The document discusses the history of antibiotics and antibiotic resistance. It describes some of the key events in the discovery of antibiotics like penicillin and sulfonamides. It also discusses the emergence of resistant bacteria like MRSA and how bacteria can develop resistance through mechanisms such as modifying antibiotic targets, inactivating enzymes, or pumping antibiotics out of the cell. The evolution of antibiotic resistance is an ongoing process driven by selective pressure from antibiotic use.
Basic principles of chemotherapy/ AMAs covers definition, history of AMAs development, principles of AMAs, problems associated with AMAs, failure of therapy with examples.
penicillins - power point - History,mechanism of action,classification,chemis...Dr. Ravi Sankar
Antibiotics - Penicillin's - power point - History, mechanism of action, classification, chemistry, SAR, Nomenclature, uses, side effects- Medicinal chemistry.
Prof. P. Ravisankar M. Pharm., Ph.D.
HOD .,
Vignan Pharmacy college
vadlamudi- Guntur-A.P, India.
banuman35@gmail.com
Phone: 0 9059994000
0 9000199106
Pharmacology of Penicllins (Beta lactam antibiotics), description of their mechanism of action, mechanism of resistance, classification, indications and adverse effects
Tetracyclines slide contains full information about uses, adverse effect, marketed preparation, precaution, route of drug administration, antimicrobial spectrum, mechanism of action, pharmacokineticks and pharmacodynamics of tetracyclines. This slide is very helpful for pharmacy and pharmacology student for the study about tetracyclines.
Definition
History
Chemistry
Properties
Classification & its Generation
Pharmacokinetics
Mechanism of action
Indication
Contraindication
Therapeutic use
Adverse effect
Resistance
Comparison with penicillin
Market preparation
Basic principles of chemotherapy/ AMAs covers definition, history of AMAs development, principles of AMAs, problems associated with AMAs, failure of therapy with examples.
penicillins - power point - History,mechanism of action,classification,chemis...Dr. Ravi Sankar
Antibiotics - Penicillin's - power point - History, mechanism of action, classification, chemistry, SAR, Nomenclature, uses, side effects- Medicinal chemistry.
Prof. P. Ravisankar M. Pharm., Ph.D.
HOD .,
Vignan Pharmacy college
vadlamudi- Guntur-A.P, India.
banuman35@gmail.com
Phone: 0 9059994000
0 9000199106
Pharmacology of Penicllins (Beta lactam antibiotics), description of their mechanism of action, mechanism of resistance, classification, indications and adverse effects
Tetracyclines slide contains full information about uses, adverse effect, marketed preparation, precaution, route of drug administration, antimicrobial spectrum, mechanism of action, pharmacokineticks and pharmacodynamics of tetracyclines. This slide is very helpful for pharmacy and pharmacology student for the study about tetracyclines.
Definition
History
Chemistry
Properties
Classification & its Generation
Pharmacokinetics
Mechanism of action
Indication
Contraindication
Therapeutic use
Adverse effect
Resistance
Comparison with penicillin
Market preparation
Multi Drug Resistant Bacteria.
multidrug resistance is a condition enabling a disease causing organism to resist distinct drug or chemical of a wide variety of structure & function targeted at eradicating the organism
this ppt is compiled from different sources and talks about basics of immunology, brief history, overview of the immune system, immune responses to different pathogens and other aspects of immunology.
Brief historical background & classification of antibiotics.
Antibiotics are defined as chemical substances or compounds produced by various species of microorganisms such as bacteria and fungi, which in low concentrations destroy, kill or inhibit the growth of other species of microorganisms.
Antibiotics classification Antibiotics are usually classified based on their structure, Function and/or spectrum of activity.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Antibiotics – mechanism of resistance – related history [MRSA , VRE , VISA, ESBLS] By Dr.Raghu prakash reddy
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4. Ignác Semmelweis (1818-1865) – assistant in midwifery of Allgemeines Krankenhaus (Vienna) in 1846 – noted that up to 1/5 women died from "childbed" puerperal fever after physician-assisted delivery – by contrast, mortality was low in deliveries performed by midwives
5. History of infection control • Ignác Semmelweis – discovered that physician handwashing with carbolic acid prior to delivery dramatically reduced mortality – he wrote a bunch of letters to the establishment outlining his discovery – he was declared a lunatic and institutionalized – died from blood poisoning 10 d after receiving a finger cut while forced into a straightjacket
6. History of infection control • Joseph Lister (1827-1912) – English surgeon – knew of Louis Pasteur's "germ theory" – reasoned that if airborne microbes could sour milk and rot meat, they may also infect wounds – in the 1860s, he introduced disinfection of operating theatres using carbolic acid spray "Listerian antisepsis“ – gloves were originally introduced to prevent dermatitis from antiseptics
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8. Asepsis • Antisepsis vs. asepsis – aseptic techniques introduced in early 1900s – focused on preventing microbes from getting to the patient rather than fumigating everything – surgeons used gloves, gowns, masks, filtered air, etc. in combination with disinfection – asepsis continued as the primary means of infection control into the 1950s
9. Selman Waksman suggests the word "antibiotic" (coined in 1889 by P. Vuillemin) after Dr. J. E. Flynn, the editor of Biological Abstracts asked him to suggest a term for chemical substances, including compounds and preparations that are produced by microbes and have antimicrobial properties. Although there is no journal citation, Waksman recalled the incident in his book The Antibiotic Era . Because the word was accepted quickly and the meaning became confused, Waksman published a comprehensive definition in 1947: "an antibiotic is a chemical substance produced by microbes that inhibits the growth of and even destroys other microbes (and is active in dilute solutions)" was added later The word antibiotic came from the word antibiosis a term coined in 1889 by Louis Pasteur's pupil Paul Vuillemin which means a process by which life could be used to destroy life
10. Brief History of Antibiotics • 1928- Penicillin discovered by Fleming • 1932- Sulfonamide antimicrobial activity discovered {Erlich}• • 1943- Drug companies begin mass production of penicillin • 1948- Cephalosporins precursor sent to Oxford for synthesis • 1952- Erythromycin derived from Streptomyces erythreus • 1956- Vancomycin introduced for penicillin resistant staphylococcus • 1962- Quinolone antibiotics first discovered • 1970s- Linezolide discovered but not pursued • 1980s- Fluorinated Quinolones introduced, making then clinically useful • 2000- Linezolide introduced into clinical practice
12. The End of Infectious Disease • In 1967, U.S. Surgeon General William H. Stewart told a White House gathering of health officers that “it was time to close the book on infectious diseases”and shift all national attention (and dollars) to what he termed ‘the New Dimensions’of health: chronic diseases” • In the US, deaths from infectious disease dropped by 8.2% annually from 1938 to 1952, and by 2.3% annually thereafter until 1980. • New antibiotics were being discovered on a yearly basis to replace any that had lost effectiveness
13. The End of Infectious Disease •From 1981 to 1995 deaths from infectious disease increased by 4.8% annually. •In 1998 WHO estimated that over 13 million deaths worldwide were caused by infectious disease, almost a quarter of the total deaths in that period. That percentage was up to 26% in 2001. •In 1995 the annual in-hospital costs associated with resistance of 6 bacterial species to a single antibiotic were estimated to be $1.3 billion. •37 new human pathogens have been identified in the last 30 years. •12% of known human pathogens have been recognized as emerging or reemerging health threats
14. The End of Infectious Disease • Since 1967: – Legionnaire’s disease – Toxic shock syndrome – AIDS – Lymedisease – West Nile encephalitis – SARS – Avian Flu • Chronic diseases associated with pathogens: – Peptic ulcers ( Helicobacter pylori ) – Liver cancer (Hepatitis B and C) – Lymearthritis ( Borreliaburgdorferi )
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16. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body… — Alexander Fleming, 1945
17. The greatest possibility of evil in self-medication is the use of too small doses so that instead of clearing up infection, the microbes are educated to resist penicillin and a host of penicillin-fast organisms is bread out which can be passed to other individuals and from them to other until they reach someone who gets a septicemia or a pneumonia which penicillin cannot save. . Sir Alexander Flemming
22. Basic Classes of Antibiotics • Although a large number of antibiotics exist, they fall into only a few classes with an even more limited number of targets. – β-lactams (penicillins) –cell wall biosynthesis – Glycopeptides (vancomycin) –cell wall biosynthesis – Aminoglycosides (gentamycin) –protein synthesis – Macrolides (erythromycin) –protein synthesis – Quinolones (ciprofloxacin) –nucleic acid synthesis – Sulfonamides (sulfamethoxazole) –folic acid metabolism
28. Historical Aspects • 1941 Albert Alexander first recepient of penicillin • 1942 first resistant isolates of Staph aureus reported • 1960 Methicillin introduced • 1964 first MRSA reported • 1980s MRSA became major nosocomial infection
31. Evolution of b-Lactamase Plasmid-Mediated TEM and SHV Enzymes Ampicillin Third-Generation Cephalosporins 1963 1965 TEM-1 E coli S paratyphi 1970s TEM-1 Reported in 28 Gram- Negative Species 1980s 1983 ESBL in United States 1987 ESBL in Europe 2000 >120 ESBLs Worldwide
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35. What does not destroy me makes me stronger . — Nietzsche, 1899
42. Resistance to Antibiotics • Bacteria (and viruses) are very resourceful creatures and they have developed resistance mechanisms to essentially every antibiotic that has been developed. • Moreover, increased use of antibiotics results in increased resistance (the paradox of antibiotics). • The basic resistance mechanisms are quite simple: 1.Modify the antibiotic 2.Modify the target of the antibiotic 3.Destroy the antibiotic 4.Make it more difficult for the antibiotic to get into the cell 5.Actively remove the antibiotic from the cell
44. Efflux pump is a less potent and less common cause of resistance Efflux pump PmrA Mutation of bacterial genes for binding sites causes resistance gyrA, parC, ( parE, gyrB )
47. Genetic basis Genetic selection underlies all resistance Some single amino acid substitution by mutation (ESBL) are rapid and some need multiple genes to cause resistance (VRE) • Mutations • Plasmids • Transposons • Integrons
48. Beta Lactamases • Classified based on Prim structure – Class A (Serine residue) – Class B (metallo-enzyme) – Class C (Serine residue) – Class D (Serine residue) • Class A&D - plasmid mediated • Class B&C - encoded by chromosomal genes
49. Beta Lactamases • Major defence of GNB against B lactams • Hundreds have co-evolved with newer drugs • Spread from Staphylococci to H Influenzae and N gonorrhoeae • With over-use of new B lactams in last 2 decades “new” Extended spectrum beta lactamases(ESBLs), carbapenemases
50. • TEM type ESBL • SHV type ESBL • CTX type ESBL • OXA type ESBL • Plasmid mediated Amp C enzymes • Carbapenemases New Beta lactamases
53. Antibiotics Subject Antimicrobial (Pounds) Human 3,000,000 Beef* 3,700,000 Swine* 10,300,00 Chicken* 10,500,000 Total in animals 24,500,000
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57. The Dramatic Rise in Plasmid-Mediated MBL and Other Carbapenemases • The quiet before the storm • Only 1 publication of a transferable MBL in P aeruginosa in 1993 • 2005 – The presence of transferable MBLs in 28 countries • 2005 ICAAC – 31 abstracts on carbapenemases/MBLs • 2005 ICAAC – major scientific symposium: The Expanding World of Carbapenemases • They have arrived in the United States • Government, industry, and academics working as one seems to be the required path to regain our previous advantage over infesting microbes – promote antimicrobial prescription discipline Walsh TR, et al. Clin Micro Reviews. 2005;18:306-325. Jones RN, et al. Diagn Microbiol Infect Dis. 2005;51:77-84. ICAAC 2005 Symposium 113 (C1), December 16, 2005.
58. The History of Medicine 2000 B.C.—Here, eat this root. 1000 A.D.—That root is heathen. Here, say this prayer. 1850 A.D.—That prayer is superstition. Here, drink this potion. 1920 A.D.—That potion is snake oil. Here, swallow this pill. 1945 A.D.—That pill is ineffective. Here, take this penicillin. 1955 A.D.—Oops…bugs mutated. Here, take this tetracycline. 1960–1999—39 more “oops.”Here, take this more powerful antibiotic. 2000 A.D.—The bugs have won! Here, eat this root. — Anonymous (WHO, 2000)
61. What Is Antimicrobial Stewardship? • A marriage of infection control and antimicrobial management • Mandatory infection control compliance • Selection of antimicrobials from each class of drugs that does the least collateral damage • Collateral damage issues include – MRSA – ESBLs – C difficile – Stable derepression – MBLs and other carbapenemases – VRE • Appropriate de-escalation when culture results are available Dellit TH, et al. Clin Infect Dis. 2007;44:159-177 .
62. IDSA Guidelines – Definition of Antimicrobial Stewardship • Antimicrobial stewardship is an activity that promotes – The appropriate selection of antimicrobials – The appropriate dosing of antimicrobials – The appropriate route and duration of antimicrobial therapy
63. The Primary Goal of Antimicrobial Stewardship • The primary goal of antimicrobial stewardship is to – Optimize clinical outcomes while minimizing unintended consequences of antimicrobial use • Unintended consequences include the following – Toxicity – The selection of pathogenic organisms, such as C difficile – The emergence of resistant pathogens
64. Antimicrobial Stewardship: Suggested Starting Points • Obtain baseline information – Antimicrobial usage and expenditures – Institutional susceptibilities – Recurrent problems • Strategies – Baseline: create collaborative antibiotic guidelines (participation and buy-in from as many doctors as possible) – Low-hanging fruit: IV to per os switches, dosing, streamlining antimicrobials based on culture results