This document discusses antibiotics, including their definitions, classifications, mechanisms of action, and issues related to antibiotic resistance and stewardship. It defines antibiotics as substances that can kill or inhibit the growth of microorganisms. It describes various classifications of antibiotics including their spectrum of activity (broad vs narrow), site of action, and type of action (bacteriostatic vs bactericidal). The document also discusses the emergence of antibiotic resistance and the importance of antibiotic stewardship programs in health care facilities to promote appropriate antibiotic use and reduce resistance.

3. ANTIBIOTICS
• Antibiotics can be defined as substances
capable of killing & inhibiting the growth of
micro organisms.
• The term antibiotics literally means “against
life”; in this case, against microbes.
• There are many types of antibiotics—
antibacterials, antivirals, antifungals, and
antiparasitics.

4. 4Con…
COMMON BACTERIA BY SITE OF INFECTION

5. Classifications of Antibiotics
Classifications of Antibiotics
Spectrum of
activity
Broad
spectrum
Narrow
spectrum
Site of action
Type of
action
Bacteriostatic Bactericidal

6. 1. Mechanism of action

7. 2. Mode of action
• Bacteriostatic vs. bactericidal drugs;
• Bacteriostatic
– arrest the growth and replication of bacteria at
serum levels achievable in the patient.
– limit the spread of infection while the body's immune
system attacks, immobilizes, and eliminates the
pathogens.
– If the drug is removed before the immune system has
scavenged the organisms, enough viable organisms
may remain to begin a second cycle of infection.

8. • Bactericidal
– kill bacteria at drug serum levels achievable in the
patient. - often drugs of choice in seriously ill
patients.
• It is possible for ATB to be bacteriostatic for
one organism and bactericidal for another.
2. Mode of action

9. 2. Type of action

10. 3. Spectrum of activity
• Narrow spectrum
• only against a single or a limited group of
microorganisms,
• e.g. INH is active only against mycobacteria.
• Broad spectrum
• affect a wide variety of microbial species.
• e.g. tetracycline and chloramphenicol
• Alter the normal bacterial flora ????
• precipitate a superinfection of an organism, e.g.,
candida.

11. 3. Spectrum of activity

12. Drug resistance
• Growth of bacteria is not halted by the maximal level of
that antibiotic that can be tolerated by the host.
 Primary
 Some organisms are inherently resistant to an antibiotic
 e.g., gram-negative organisms are inherently resistant to
vancomycin.
 Secondary
 spontaneous mutation or acquired resistance and selection.
 Cross-resistance
 resistant to more than one antibiotic.

13. Drug resistance
• Factors that may contribute to the
emergence and dissemination of
antimicrobial resistance
o ► Inadequate infection control
o ► High antimicrobial usage per geographic
area per unit time
o ► Increased use of antimicrobial prophylaxis
o ► Increased empiric polymicrobial
antimicrobial therapy.

14. o ► Greater severity of illness of hospitalized
patients
o ► More severely immunocompromised patients
o ► Newer devices and procedures in use
o ► Agricultural use of antimicrobials
o ► Social factors
o ► International travel
o ► Evolution of pathogens
Drug resistance

15. Facing the End of the Antibiotic Era
• Very few new
antibiotics during past
30 years
• More toxic antibiotics
being used to treat
common infections
• Future currently not
looking very promising

16. What is Misuse of Antibiotics?:
• When antibiotics are prescribed unnecessarily;
• When antibiotic administration is delayed in
critically ill patients;
• When antibiotic treatment is not given according
to microbiological culture data results.
• When the dose is lower or higher than
appropriate for the specific patient; and route of
administrations [IV vs. oral] not appropriate
• When the duration of treatment is too short or
too long;

17. Inappropriate prescription
• CDC estimates more than two million people are
infected with antibiotic-resistant organisms, resulting in
approximately 23,000 deaths annually.
• “Antibiotic resistance comes mainly because of
inappropriate or improper use of antibiotics by
physicians. Some 150 million prescriptions are written
annually in this country. And 60 percent of them —
that translates to 90 million prescriptions — are for
antibiotics. Of those, 50 million are absolutely
unnecessary or inappropriate”.
— Dr. Philip Tierno, director of clinical microbiology and diagnostic
immunology at New York University Medical Center

18. Stewardship Programs
• Is an organized antimicrobial management
program that can be undertaken to improve
antimicrobial usage in order to achieve
optimal outcomes to cure or prevent
infection, and while minimizing toxicity and
emergence of resistance.

19. • Antibiotic stewardship ensures that the patient
only receives an antibiotic when needed AND the
right drug, dose, and duration is prescribed
• In 2014,CDC recommends that all hospitals
should have antimicrobial stewardship programs
• Programs will look different in various hospitals,
depending on the size and complexity of the
patient population

20. Stewardship Team

21. Antimicrobial stewardship is the 8 R’s:
• Right drug,
• Right time
• Right dose
• Right route
• Right Resident
• Right Documentation
• Right Reason
• Right Response

22. • Right drug
– Check the medication label, check the order
• Right time
– Check the frequency of ordered medication
– Confirm when last dose was given
• Right dose

23. • Right route
– Check order for appropriateness of route
ordered(IV/IM/oral)
– Confirm resident can take or receive med by
the ordered route
• Right resident
– Check name on the order and the resident

24. • Right documentation
– Document administration after giving med
– Chart the time, route, and other necessary
information
• Right reason
why medication ordered
• Right response
– Desired response achieved

25. Goals of Antibiotic
Stewardship Programs
1. Reduce antibiotic consumption and
inappropriate us
2. Improve patient outcomes & decrease
morbidity and mortality
3. Increase adherence/utilization of
treatment guidelines
4. Reduce adverse drug events
5. Decrease or limit antibiotic resistance
6. reduce healthcare costs

26. Why Stewardship

27. Classification of Antibiotic According
to steward ship program
• A-Green flag : prescribed by all doctors
• Amoxil, ampicilline,Ampiclox,
• Gentamycine, Amikacin
• Aciclovir IV
• Ceftriaxone / Cefotaxime
• Clarithromycin
• Amikacin
• Azithromycin
• Keflex,cefixim and others…..etc

28. which can be prescribed with the permission of infectious disease
comitte
• Vancomycin
• meropenem,imipeme
m,cefepime,
• levofloxacine
• Itraconazole
• levofloxacine
• Piperacillin +
Tazobactam (Tazocin®)
• Ribavirin
• Teicoplanin
• Terbinafine
• Ticarcillin + Clavulanate
(Timentin)
• Valganciclovir
• Fluconazole IV
• Sodium Fusidate
B-Orange flag continue

29. C-Red flag:
• Used only by infectious disease doctors (consultant)
• linezolid,
• daptomycin,
• colistin,
• Amphotericin ,
• Caspofungin,
• Moxifloxacin,
• Pristinamycin
• Tigecycline,
• Voriconazole

30. Duhok Stewardship Team
Dr.Nawfal
Rasheed
Hussein
Shameran
Slewa Daniel
Sulaf khorshed
adil
Azad A. Haleem Heevi
hospital
Nawzad Sulaeman
Murad. Emergency
Hospital
Ayid Murad Qasim
Azadi Hospital
Bayram Dawod
Ahmed

31. Heevi pediatric hospital
Dr.name
Sep-2016 Jan 2017
Patients NO. % Patients NO. %
Dr.Mahdeya 64 50% 83 30%
Dr.Nzar 120 43% 113 38%
Dr.Khalid Barware 34 95% 40 66%
Dr.Ahmeed Ezat 70 54% 67 37%
Dr.Salah 52 55% 95 53%
Dr.Nader 90 40% 118 44%
Dr.Azad 80 40% 90 47%
Dr.Akram Atroshe 56 41% 63 39%
Dr.Sardar 34 50% 37 55%
Dr.Akram Ismaeel 60 43% 53 40%
10 Doctors 660 51% 759 45%
By:Dr.sulaf Khorsheed Adel