Antibiotic Policy
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    Antibiotic Policy Antibiotic Policy Presentation Transcript

    • Antibiotic Policy in Medical Care Dr.T.V.Rao MD
    • Discovery Of Penicillin changes the History of Medicine
    • Why we Need Antibiotics
      • Nearly One half of the Hospitalized patients receive antimicrobial agents.
      • Antibiotics are valuable Discoveries of the Modern Medicine.
      • All current achievements in Medicine are attributed to use of Antibiotics
      • Life saving in Serious infections.
    • What went wrong with Antibiotic Usage
      • Treating trivial infections / viral Infections with Antibiotics has become routine affair.
      • Many use Antibiotics without knowing the Basic principles of Antibiotic therapy.
      • Many Medical practioners are under pressure for short term solutions.
      • Commercial interests of Pharmaceutical industry pushing the Antibiotics, more so Broad spectrum and Newer Generation antibiotics. as every Industry has become profit oriented.
      • Poverty encourages drug resitance due to under utilization of appropriate Antibiotics.
    • Drug usage = Drug resistance
    • Basis of Antibiotic Resistance
      • The antibiotic resistance is guided by Genomic changes
      • Spread of R plasmids among the Bacteria
      • Do remember Antibiotics are used in Animal husbandry apart from Medical use
      • The discovery of antibiotic resistance was discovered with spread of R plasmids from animal sources
      • The Human gut forms the interconnecting area in R plasmids transmission leading ultimately to antibiotic resistance
    • Plasmids played a Major Role in spread of Antibiotic resistance.
    • Frequent, Irrational, and Indiscriminate use increases Antibiotic resistance,
    • Spread of Antibiotic Resistance
      • Indiscrimate use of Antibiotics in Animals and Medical practice
      • R plasmids spread among co-inhabiting Bacterial flora in Animals ( in gut )
      • R plasmids may be mainly evolved in Animals spread to Human commensal, - Escherichia coli followed by spread to more important human pathogens Eg Shigella spp.
    • Why we Need Antibiotic Policy
    • Aim of Antibiotic Policy
      • Reduce the Antimicrobial resistance
      • Initiate best efforts in the hospital area as many resistance Bacteria are generated in Hospital areas and in particular critical care areas.
      • Initiate good hygienic practices so these bacteria do not spread to others
      • Practice best efforts, these resistance strains do not spill into critically ill patients in the Hospital
      • To prevent spill into Society, as they present as community associated infections..
    • Objectives of Antibiotic Policy .
      • Antibiotics should not be used casually
      • Policy emphasizes, avoiding the use of powerful Antibiotics in the Initial treatments.
      • We should create awareness that we are sparing the powerful Broad spectrum Drugs for later treatment
      • Patient saves Money
      • Doctors save Lives .
    • Policy Deals with
      • We discuss on the Broad basis
      • Clinicians / Microbiologists / Pharmacists and Nurses do take part .
      • Policies are framed on demands of the Clinical areas, depending on recent Infection surveillance data contributed from Microbiology Departments.
    • Aims of the Antibiotic Policy
      • Create awarness on Antibiotics as misuse is counterproductive.
      • More effective treatments in serious Infections.
      • Reduce Health care associated infections spilling to society and increase of Community associated Infections.
      • ( A growing concern in Devloping world )
    • Antibiotic working Group Monitors
      • Formulate Optimal guidelines in Treatment of Infections with minimal risk of Health care associated Infections.
      • Create a plan for monitoring the Use of Antibiotics across the Hospital
    • Education On Antibiotic policy
      • Acton plan for Education to all concerned clinical staff on Antibiotic prescriptions.
      • Evaluate the feed back of success and failures of the policy.
      • Create Infection surveillance Data
      • Developing facilities in Microbiology departments for auditing data and guidance
      • Restrictions in prescribing and Antibiotic availability.
      • A continuous education to Junior Doctors
    • Sample collection
      • Proper specimen collection is combined responsibility of Clinical and Microbiological Departments.
      • Continuous training of junior staff on sample collection, and is most neglected necessity
      • A good clinical history is greatly helpful in differentiating community acquired infections from hospital acquired infections.
    • Pitfalls in Specimen collection
      • A proper specimen collection is most neglected area of Microbiology.
      • Scientific approaches in Sample collection is concern for successful Microbiological evaluations,
    • Microbiology Services
      • Constant up graduation of Microbiology departments is good investment.
      • Quality control methods in testing of antibiotic resistance pattern is a top priority.
    • Role of Microbiology Department
      • Microbiology departments asses trends in development of antimicrobial resistance.
      • The results of sensitivity/resistance patterns should be correlated with Antimicrobial agents currently used in the Hospital.
      • Identify and forecast that nature of relation between antibiotic use and resistance.
    • Better services from Microbiology Departments.
      • Basic infrastructure should be updated for detection of MRSA and ESBL producers.
      • Documentation of all Opportunistic infections. and Hospital infection outbreaks
    • Good Microbiology practices will save the resources and reduces the Antibiotic usage
    • Empherical Therapy
      • To many drugs creates complex problems in drug resitance.
      • The clinicians should optimize the duration of empherical treatment.
    • Advantages of Antibiotic Policy
      • Saves the Lives
      • Reduces the morbidity
      • Saves Health related costs
      • Reduces the Antibiotic related toxicity.
      • Patients are satisfied.
    • Staff Education on Antibiotic Policy
      • Staff education is most Important principle in success
      • Draw your own plans according to nature of patients, your past experiences
      • Induction training for new staff
      • Continuing Medical Education to both Junior and Senior practioners.
      • Include nursing staff, pharmacists for the success of the Programme
    • Our Policy is Successful
      • If the Staff will understand the potential hazards of Antibiotics
      • Use of Antibiotic guidelines in teaching Under and Post graduate Medical Students,
      • If we are united we can reduce Hospital generated infections
    • We will succeed with Antibiotic Policy If
      • Both patients and Doctors reduce their expectation on the role of Antibiotics
      • If the Medical profession realizes our aim is to give Right Drug for Right Bug.
    • Patient Education on Antibiotic Policy
      • Education of the patients and society is important in Devloping world.
      • Educate the patients many infections are trival,viral, Do not need Antibiotics
      • If they understand Unnecessary consumption of Antibiotics kills the Normal flora, and reduces the Immunity and makes them potential victims in future.
      • A difficult task in Devloping countries .
    • Proved success of Antibiotic Policies
          • Studies Prove
      • 1 Rapid reversal of major clinical problems of resistance to Choramphenicol ,Erythromycin, and Tetracycline in Staphylococcus aureus on withdrawal of antibiotics.
      • 2 Out breaks of Erythromycin resistant Group A Streptococci and Penicillin resistant Pneumococci , can be controlled by major reduction in prescription of Erythromycin and Penicillin.
      • 3 Control of multiple resistant Gram – ve bacteria and role played by reducing the prescription of 3 rd generation of Cephalosporins
      • .
      • ( I.M.Gould Review of the role of antibiotic policies in the control of antibiotic resistance, Journal of Antimicrobial Chemotherapy 1999 43, 459 – 465. )
    • Make your conclusions and contribute to Antibiotic Policy
      • It is true to say that there is no absolute proof of causative association between antibiotic use and resistance, But many authorities believe the association to be virtually certain.
      • It is pragmatic and essential approach to control of antibiotic resistance with control of antibiotic use.
      • Make every one a partner in prevention of Antibiotic resistance, and success will follow.
    • How to prove the Success
      • Prove your action plans with evidence based success outcomes
      • Senior practioners should be role models
      • Prove how rationalism helps, saves money, morbidity and mortality.
    • Why Everyone worried about Antibiotic ( misuse ) Use.
      • Drug resistance can reverse Medical progress
      • The following diseases are already in the list of attaining the drug resistance, and Medical profession will find difficult to cure in future.
      • 1. Tuberculosis
      • 2. Malaria
      • 3. Sore throat and Ear Infections .
    • Best way to keep the matters in Order
      • Every Hospital should have a policy which is practicable to their circumstances.
      • Rigid guidelines without coordination will lead to greater failures
      • The only way to keep Antimicrobial agents useful is to use them appropriately and Judiciously
      • ( Burke A.Cunha, MD,MACP Antimicrobial Therapy. Medical Clinics of North America NOV 2006)
    • Working together creates Safe Hospitals
    • Created for Benefit of Medical and paramedical personal in Developing world Dr.T.V.Rao MD Email ; [email_address]