Antibiotic policy


Published on

Published in: Health & Medicine
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Antibiotic policy

  1. 1. Antibiotic Policy Principles and Implementation Dr.T.V.Rao MD Professor of Microbiology In our country like many Developing countries wherethere is unrestricted sale “over the counter"of antibiotics, and uncontrolledmisuse of antibiotics is responsible for a general pool of resistant strains in themicrobial population. Within hospitals, the unnecessary use or overuse ofantibiotics encourages the selection and proliferation of resistant and multiplyresistant strains of bacteria. Once selected, resistant strains are favored byantibiotic usage and spread by cross-infection. As manyMedical Colleges, Healthcare Institutionsand hospitals have steeped tosuper specialty care withterminalcare facilities.It is expected, we have accountability to use of life savingantibiotics. Early options to use broad spectrum antibiotics, and newer generationof antibiotics for trivial conditions will certainly lead to emergence of Multidrugdrug resistant and Pan resistant microbes. It is not possible to completelyeliminate this evolutionary phenomenon, but it can be slowed or modified byprudent antibiotic use. This requires the inclusion of an antibiotic policy in theinfection control programme. All Medical Colleges will be transformed into full-fledged Postgraduate Institutions in a matter of few years, when many juniorDoctors will be caring and prescribing the Antibiotics in and out of regular hours.That committed policy implementation will bring in 1 Implement patient care by promoting the best practice in antibiotic prophylaxisand therapy, 2 Make better use of resources by using orally administered and economicaldrugs, wheneverpossible. 3 Retard the emergence and spread of multiple antibiotic-resistant bacteria.Hand washing still the best and least Option to stop the spread of resistantstrains in the Hospitals 4Improve education of junior doctors by providing guidelines for appropriatetherapy
  2. 2. 5Eliminate the use of unnecessary or ineffective antibiotics and restrict the use ofexpensive or unnecessarily and commercially promoted antibiotics.We can initiate policy with the support of the following staffClinical doctors and nursesresponsiblefor direct patient care who provide alink between clinical practice and the Antibiotic Committee.The Microbiologist who will report on antibiotic susceptibility patterns ofbacteria isolated from major infections. Emerging Drug resistance patterns ofMRSA, ESBL and Carbapenemasesproducing strains, isolated from different areasof the Hospital. We have to create acompetent, Quality support system at ourHospitalsand an early action will be taken whenever trends in the Antibioticresistance patterns change.The Pharmacistwho will report back to the Antibiotic Committee at eachmeeting on drug utilization of newer generation of antibiotics and costs incurredon infected patients on drug resistant bacteria.Administrative staff willensure the resources are available for implementation ofthe antibiotic policy. And for overall implantationThe Medical Directors and Medical Superintendentsare active membersfor smooth running and proving the resources to run the system efficiently.Contribution from the Microbiology Laboratory is the foundation forimplementation of a good policyWe need to improve our Microbiology Departmentsfor long term goalswith investments withcommitted faculty, qualified technical staff, and facilities toupgrade the system to Automation (Bactec methods in Blood cultures to savemany patients before discontinuation of empirical treatments )The clinician willreceive reports of antibiotic susceptibility based on the drugs available in theagreed formulary. The testing should be performed with a limited number of
  3. 3. antibiotics selected to optimize patient care and cost effectiveness. The AntibioticCommittee and the Infection Control Committee should receive regular updateson antibiotic susceptibility of bacterial isolates from the local area. The laboratoryshould also alert the Committees on the emergence of widespread resistance tocertain agents.Culturing of the environment or screening of staff should be discouraged and onlydone after authorization by the Infection Control Team.We have to formulate theTime Table for environmental surveillance in our Hospitals;the policy can bereviewed periodically by the Infection control committee to overcome newerchallengesAn effective training on antibiotic policy provides and ensures education onthe use of antibiotics at undergraduate and postgraduate level for medical andnursing staff.The educational programmes should teach how to critically evaluate and assessnew drugs and provide education on the use and misuse of antibiotics to hospitalstaff and practicing physicians. This will reduce inappropriate prescribing. Theprogramme will instruct in correct dosage, route and frequency from the point ofview of cost effectiveness, and provide information to prescribers on the impact oftheir decisions on both economics and bacterial ecology.We should create guidelines to choose our own needs at our Hospital withcontributions from several doctors working at our Hospitals which shouldinclude Guidelines to be drawn up after wide consultation and agreement in the hospital. Documentation to be provided to all faculty and concerned staff. Information to be provided to all newly appointed doctors and nurses and readily available in the hospital. The documentation contain guidance on antibiotic prophylaxis (e.g. in surgery with details of timing, route, dosage and frequency) Should contain guidance on the choice of antibiotics for empirical and targeted therapy of major infections It is essential indicate first and second line therapy for common infections (might limit the use of certain second line drugs to consultant prescription only)
  4. 4. List of available antibiotics agreed by all clinicians, indicating dosages,routes of administration and toxicities.Guidelines for therapy and prophylaxis.This programme can be made a successful with cooperation of everyhealth care professional, as the scarcity of new antimicrobial agents andthe dearth of new agents in the drug development pipeline limit treatmentoptions, particularly for patients with infections caused by multidrug-resistant (MDR) organisms. The individuals infected with drug-resistantorganisms are more likely to remain in the hospital for a longer period oftimeand spend enormous amount money, with greater economic loses tohospital, and to have a poor prognosis.Request your suggestions and CommentsMob 9961785124Email;