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Antibiotic Policy


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Antibiotic Policy

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