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Antimicrobial Stewardship Program
- 1. Jason Vanstone, Ph.D. – Research Scientist Casey Phillips, Pharm.D. – Lead Pharmacist Robert Parker – Program Manager
- 2. 45 Years 80 Years Life Expectancy
- 3. The discovery of antibiotics…
- 4. Antibiotic resistance… Antibiotic resistance is driven by overuse and improper use of antibiotics.
- 5. Antibiotic resistance… Source: PHAC, Canadian Antimicrobial Resistance Surveillance System 2017 Report
- 6. Why do we need antimicrobial stewardship? The more antibiotics we use, the more antibiotic resistant bacteria we see.
- 7. What is antimicrobial stewardship? The right drug. The right dose. The right duration. The right route. Is an antibiotic necessary?
- 8. What antimicrobial stewardship is not… Our goal is to establish a collaborative effort among health care professionals to support each other in achieving the best possible outcomes for our patients. It’s not about policing, shaming, or eliminating prescriber autonomy.
- 9. Why do we need antimicrobial stewardship? In Canada (2016), 92% of antimicrobial doses were dispensed in the community. Source: PHAC, Canadian Antimicrobial Resistance Surveillance System 2017 Report
- 10. Why do we need antimicrobial stewardship? In Canada (2016), Saskatchewan was the 2nd highest user of community-prescribed antimicrobials. Source: PHAC, Canadian Antimicrobial Resistance Surveillance System 2017 Report
- 11. In the US, dentists account for ~10% of antibiotic prescriptions nationally. (K. Grady et al., 2017, Antibiotic Prescribing and Stewardship Opportunities within a Veterans Affairs Dental Care Practice) Why do we need antimicrobial stewardship? Source: PHAC, Canadian Antimicrobial Resistance Surveillance System 2017 Report Who is prescribing…
- 12. Rank (by # Prescriptions) Physician Dentist Nurse Practitioner Pharmacist Optometrist 1 15991 (3.7%) 1502 (3.8%) 845 (8.1%) 367 (6.7%) 65 (16.0%) 2 9217 (2.2%) 1462 (3.7%) 739 (7.1%) 72 (1.3%) 57 (14.0%) 3 7306 (1.7%) 1103 (2.8%) 617 (5.9%) 66 (1.2%) 33 (8.1%) 4 7120 (1.7%) 1067 (2.7%) 600 (5.7%) 62 (1.1%) 33 (8.1%) 5 6775 (1.6%) 930 (2.4%) 550 (5.2%) 60 (1.1%) 32 (7.8%) Total 46409 (11%) 6064 (15%) 3351 (31.9%) 627 (11.5%) 220 (54.1%) Prescriber Designation # Prescriptions % of Prescriptions Physicians 427,316 88.4% Dentists 39,493 8.2% Nurse Practitioners 10,489 2.2% Pharmacists 5,471 1.1% Optometrist 407 0.08% Midwives 62 0.01% Total 483238 100% Data Source: eHealth/MoH DPEBB, RQHR, April 2015 – Dec 2016 Rank Antibiotic # of Prescriptions 1 AMOXICILLIN 28053 (71.0%) 2 CLINDAMYCIN 3787 (9.6%) 3 CEPHALEXIN 2524 (6.4%) 4 METRONIDAZOLE 1372 (3.5%) 5 PENICILLIN V 1161 (2.9%) Total 36897 (93.4%) Why do we need antimicrobial stewardship? Locally…
- 13. Why do we need antimicrobial stewardship?
- 14. This is considered a conservative estimate, unnecessary prescriptions could be as high as 50%. Why do we need antimicrobial stewardship?
- 15. Resources for antimicrobial stewardship… www.rqhealth.ca/asp Our Program has a dedicated website containing information and resources for health care workers to continue learning and to help educate patients about antibiotic resistance and stewardship.
- 16. The Regina Area antibiogram is produced and updated annually by Laboratory Services. Resources for antimicrobial stewardship… It contains both inpatient (hospital) and outpatient (community) information.
- 17. Resources for antimicrobial stewardship… The antibiogram is available online (pdf download) or as a free Android/iPhone app!
- 20. Resources for antimicrobial stewardship… http://antibioticwise.ca/campaign/antibiotics-and-dental-care/
- 21. The big picture… If we maintain the status quo… … >10 million deaths/year.
Editor's Notes
- Antibiotics have drastically reduced the burden of death from infectious diseases (from 46% in the early 1900s to 3% now). Life expectancy has also nearly doubled in this time.
- First antibiotic discovered was in 1928, by Sir Alexander Fleming. He noticed Penicillium mold growing on his Staphylococcus cultures and inhibiting their growth. Penicillin was isolated and went into mass production during WWII. Discovery of new classes of antibiotics exploded throughout the 20th century.
- We know that this process of developing antibiotic resistance happens to every antibiotic we discover or create…it’s only matter of time. Because of this process, we have seen in recent decades a sharp increase in the number of antibiotic resistant infections. This process is driven by our overuse and improper use of antibiotics.