Antibiotic policy


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Antibiotic policy

  1. 1. Antibiotic Policy Dr. Chinmay Dash Department of Microbiology IQ City Medical College, Durgapur
  2. 2. • Intensive use of antibiotics – increase prevalence of resistance • Due to the selective pressure of antibiotic use • The modification of the endogenous flora • Other risk factors:- presence of indwelling devices, -Exposure to broad spectrum antibiotics and treatment under dosing, -Admission to wards where resistant strains are epidemic or endemic and -Frequent exposure to nursing and invasive procedures.
  3. 3. Antibiotic Control Programs Its an ongoing effort by a health care institution to optimize antimicrobial use among hospitalized patients in order to improve patient outcomes, ensure cost- effective therapy, and reduce adverse sequelae of antimicrobial use
  4. 4. To recommend specific intervention measures such as rational use of antibiotics and antibiotic policies in hospitals which can be implemented as early as possible. Intervention Measures • Formulation of antibiotic policies • Education and training of all prescribers • Implementation of infection control guidelines
  5. 5. • Formulation of an antibiotic policy • Implementation of an antibiotic policy • Antibiotic Management Team • The policy for Presumptive / Empiric therapy and Prophylactic therapy • Monitor implementation • Assess outcome
  6. 6. • With quality assured laboratory data in real time ( develop antibiotic policies that are standard national / local treatment guidelines) • This must include consideration of spectrum of antibiotics, pharmacokinetics / pharmacodynamics, adverse effects, cost and special needs of individual patient groups. A. Formulation And Implementation of an antibiotic policy
  7. 7. o Compile Local Hospital data based on AMR o Site of infection o Geographic Variations (ICUs / Wards / Surgical Site Infections etc.) o % Distribution of organisms o %Susceptibility to identified antibiotics A.1. Formulation-Step I
  8. 8. Put the data in given template: o Site of Infection, Type of Infection. o Causative pathogens. o Recent 12 month antimicrobial data. o Capture pathogens contributing to (80-90)% of infections. o Capture the susceptibility of antimicrobials from highest to lowest. o Pneumonia o IAI o UTI o BSI o SSTI o Surgical Prophylaxis. A.2. Formulation-Step II
  9. 9. o Put in database, based on site of infection? o Data will be separate for Ward and ICU isolates o 5 most common pathogens be identified and most antibiotics in decreasing order of sensitivity also be identified. o Generate the Validity period (X+1yr) A.3. Formulation-Step III
  10. 10. Hospital surveillance data (Jan- Dec of X year) Validity of these data: Dec X +1yr S. No Most Common Pathogen % Prevalence S. No Most Sensitive antibiotics in descending order 1. 1. 2. 2. 3. 3. 4. 4. 5. 5.
  11. 11. B. Implementation Do Stratification for each patients’ type
  12. 12. Type -1 Type-2 Type-3 Health care contacts No Yes Prolonged Procedures No Minimum Major Invasive procedures Antibiotic treatment history No in last 90 Days Yes in last 90 Days Repeated multiple antibiotic Patient Characteristic Young – No co-morbid conditions Elderly few co-morbid conditions Immunocopromised +/- many co-morbid condition Possible causative pathogen No MDRs pathogen susceptible to common antibiotics ESBLs/MRSA ESBLs+ Pseudomonas+ MRSA
  13. 13. 5
  14. 14. WHO?
  15. 15. Antibiotic Management Team
  16. 16. Functions
  17. 17. The policy for Presumptive / Empiric therapy and Prophylactic therapy
  18. 18. Presumptive/ Empiric antibiotic policy • should be simple, clear, non-controversial, clinically relevant, flexible and applicable to day-to-day practice and available in user friendly format. • should also include optimal selection dosage, route of administration, duration, alternatives for allergic to first-line agents; adjusted dosage for patients with impaired renal functions. • Previous history of antimicrobials or current antibiotics along with patient co morbidities may play a role in final prescribing.
  19. 19. Levels for prescribing antibiotics: • First choice antibiotics: Can be prescribed by all doctors • Restricted list of antibiotics: Only after permission from HoD or AMT representative • Reserve antibiotics: (for life threatening infections) Only after permission from AMT members Presumptive therapy only applicable for 48 hrs after that it needs to be converted into a definitive therapy (de-escalation step) based on evidence whether clinical or microbiological.
  20. 20. Prophylactic Antibiotic Policy • Procedure for which antibiotic are needed should be posted in Operating Room with Optimal agents, dosage, timing, route and duration of administration e.g. Inj Cefuroxime 1.5 gm I/V before induction of anaesthesia, repeat another dose if procedure extends beyond 4 hrs. • should be given for a short duration, free of side effects and relatively inexpensive and should not be used as a therapy
  21. 21. Constructive FEEDBACK of policy prior to implementation After formulation of the presumptive / empiric & prophylactic policies they should be circulated to receive constructive feedback. Policy should be reviewed by respected peers who are not the members of the AMT, but are also experts in the relevant field
  22. 22.  Formulation of an antibiotic policy  Implementation of an antibiotic policy  Antibiotic Management Team  The policy for Presumptive / Empiric therapy and Prophylactic therapy • Monitor implementation • Assess outcome
  23. 23. Monitor implementation: we may form Drug and Therapeutics Committee (DTC) 1. Basis for approval of new drugs: Based on safety, efficacy, availability and cost of the medication. 2. Fixing of three brands per approved generic 3. Banning of harmful drugs in the Hospital (viz. Phenylpropanolamine (PPA), Nimesulide etc) 4. Development of over the counter (OTC) drug list. This OTC drug list should also contain the quantity to be dispensed Which may carry out the following:
  24. 24. Assess outcome of Intervention A monthly update of antibiotic consumption of a unit is sent with a comparison of other units in the institute this highlights any excess.
  25. 25. Update and Revise Should be updated EVERY YEAR (based on local surveillance of antimicrobial susceptibility data, clinical practice and local circumstances)
  26. 26. What India need ????? “An Implementable antibiotic policy” and NOT “ A perfect policy”
  27. 27. "A Roadmap to Tackle the Challenge of Antimicrobial Resistance “ A Joint meeting of Medical Societies in India" was organized as a pre-conference symposium of the 2 nd annual conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai on 24th August.
  28. 28. Introduce STEP BY STEP regulation of antibiotic usage, concentrating on higher end antibiotics first and then slowly extending the list to second and first line antibiotics
  29. 29. ROAD MAP
  30. 30. Conclusion Although many measures may impact on antimicrobial resistance, reducing the use of antimicrobials to only those situations where they are warranted, at the proper dose and for the proper duration, is the best solution. Hospitals, as the primary incubators of antimicrobial-resistant pathogens, carry the highest responsibility for proper stewardship of our antimicrobial resources.
  31. 31. Florence Nightingale, Notes on Hospitals, 1863 It may seem a strange principle to enunciate as the very first requirement of a hospital that it do the sick no harm THANK YOU