Antibiotic policy of hospital

1. ANTIBIOTIC
POLICY
By :
Dr.D.W.Deshkar

2. Discovery Of Penicillin changes
the History of Medicine

3. 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.

4. 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 practitioners 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 resistance due to under
utilization of appropriate Antibiotics.

5. Drug usage = Drug resistance

6. 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.

7. Plasmids played a Major Role in
spread of Antibiotic resistance.

8. Frequent, Irrational, and Indiscriminate
use increases Antibiotic resistance,

9. Spread of Antibiotic Resistance
 Indiscriminate 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 E.g. Shigella spp.

10. Antibiotic Use and Emergence of
Resistance
MRSA
Methicillin Resistant Staphylococcus Aureus
Ciprofloxacin
Cephalosporins
Other Beta-lactams

11. Antibiotic Use and Emergence of
Resistance
 Glycopeptide resistant enterococci (GRE)
 Beta-lactam resistant gram-negative bacilli
 Carbapenem resistant gram-negative bacilli
 Quinolone resistant gram-negative bacilli
 Penicillin resistant pneumococci

12. Antibiotic Associated Diarrhoea
Clostridium difficile diarrhoea
clindamycin
cephalosporins
Other beta-lactams
quinolones

13. Evidence is Overwhelming
Change of antibiotic prescribing and
antibiotic policy and reduction and
control of emergence of resistant
organisms and HCAIs and their spread.

14. Red Alert Action Plan
to Reduce C. diff Infections
 Antibiotic prescribing
 Hand washing
 Signage
 Patient flow
 Isolation procedures
 Cleaning of environment
 Cleaning of medical equipment
 Education and training

15. Antibiotic Policy
Engagement of all Consultants and
Other Career Grade Prescribers

16. Antibiotic Policy
 Withdrawal of 3rd generation cephalosporins.
 More rigorous restriction of certain
antibiotics.
 Encourage use of oral antibiotics.
 Switching from i/v to oral within 24-48 hrs.
 Duration not exceeding 5 days.

17. Ensuring Adherence to Antibiotic
Policy
 Daily antibiotic surveillance.
 Clinical Pharmacist.
 Drug chart.
 ICNs and ward nurses.
 Clinical audit.
 Education and training

18. Why we Need Antibiotic Policy?

19. 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..

20.  Spread of HCAIs.
 Better use of resources.
 Improve education of junior doctors
 Local policy more effective than national
Aim of Antibiotic Policy contd.

21. Evidence for Policy
 Randomised controlled trials ??
 Descriptive and analytical studies
 Expert opinion

22. 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.

23. Antibiotic Policy Deals with :
 We discuss on the Broad basis
 Clinicians / Microbiologists / Clinical
Pharmacologist / 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.

24. Aims of the Antibiotic Policy
 Create awareness 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 Developing world )

25. 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

26. 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.
 Regular interaction with clinical pharmacologist.

27. Proactive Engagement of
Microbiologist
 List of patients on i /v antibiotics faxed to
Microbiology daily.
 Microbiologist contact clinicians and agree
on antibiotic management plan.
 This has led to reduction in use of broad –
spectrum antibiotics.

28. Role of Microbiologist and
Microbiology Department
 Inform antibiotic policy.
 Restrict antibiotic reporting.
 Disseminate to all clinical areas types of
isolates and their sensitivity patterns.
 Appropriate advice on the report.

29. 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.

30. 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,

31. Microbiology Services
 Constant up
graduation of
Microbiology
departments is good
investment.
 Quality control
methods in testing of
antibiotic resistance
pattern is a top
priority.

32. 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.

33. Better services from Microbiology
Department.
 Basic infrastructure
should be updated for
detection of MRSA and
ESBL producers.
 Documentation of all
Opportunistic infections.
and Hospital infection
outbreaks

34. Good Microbiology practices will save
the resources and reduces the
Antibiotic usage

35. Empherical Therapy
 To many drugs
creates complex
problems in drug
resistance.
 The clinicians should
optimize the duration
of empherical
treatment.

36. Advantages of Antibiotic Policy
 Saves the Lives.
 Reduces the morbidity.
 Saves Health related costs.
 Reduces the Antibiotic related toxicity.
 Patients are satisfied.

37. 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 practitioners.
 Include nursing staff, pharmacists for the success of
the Programme

38. 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.

39. 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.

40. 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.

41. 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 3rd 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. )

42. 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.

43. How to prove the Success
 Prove your action plans with evidence based
success outcomes.
 Senior practitioners should be role models.
 Prove how rationalism helps, saves money,
morbidity and mortality.

44. 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.

45. Working together creates Safe
Hospitals

46. Governance Arrangements
Ownership by the clinical directorate.
Antibiotic committee.
Drugs and Therapeutics Committee & Infection
Control Committee.
Quality and risk governance committee.
Hospital Management Board
Trust Board

48. “If You Always Do What You Have
Always Done, You Always Get What
You Always Got!”
Mark Twain

49. Aim High …You Will Succeed!