This document discusses antimicrobial resistance and the importance of antimicrobial stewardship programs. It notes that factors like misuse of antibiotics, increased severity of illness in hospitalized patients, and agricultural use of antimicrobials can contribute to the emergence of antimicrobial resistance. Antimicrobial stewardship programs aim to optimize antibiotic use and minimize resistance by ensuring the right drug, dose, duration and route of administration for each patient. The goals of these programs are to reduce antibiotic consumption and resistance while improving patient outcomes. The document also provides examples of how antibiotics may be classified under a stewardship program based on restrictions on their use.

2. Introduction
• 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.

3. 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

4. Bad Bugs, No Drugs: No ESKAPE!
• Over past 30 years at least one new infectious
disease
• discovered /year
• Very few new antibiotics during that time
• Future currently not looking very promising
• Antibiotics considered to be one of the 5 most
important medical developments
• Without antibiotics medicine as we know it will
changeforever

5. 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;

6. 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.
• One overarching programme of policies,
management programmes, control programmes
directed at improving antimicrobial use,
resistance and clinical outcomes

7. Stewardship Team

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

9. • 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

10. • 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

11. • 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

12. 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

13. Why Stewardship

14. 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,suprax and others…..etc

15. 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

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