15. “...... 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
36. Categories of acquired resistance
• Mutational
• Single drug
• Low level resistance
• Surpassable
Transferable
Often multiple drugs
High level resistance
Unsurpassable
48. Man vs Microbe : Are we lost ??
• We are not winning
• But let us not lose
• Let us not overuse antibiotics
49. Physician practices in antibiotic use
• 2/3 of outpatient antibiotic use is avoidable
• 40% inpatient antibiotic selection incorrect
• Costly antibiotics being overused
50. 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
51. 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
52. 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 !!
54. Preventing infections
• Universal precautions
• Hand washing
• Avoid non-essential lines and tubes
• Isolation of patients infected with muti-
drug resistant pathogens
55. Essential treatment
• Use the right antibiotic
• Avoid broad spectrum antibiotic
• Use the right dose
• Use for the right time