ROJoson PEP Talk: ANTIBIOTICS: USE & MISUSE

1. Empowerment
objective - for
laypeople to have an
understanding of
ANTIBIOTIC USE &
MISUSE in their
health management.
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
August 27, 2022
1400H - 1500H
Via Zoom

2. Empowerment
objective - for
laypeople to have an
understanding of
ANTIBIOTIC USE &
MISUSE in their
health management.
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

3. There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

4. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.

5. Empowerment
objective - for
laypeople to have an
understanding of
ANTIBIOTIC USE &
MISUSE in their
health management.
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
My PEP TALK today
is entitled:
ANTIBIOTICS –
USE & MISUSE.
This is part of the
Health Issue Course.

6. Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Contents of ANTIBIOTICS – USE & MISUSE
• What are antibiotics?
• What is MISUSE and USE of antibiotics?
• What are germs? What are bacteria?
• What are examples of bacterial infections? How to recognize bacterial infections?
• What are the different classes of antibiotics?
• How do antibiotics control bacterial infections?
• What are the general objectives in prescribing antibiotics?
• How physicians decide on what antibiotics to prescribe for bacterial infections?
• How long do you take the antibiotics?
• What are the potential side-effects of antibiotics?
• What is antibiotic resistance and its usual causes?
• What are ROJoson’s advocating statements and advice on ANTIBIOTICS USE &
MISUSE?

7. • What are antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Antibiotics are medicines.
Antibiotics are medicines that help stop infections
caused by harmful BACTERIA.

8. • What is “MISUSE” of antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
MISUSE of antibiotics means using them for the
wrong purpose and/or in the wrong way which
pose greater risk than benefit to the health of the
patients as well as in contributing to development
of antibiotic resistance (and eventual
ineffectiveness).

9. • What is “USE” of antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
USE of antibiotics means using them for the right
purpose and/or in the right way which justifiably
balance the benefit and risk of treatment in the
patients as well as in avoiding the development of
antibiotic resistance (and eventual
ineffectiveness).

10. • What are “germs”? What are “bacteria”?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
As mentioned, antibiotics are medicines that help
stop infections caused by harmful BACTERIA.
Bacteria is a kind of a germ.
The word “germ” is a catch-all term that describes
very small microorganisms like bacteria, viruses,
fungi, and protozoa.
Germs are everywhere. Most are harmless or
even helpful. But some may cause disease, an
infection or an infectious disease.
What are bacteria?
Microscopic single-celled
organisms lacking a
distinct nucleus are known
as bacteria.
They may be shaped like
spheres, rods, or spirals.

11. • What are “germs”? What are “bacteria”?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Our bodies are home to an estimated 100 trillion
“good” bacteria, many of which reside in our gut.
Not only do we live in harmony with these
beneficial bacteria, but they are actually essential
to our survival. They contribute to digestion,
produce vitamin K, promote development of the
immune system, and detoxify harmful chemicals.
To help you remember that germs are not all
harmful, think of the microbes that contribute to
making many foods we enjoy, such as bread,
cheese, and wine.
Remember these
statements on
“good” bacteria in
our body when we
talk of risk of taking
antibiotics, especially
in misusing them.
Antibiotics can affect
the normal bacteria
in our body when
misused.

12. • Use and Misuse of Antibiotics
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Again, antibiotics are medicines that help stop
infections caused by harmful BACTERIA.
There are “right” medicines for the different types
of germ infections:
• Bacteria – antibiotics
• Viruses – anti-virus drugs
• Fungi – anti-fungal drugs
• Protozoa – anti-protozoal drugs (some of these
may be used to treat bacterial infection – ex.
metronidazole)
So, antibiotics are
used for bacterial
infections only,
not for infections
caused by viruses,
fungi and protozoa.

13. • What are examples of bacterial infections?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Examples of bacterial infections:
• Pneumonia - Klebsiella pneumoniae
• Tuberculosis – Mycobacterium tuberculosis
• Tetanus – Clostridium tetani
• Cholera - Vibrio cholerae
• Dysentery - genus Shigella
• Pseudomonas Infection - Pseudomonas aeruginosa
• Gonorrhea - Neisseria gonorrhoeae
• Syphilis - Treponema pallidum
• Meningitis - Neisseria meningitidis, E.coli, Listeria
monocytogenes, and Streptococcus pneumonia
• Leptospirosis - Leptospira sp.
Examples of Viral
Infections:
• COVID19
• FLU
Examples of Fungal
Infections:
• RINGWORMS
ATHLETE’S FOOT
Examples of
Protozoal Infections:
• MALARIA
• AMEBIASIS

14. • What are examples of bacterial infections?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Examples of bacterial infections:
• Pneumonia - Klebsiella pneumoniae
• Tuberculosis – Mycobacterium tuberculosis
• Tetanus – Clostridium tetani
• Cholera - Vibrio cholerae
• Dysentery - genus Shigella
• Pseudomonas Infection - Pseudomonas aeruginosa
• Gonorrhea - Neisseria gonorrhoeae
• Syphilis - Treponema pallidum
• Meningitis - Neisseria meningitidis, E.coli, Listeria
monocytogenes, and Streptococcus pneumonia
• Leptospirosis - Leptospira sp.
Examples of Viral
Infections:
• COVID19
• FLU
Examples of Fungal
Infections:
• RINGWORMS
ATHLETE’S FOOT
Examples of
Protozoal Infections:
• MALARIA
• AMEBIASIS
How to recognize and diagnose and
differentiate?
Using pattern recognition (symptoms
and signs) and prevalence processes
(frequency)
By physician
By diagnostic tests

15. • Use and Misuse of Antibiotics
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Again, antibiotics are medicines that help stop
infections caused by harmful bacteria.
There are “right” medicines for the different types
of germ infections:
• Bacteria – antibiotics
• Viruses – anti-virus drugs
• Fungi – anti-fungal drugs
• Protozoa – anti-protozoal drugs (some of these
may be used to treat bacterial infection – ex.
metronidazole)
So, antibiotics are
used for bacterial
infections only,
not for infections
caused by viruses,
fungi and protozoa.

16. • What are different classes of antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Classes:
• penicillins
• macrolides
• cephalosporins
• fluoroquinolones
• beta-lactams with increased activity
• tetracyclines
• trimethoprim-sulfamethoxazole
• lincosamides
• urinary anti-infectives
• others

17. • How do antibiotics control bacterial infection?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Some antibiotic classes work by killing bacteria
and others work by preventing the ability of
bacteria to multiply through the following means:
 attacking the wall or coating surrounding
bacteria
 interfering with bacteria reproduction
 blocking protein production in bacteria

18. • What are the different spectrum of activities of
antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Antibiotics can be categorized by their spectrum
of activity—namely,
• Whether they are narrow-, broad-, or
extended-spectrum agents.
• Whether they are best against Gram(+) or
Gram(-) or both.
• Whether they are effective against aerobes,
anaerobes or both.
Types of bacteria
based on:
Staining:
• Gram (+)
• Gram (-)
Requiring oxygen:
• Aerobes
• Anaerobes

19. • What are the different spectrum of activities of
antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Narrow-spectrum antibiotic can only kill or inhibit
limited species of bacteria.
Eg. penicillin G affects primarily gram-positive
bacteria.
Broad-spectrum antibiotics can kill or inhibit a
wide range of microorganisms.
Eg. azithromycin and clarithromycin

20. • What are the different spectrum of activities of
antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Extended-spectrum antibiotic can kill or inhibit
Gram positive bacteria and some Gram negative
bacteria.
Eg. carbenicilllin, mezlocillin, piperacillin and
ticarcillin

21. • What are the general objectives in prescribing
antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Therapeutic – to treat when bacterial infection
has already set in
Prophylactic – to prevent the onset of bacterial
infection in situations where risk is high
• Surgical prophylaxis – antibiotics to prevent
wound infections after surgery
• Leptospirosis prophylaxis – doxycycline

22. • How physicians decide on what antibiotics to
prescribe for bacterial infections?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Start with: diagnosis of a bacterial infection.
Then: from experience and/or lab tests, determine the
usual bacteria that are causing the infection.
Answer: Is the infection mild, moderate or severe?
Then DECIDE:
• Narrow / broad / extended-broad spectrum
• Benefit – risk – cost – availability analysis of
different antibiotic options
*Oral – parenteral - topical // inpatient /
outpatient

23. Health Issue
Course –
CANCER
INCURABILITY
& HOSPICE
CARE
• Narrow vs Broad Spectrum Antibiotics
General Recommendations:
• As much as possible, narrow-spectrum
antibiotics are used when the specific
causative bacterial agents are known to be the
usual culprit (or determined by lab tests).
Narrow-spectrum antibiotics kill or inhibit only
those bacteria species that are unwanted (i.e.
causing disease). As such, they leave most of the
beneficial bacteria unaffected, hence minimizing
the collateral damage on the microbiota and
there is low propensity for bacterial resistance
development.
Examples of narrow-
spectrum antibiotics:
• Penicillin
• Amoxycillin

24. Health Issue
Course –
CANCER
INCURABILITY
& HOSPICE
CARE
• Narrow vs Broad Spectrum Antibiotics
General Recommendations:
• Use a broader-spectrum antibiotics only when
needed such as when the harmful bacteria are
multiple such as combination of Gram(+) and
Gram(-).
• Using a broader-spectrum antibiotics when
only narrow-spectrum antibiotics are needed
– otherwise, may cause damage to normal
bacteria flora and antibiotic resistance.
Examples of broad-
spectrum antibiotics:
• Co-amoxiclav
• Azithromycin

25. Health Issue
Course –
CANCER
INCURABILITY
& HOSPICE
CARE
• Topical vs Oral Antibiotics for Skin Lesions
General Recommendations:
• NO need for topical antibiotics for minor skin
and soft tissue wounds and infections
(commonly done in the community). Usually
antibiotics are NOT needed – just cleaning
with soap and water will do.
• For moderate to severe wounds and
infections, oral or at times, parenteral
antibiotics are preferred.
• Using topical antibiotics commonly lead to
antibiotic resistance and allergy.

26. Health Issue
Course –
CANCER
INCURABILITY
& HOSPICE
CARE
• Selection of an antibiotic for a patient
There are usually many options in the selection of
antibiotics. A physician has to use the BRCA in
the selection of the most cost-effective
antibiotics.
Antibiotics Benefit
(effective)
Risk
(side-effects)
Cost Availability
Antibiotic1
Antibiotic2
Antibiotic3
Antibiotic4

27. • How long should be a course of antibiotic
treatment?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
The traditional recommendation is at least 7 days
(and some 14 days) for all antibiotics to avoid
antibiotic resistance.
However, nowadays, the recommendations on
duration may be shorter, may be as short as 3 to 5
days. But it all depends on the type and severity
of bacterial infections. The duration can still
reach 7 to 14 days.
Recommendations:
1. Take for at least 3 days
initially and observe.
2. If infection is
subsiding, add 2 to 3
more days and
observe. After
complete subsidence,
add 2 to 3 more days.
If no recurrence, stop.
3. If after 3 days NO
response, change
antibiotics.

28. • What are the potential side effects of
antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Common side effects:
• Nausea / Vomiting
• Abdominal discomfort
• Diarrhea
Some may develop ALLERGY and TOXIC EFFECT.

29. • What are the potential side effects of
antibiotics?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Antibiotic-associated diarrhoea is among the
most common adverse events related to
antibiotic use.
Most cases are mild, but Clostridium difficile
infection causes a spectrum of disease, ranging
from occasional diarrhoea to colitis, toxic
megacolon, and potentially death.
Why do antibiotics cause
Clostridium difficile?
Taking antibiotics can kill
the "good" bacteria,
allowing C. difficile to
multiply and release
toxins that damage the
cells lining the intestinal
wall, causing diarrhea,
abdominal pain, and fever
as well as other
symptoms.

30. • What is antibiotic resistance?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Before the advent of high frequency of antibiotic
resistance, antibiotics are powerful medications
that work very well for control of bacterial
infections.
However, some antibiotics are now less useful
than they once were due to an increase in
antibiotic resistance. Antibiotic resistance occurs
when bacteria can no longer be controlled or
killed by certain antibiotics. In some cases, this
can mean there are no effective treatments for
certain conditions.
When you take an
antibiotic, the sensitive
bacteria are eliminated.
The bacteria that survive
during antibiotic
treatment are often
resistant to that
antibiotic. These bacteria
typically have unique
characteristics that
prevent antibiotics from
working on them.

31. • What are the causes of antibiotic resistance?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Antibiotic resistance is commonly
due to misuse of antibiotics by
physicians and patients.

32. Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
• ROJoson advocating statements and advice on
ANTIBIOTICS – USE & MISUSE
Promote correct use of antibiotics on yourself and
on other people.
• To maximize their benefits (prevention and
treatment of bacterial infections).
• To prevent unneeded side-effects and toxic
effects of antibiotics.
• To prevent antibiotic resistance.

33. Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
• ROJoson advocating statements and advice on
ANTIBIOTICS – USE & MISUSE
Avoid misuse of antibiotics on yourself and on
other people.
• Avoid wrong use particularly on using them for
viral infections.
• Avoid topical antibiotics if not indicated.
• Avoid too short or too long a time of antibiotics
intake which is a common cause of antibiotic
resistance.

34. Contents of ANTIBIOTICS – USE & MISUSE
• What are antibiotics?
• What is MISUSE and USE of antibiotics?
• What are germs? What are bacteria?
• What are examples of bacterial infections? How to recognize bacterial infections?
• What are the different classes of antibiotics?
• How do antibiotics control bacterial infections?
• What are the general objectives in prescribing antibiotics?
• How physicians decide on what antibiotics to prescribe for bacterial infections?
• How long do you take the antibiotics?
• What are the potential side-effects of antibiotics?
• What is antibiotic resistance and its usual causes?
• What are ROJoson’s advocating statements and advice on ANTIBIOTICS USE &
MISUSE?
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Summary
Take Away

35. Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE
Be always in touch with reliable medical
information on ANTIBIOTICS – USE & MISUSE.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of oneself by
knowing the basic principles and processes
of USE & MISUSE of ANTIBIOTICS in their
health management.
Take Away in
relation to
Patient
Empowerment

36. Empowerment
objective - for
laypeople to have an
understanding of
ANTIBIOTIC USE &
MISUSE in their
health management.
Health Issue
Course –
ANTIBIOTICS –
USE & MISUSE