ANTIBIOTIC POLICY

2. Rational Use of Antibiotics
The conference of experts on the rational use of drugs, by the WHO in 1985
defined that
“Rational use of drugs requires that patients
receive medications appropriately to their
clinical needs, in doses that meet their own
individual requirements for an adequate period
of time, at the lowest cost to them and their
community”

3. Reasons
for
Patient Concerns
• Want clear explanation
• Need to return to work
Physician Concerns
• Patient expects
antibiotic
• Time pressure
Antibiotic Prescription
Antibiotic
Overuse

4. What is inappropriate use ?
Unnecessary prescription of antibiotics, such as
for viral infections or for prolonged prophylaxis
Using broad-spectrum antibiotics when narrow-
spectrum antibiotics are effective
Prescribing too low or too high dose
Continuing treatment for longer than necessary

5. What is inappropriate use ?
Not prescribing according to microbiology results
Omitting or delaying administration of doses
Prescribing intravenous therapy when oral
therapy is known to be effective and clinically safe
Not taking antibiotics as prescribed

6. Antibiotic Resistance

7. Emergence of Antibiotic Resistance
Susceptible
Bacteria
Resistant Bacteria
Resistance Gene Transfer
New Resistant Bacteria

8. Resistant Strains
Rare
Resistant Strains
Dominant
Antimicrobial
Exposure
Selection for Antibiotic-Resistant Strains

9. Antimicrobial resistance has emerged as a major
public health problem all over the world
Infections by resistant microbes treatment fail ↑morbidity 
↑mortality.
Treatment failure longer infectivity, ↑infected people in community.
exposes general population to risk of resistant strains
Resistant to first-line antimicrobials,  high cost of the second-line drugs
 treatment failure
Most alarming caused by multidrug-resistant microbes, which are virtually
non-treatable and thereby create a “post-antibiotic era” scenario

10. Emergence of antibiotic resistance

11. Resistance spreads rapidly

13. Impact of resistance
Untreatable infections
Excess length of
stay
Increased morbidity/
mortality
Increased costs
Interference with
patient’s normal flora.
Selection of drug resistant
organisms
Increased side
effects

14. Settings that favor
antimicrobial resistance
Immune compromised patients
e.g.
– ICU
– Oncology unit
– Dialysis unit
– Rehabilitation unit
– Transplantation unit
– Burn unit

16. we have to fight against
the irrational use 
save these important
discoveries of man
Inappropriate
use of antibiotics
(life-saving ( 
many problems
notmanynew
antimicrobials
havebeen
discoveredsince
the1980th
funding on
antimicrobial
research is on
the decline

17. Antibiotic policy

18. Aim of Antibiotic Policy
↓↓ morbidity and
mortality due to
antimicrobial-resistant
infection
Preserve the effectiveness
of antimicrobial agents in
treatment
Prevention of
communicable diseases

19. Detect resistant
microorganisms
Ensure effective
treatment
Recognize trends in
antimicrobial resistance
within the institution
Assure infection
control procedures
Plan for identifying,
transferring, discharging and
with
patients
specific
resistant
readmitting
colonized
antimicrobial
pathogens
Incorporate the detection,
prevention and control of
antimicrobial resistance
into institutional strategic
goals
Rational use of
antimicrobials
Objectives of Antibiotic Policy

20. Organizational
structure of
antibiotic policy
Clinicians
Microbiologists
Pharmacists
Nurses
ANTIBIOTIC
COMMITTEE
infection
control
committee

21. Cumulative antibiogram (Hospital/Community)
Antibiotic policy
Standard treatment guidelines
Antimicrobial stewardship
Hospital acquired
infection
Surveillance of
antimicrobial resistance/
Antibiotic consumption

22. Cumulative antibiogram
• Analyses of data regularly, at least annually.
• Inclusion of diagnostic isolates.
• It is useful to stratify results by specimens type or
infection site, by nursing unit or site of care, by
organism’s resistance characteristics, by clinical
service or patient population.
• Reviewing the cumulative antibiogram data if clinical
failure occurs after empiric therapy.
• Comparing the cumulative antibiogram with national
data.

23. Development of standard treatment
guidelines
• Should be based on local antibiograms.
• Should be syndrome/diseased based.
• Should specify type of clinical setting – Outpatient
clinics, Inpatient units, ICU setting.

24. Direction of antibiotic policy
• Withdrawn agents
Frame the hospital own list of therapeutic antibiotic
categories:
• First-line
• Reservedagents
• Restrictedagents
forexample,firstchoiceantibioticscanbe prescribedbyall doctors
while restricted choice antibiotics can only be prescribed after
consulting the head of the department or the antimicrobial team
(AMT) representative.
Reserve antibiotics, are prescribed only by designated experts.

25. Interventions
Continuous surveillance of bacterial infections.
Hospital
acquired
infection
Community
acquired
infection

26. Interventions
• Prohibiting the sale of antibiotics without
medical prescription.
• Development of regulations by Ministries of
Health regarding responsible prescription of
antibiotics.
• Prohibition of advertising of antibiotics in the
community by industry and pharmaceutical
representatives.

27. Community pharmacist
• Pharmacist should be able to prescribe certain
antibiotics in appropriate circumstances to
patients needing treatment for particular
conditions
• Advice to patients to ensure that the patient
understands that:
– Antibiotic must be used properly
– Help and encourage Health Authorities.
– Ensure the implementation of the policies

28. Antibiotic
prescribing
Indication for use
(definitive, empirical,
prophylaxis)
Route of
administration,
dosage regimen,
duration of
treatment, adverse
effects
If the drug
was on a
reserved list
Drug
combinations
Whether it was
approved by a
microbiologist
Was culture
and sensitivity
performed
Development
of treatment
guidelines

29. ANTIMICROBIAL PRESCRIBING:
GOOD PRACTICES
• Send for appropriate investigations in all infections.
• All antibiotic initiations would be done after sending
appropriate cultures
• Follow Hospital policy when choosing antimicrobial therapy
whenever possible.
• Check for factors which will affect drug choice, eg, renal
function, interactions, allergy.
• Check that the appropriate dose is prescribed.
• The need for antimicrobial therapy should be reviewed on a
daily basis.
• Once culture reports are available, the physician shall step
down to the narrowest spectrum, most efficacious and most
cost effective option.

30. Empiric Therapy
Where delay in initiating therapy to await
microbiological results would be life threatening or risk
serious morbidity, antimicrobial therapy based on a
clinically defined infection is justified.
Where empiric therapy is used, the accuracy of
diagnosis should be reviewed regularly and treatment
altered/stopped when microbiological results become
available.

31. Empiric Therapy
Side effects empirical antibiotics :
• Development of resistance in pathogens infecting the
patient.
• Risk for spread of resistance.
• Suppression of normal flora.
• Development of resistance in normal flora.
• Risk for super infection.

32. • Policy should be reviewed by experts
who are not the members
policy development group,
of the
but are
experts in the relevant field.
Revise
policy
• Policy is not static. It is a living
document. It should be reviewed at
periodic intervals, updated according
to current medical knowledge, clinical
practice and local circumstances.
Revise
policy

33. THANK YOU