian tumors Lecture notes for MBBS.pptx
Ovarian tumors Lecture notes for MBBS.pptxSizan Thapa
 
bleeding disorders 1 Dr.Nannika Pradhan
bleeding disorders 1  Dr.Nannika Pradhanbleeding disorders 1  Dr.Nannika Pradhan
bleeding disorders 1 Dr.Nannika Pradhanthesalberry
 
(IDE)and(IVD),QMS,21 CFR part820 , 801)
(IDE)and(IVD),QMS,21 CFR part820  , 801)(IDE)and(IVD),QMS,21 CFR part820  , 801)
(IDE)and(IVD),QMS,21 CFR part820 , 801)chahattyagi200
 
Basic of Thyroid Hormone:- An In-depth Analysis
Basic of Thyroid Hormone:- An In-depth AnalysisBasic of Thyroid Hormone:- An In-depth Analysis
Basic of Thyroid Hormone:- An In-depth AnalysisAshishMaletha2
 
Ortho Products Franchise-solace biotech limited
Ortho Products Franchise-solace biotech limitedOrtho Products Franchise-solace biotech limited
Ortho Products Franchise-solace biotech limitedSBL DIGITAL
 
TARGET DELINEATION IN RECTUM CANCER BY DR KANHU
TARGET DELINEATION IN RECTUM  CANCER BY DR KANHUTARGET DELINEATION IN RECTUM  CANCER BY DR KANHU
TARGET DELINEATION IN RECTUM CANCER BY DR KANHUKanhu Charan
 

Recently uploaded (20)

Explaining "pathology" in digital pathology
Explaining "pathology" in digital pathologyExplaining "pathology" in digital pathology
Explaining "pathology" in digital pathology
 
Ayurveda research in Hypothyroidism, P
Ayurveda  research  in Hypothyroidism, PAyurveda  research  in Hypothyroidism, P
Ayurveda research in Hypothyroidism, P
 
HERPES SIMPLEX VIRUS 12032019 TUESDAY pptx
HERPES SIMPLEX VIRUS 12032019 TUESDAY  pptxHERPES SIMPLEX VIRUS 12032019 TUESDAY  pptx
HERPES SIMPLEX VIRUS 12032019 TUESDAY pptx
 
Neurological Evaluation of Acute Ischemic stroke in Emergency Room
Neurological Evaluation of Acute Ischemic stroke in Emergency RoomNeurological Evaluation of Acute Ischemic stroke in Emergency Room
Neurological Evaluation of Acute Ischemic stroke in Emergency Room
 
Substance use disorder (drug addict ), Addiction
Substance use disorder (drug addict ), AddictionSubstance use disorder (drug addict ), Addiction
Substance use disorder (drug addict ), Addiction
 
SGK VIÊM KHỚP DẠNG THẤP YHN .pdf
SGK VIÊM KHỚP DẠNG THẤP YHN              .pdfSGK VIÊM KHỚP DẠNG THẤP YHN              .pdf
SGK VIÊM KHỚP DẠNG THẤP YHN .pdf
 
Thyroid function tests for MBBS, LAB. MED & BDS.pptx
Thyroid function tests for MBBS, LAB. MED & BDS.pptxThyroid function tests for MBBS, LAB. MED & BDS.pptx
Thyroid function tests for MBBS, LAB. MED & BDS.pptx
 
clean rooms and its classification .pptx
clean rooms and its classification .pptxclean rooms and its classification .pptx
clean rooms and its classification .pptx
 
Routine Medicine Laboratory Testing _ CÁC XÉT NGHIỆM THƯỜNG QUY ÁP DỤNG TRON...
Routine Medicine Laboratory Testing  _ CÁC XÉT NGHIỆM THƯỜNG QUY ÁP DỤNG TRON...Routine Medicine Laboratory Testing  _ CÁC XÉT NGHIỆM THƯỜNG QUY ÁP DỤNG TRON...
Routine Medicine Laboratory Testing _ CÁC XÉT NGHIỆM THƯỜNG QUY ÁP DỤNG TRON...
 
Laryngeal papillomatosis .pdf ENT BY QUICKMEDTALK
Laryngeal papillomatosis .pdf ENT BY QUICKMEDTALKLaryngeal papillomatosis .pdf ENT BY QUICKMEDTALK
Laryngeal papillomatosis .pdf ENT BY QUICKMEDTALK
 
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptxANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
 
Derma Pharmaceutical Franchise Company - Solace Biotech Limited
Derma Pharmaceutical Franchise Company - Solace Biotech LimitedDerma Pharmaceutical Franchise Company - Solace Biotech Limited
Derma Pharmaceutical Franchise Company - Solace Biotech Limited
 
NECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptx
NECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptxNECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptx
NECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptx
 
Brief introduction to information ecosystem x public health.pptx
Brief introduction to information ecosystem x public health.pptxBrief introduction to information ecosystem x public health.pptx
Brief introduction to information ecosystem x public health.pptx
 
Ovarian tumors Lecture notes for MBBS.pptx
Ovarian tumors Lecture notes for MBBS.pptxOvarian tumors Lecture notes for MBBS.pptx
Ovarian tumors Lecture notes for MBBS.pptx
 
bleeding disorders 1 Dr.Nannika Pradhan
bleeding disorders 1  Dr.Nannika Pradhanbleeding disorders 1  Dr.Nannika Pradhan
bleeding disorders 1 Dr.Nannika Pradhan
 
(IDE)and(IVD),QMS,21 CFR part820 , 801)
(IDE)and(IVD),QMS,21 CFR part820  , 801)(IDE)and(IVD),QMS,21 CFR part820  , 801)
(IDE)and(IVD),QMS,21 CFR part820 , 801)
 
Basic of Thyroid Hormone:- An In-depth Analysis
Basic of Thyroid Hormone:- An In-depth AnalysisBasic of Thyroid Hormone:- An In-depth Analysis
Basic of Thyroid Hormone:- An In-depth Analysis
 
Ortho Products Franchise-solace biotech limited
Ortho Products Franchise-solace biotech limitedOrtho Products Franchise-solace biotech limited
Ortho Products Franchise-solace biotech limited
 
TARGET DELINEATION IN RECTUM CANCER BY DR KANHU
TARGET DELINEATION IN RECTUM  CANCER BY DR KANHUTARGET DELINEATION IN RECTUM  CANCER BY DR KANHU
TARGET DELINEATION IN RECTUM CANCER BY DR KANHU
 

Antibiotics use and overuse