This document discusses antibiotic overuse and resistance. It notes that overuse of antibiotics can lead to adverse drug events, antibiotic resistance, and Clostridium difficile infections. It summarizes the 2013 CDC Threat Report on antibiotic resistance and lists several "superbugs" as major threats. The document advocates for antibiotic stewardship programs and lists seven ways healthcare providers can improve antibiotic prescribing practices to help address the growing crisis of antibiotic resistance.
Dr. Lauri Hicks - Out-Patient Antibiotic Resistance (AMR) IssuesJohn Blue
Out-Patient Antibiotic Resistance (AMR) Issues - Dr. Lauri Hicks, Commander, U.S. Public Health Service, Medical Epidemiologist, Respiratory Diseases Branch; Medical Director, Get smart: Know When Antibiotic Work Program; Centers for Disease Control and Prevention (CDC), from the 2015 NIAA Antibiotic Symposium - Stewardship: From Metrics to Management, November 3-5, 2015, Atlanta, Georgia, USA.
More presentations at http://swinecast.com/2015-niaa-symposium-antibiotics-stewardship-from-metrics-to-management
Dr. Beth Bell - CDC’s Overall Effort on Antibiotics, FY 2015 Requested Fundin...John Blue
CDC’s Overall Effort on Antibiotics, FY 2015 Requested Funding and CARB Program - Dr. Beth Bell, Director of the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), from the 2015 NIAA Antibiotic Symposium - Stewardship: From Metrics to Management, November 3-5, 2015, Atlanta, Georgia, USA.
More presentations at http://swinecast.com/2015-niaa-symposium-antibiotics-stewardship-from-metrics-to-management
Updates from the CDC - Michael Craig, Senior Advisor for Antibiotic Resistance Coordination and Strategy, National Center for Emerging and Zoonotic Infectious Diseases, CDC, from the 2016 NIAA Antibiotic Symposium - Working Together For Better Solutions, November 1 - 3, 2016, Herndon, Virginia, USA.
More presentations at http://www.swinecast.com/2016-niaa-symposium-antibiotic-use-working-together-for-better-solutions
Dr. Larry Granger - USDA Antimicrobial Resistance StrategyJohn Blue
USDA Antimicrobial Resistance Strategy - Dr. Larry Granger, Leads the Antimicrobial Resistance Program for the U.S. Department of Agriculture's Animal and Plant Health Inspection Service, Veterinary Services, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Role of PK PD in Antibiotic Stewardship Program with case study. This presentation gives an comprehensive overview about role of PK PD in antibiotic stewardship program.
Hiv activists-call-for-longer-hiv-treatment-refillsSABC News
HIV activists today released the results of a rapid survey assessing the length of supply of antiretrovirals (ARVs) people living with HIV are being given. The results highlight that during lockdown in South Africa, more than a quarter of people surveyed (28%) received one month or less supply — having to return to the clinic each month for refills. This means that many people living with HIV will have to return to health facilities during the COVID-19 pandemic just to collect a medicine refill, risking exposure to people with COVID-19, and unnecessarily congesting the health system.
Dr. Lauri Hicks - Out-Patient Antibiotic Resistance (AMR) IssuesJohn Blue
Out-Patient Antibiotic Resistance (AMR) Issues - Dr. Lauri Hicks, Commander, U.S. Public Health Service, Medical Epidemiologist, Respiratory Diseases Branch; Medical Director, Get smart: Know When Antibiotic Work Program; Centers for Disease Control and Prevention (CDC), from the 2015 NIAA Antibiotic Symposium - Stewardship: From Metrics to Management, November 3-5, 2015, Atlanta, Georgia, USA.
More presentations at http://swinecast.com/2015-niaa-symposium-antibiotics-stewardship-from-metrics-to-management
Dr. Beth Bell - CDC’s Overall Effort on Antibiotics, FY 2015 Requested Fundin...John Blue
CDC’s Overall Effort on Antibiotics, FY 2015 Requested Funding and CARB Program - Dr. Beth Bell, Director of the National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), from the 2015 NIAA Antibiotic Symposium - Stewardship: From Metrics to Management, November 3-5, 2015, Atlanta, Georgia, USA.
More presentations at http://swinecast.com/2015-niaa-symposium-antibiotics-stewardship-from-metrics-to-management
Updates from the CDC - Michael Craig, Senior Advisor for Antibiotic Resistance Coordination and Strategy, National Center for Emerging and Zoonotic Infectious Diseases, CDC, from the 2016 NIAA Antibiotic Symposium - Working Together For Better Solutions, November 1 - 3, 2016, Herndon, Virginia, USA.
More presentations at http://www.swinecast.com/2016-niaa-symposium-antibiotic-use-working-together-for-better-solutions
Dr. Larry Granger - USDA Antimicrobial Resistance StrategyJohn Blue
USDA Antimicrobial Resistance Strategy - Dr. Larry Granger, Leads the Antimicrobial Resistance Program for the U.S. Department of Agriculture's Animal and Plant Health Inspection Service, Veterinary Services, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Role of PK PD in Antibiotic Stewardship Program with case study. This presentation gives an comprehensive overview about role of PK PD in antibiotic stewardship program.
Hiv activists-call-for-longer-hiv-treatment-refillsSABC News
HIV activists today released the results of a rapid survey assessing the length of supply of antiretrovirals (ARVs) people living with HIV are being given. The results highlight that during lockdown in South Africa, more than a quarter of people surveyed (28%) received one month or less supply — having to return to the clinic each month for refills. This means that many people living with HIV will have to return to health facilities during the COVID-19 pandemic just to collect a medicine refill, risking exposure to people with COVID-19, and unnecessarily congesting the health system.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
A benefits case study describing how Diabetes UK has used HSCIC's data and statistical outputs to inform the Putting Feet First campaign. https://www.diabetes.org.uk/Get_involved/Campaigning/Our-campaigns/Putting-feet-first/
A benefits case study describing how national stakeholders have used HSCIC's immunisation statistics to help drive improvements in immunisation services and inform decisions when managing disease outbreaks
Developing a national strategy to bring pathogen genomics into practiceExternalEvents
http://www.fao.org/about/meetings/wgs-on-food-safety-management/en/
Developing a national strategy to bring pathogen genomics into practice. Presentation from the Technical Meeting on the impact of Whole Genome Sequencing (WGS) on food safety management and GMI-9, 23-25 May 2016, Rome, Italy.
El 12 de mayo de 2017 celebramos en la Fundación Ramó Areces una jornada con IS Global y Unitaid sobre enfermedades transmitidas por vectores, como la malaria, entre otras.
A teaching aid on addressing hesitancy to Covid-19 vaccination. WHO has identified vaccine hesitancy as a major threat to global health. Learn more about how to work with patients, the public and communities to improve confidence in Covid-19 vaccines.
Smart Use of Antibiotics (SUA) in Indonesiamarkovingian
Smart Use of Antibiotics (SUA) in Indonesia
Diberikan dan disampaikan pada Seminar "Cegah Resistensi Antibiotik: Demi Selamatkan Manusia", kerjasama Kemenkes, WHO, dan Yayasan Orang Tua Peduli, didukung oleh React, 5 Agustus 2015
• Describe the role of antibiotic use in the
development of resistance
• Review toxicity of commonly used antibiotics
• Understand the prevalence and clinical impact
of carbapenem resistant enterobacteriaceae
• State the prognosis antimicrobial resistant
Staph aureus infections
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
A benefits case study describing how Diabetes UK has used HSCIC's data and statistical outputs to inform the Putting Feet First campaign. https://www.diabetes.org.uk/Get_involved/Campaigning/Our-campaigns/Putting-feet-first/
A benefits case study describing how national stakeholders have used HSCIC's immunisation statistics to help drive improvements in immunisation services and inform decisions when managing disease outbreaks
Developing a national strategy to bring pathogen genomics into practiceExternalEvents
http://www.fao.org/about/meetings/wgs-on-food-safety-management/en/
Developing a national strategy to bring pathogen genomics into practice. Presentation from the Technical Meeting on the impact of Whole Genome Sequencing (WGS) on food safety management and GMI-9, 23-25 May 2016, Rome, Italy.
El 12 de mayo de 2017 celebramos en la Fundación Ramó Areces una jornada con IS Global y Unitaid sobre enfermedades transmitidas por vectores, como la malaria, entre otras.
A teaching aid on addressing hesitancy to Covid-19 vaccination. WHO has identified vaccine hesitancy as a major threat to global health. Learn more about how to work with patients, the public and communities to improve confidence in Covid-19 vaccines.
Smart Use of Antibiotics (SUA) in Indonesiamarkovingian
Smart Use of Antibiotics (SUA) in Indonesia
Diberikan dan disampaikan pada Seminar "Cegah Resistensi Antibiotik: Demi Selamatkan Manusia", kerjasama Kemenkes, WHO, dan Yayasan Orang Tua Peduli, didukung oleh React, 5 Agustus 2015
• Describe the role of antibiotic use in the
development of resistance
• Review toxicity of commonly used antibiotics
• Understand the prevalence and clinical impact
of carbapenem resistant enterobacteriaceae
• State the prognosis antimicrobial resistant
Staph aureus infections
Antimicrobial Resistance: A One Health Challenge for Joint ActionSIANI
Presented by Juan Lubroth at the seminar "Antimicrobial resistance; linkages between humans, livestock and water in peri-urban areas" at the World Water Week, 29th August 2016.
Dr. Theoklis Zaoutis - Antimicrobial Use and Stewardship in the Pediatric Out...John Blue
Antimicrobial Use and Stewardship in the Pediatric Outpatient Setting - Dr. Theoklis Zaoutis, Chief, Division of Infectious Diseases, Professor of Pediatrics and Epidemiology of the University of Pennsylvania, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Dr. Kurt Stevenson - Antimicrobial Resistance Surveillance and Management in ...John Blue
Antimicrobial Resistance Surveillance and Management in Hospital and Community Settings - Issues for Human Population Medicine - Dr. Kurt Stevenson, The Ohio State University Medical Center, from the 2012 NIAA One Health Approach to Antimicrobial Resistance and Use Symposium, October 26-27, 2012, Columbus, OH, USA.
More presentations at:
http://www.trufflemedia.com/agmedia/conference/2012-one-health-to-approach-antimicrobial-resistance-and-use
Advisor Live: Antimicrobial Stewardship - Why Now and How?Premier Inc.
This 90-minute webinar discusses strategies and tools for implementing antimicrobial stewardship programs, including methods for measuring antimicrobial use and resistance.
Join Premier’s free Advisor Live® webinar series for a special Get Smart About Antibiotics Week presentation on Thursday, November 19 from 12-1:30 p.m. EST. The panel for this 90-minute webinar will discuss strategies and tools for implementing antimicrobial stewardship programs, including methods for measuring antimicrobial use and resistance.
EXPERT PRESENTERS:
- Gina Pugliese, RN, MS, vice president, Premier Safety Institute®, moderator
- Arjun Srinivasan, MD, (CAPT, USPHS) medical director of the CDC’s Get Smart for Healthcare program, will highlight the national focus on antibiotic stewardship and reasons for the current urgency
- Michael Postelnick, RPh, BCPS AQ- Infectious Diseases, clinical manager and senior infectious diseases pharmacist for Northwestern Memorial Hospital, will share lessons learned from implementing their antibiotic stewardship program
- Craig Barrett, Pharm.D., BCPS, director safety solutions for Premier, Inc. will share strategies from Premier member hospitals striving for antimicrobial stewardship
The New War on Bugs: Crafting an Effective Antibiotic Stewardship Program
More than half of all hospital patients are treated with antibiotics and prescribing practices vary widely, even within hospitals. Efforts to rationalize antibiotic use have been stymied by delays in obtaining specific diagnoses, by the volume of prescriptions written each day and by the difficulty of extracting meaningful data from scattered clinical, laboratory and pharmacy records. But the push is on – from the White House, the CDC, infectious disease specialists, the industry – for more judicious use of antibiotics through antibiotic stewardship programs.
Hear how leading health care institutions have moved from education to active surveillance to intervention, reducing infections and lowering costs.
Advisor Live: Advancing Antimicrobial StewardshipPremier Inc.
Fight antibiotic resistance! Join us and participate in Get Smart About Antibiotics Week 2016. Medical epidemiologist Dr. Kavita Trivedi will share her deep wealth of knowledge to help your organization implement and meet the challenges of antimicrobial stewardship.
- Current regulatory environment
- Implementation tools available
- Implementation challenges
Antibiotic Guardian Birmingham Workshop4 All of Us
Antibiotic resistance is one of the biggest threats facing us today!
European Antibiotic Awareness Day (EAAD) is part of the UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, which focuses on antibiotics and sets out actions to slow the development and spread of antimicrobial resistance.
This year, to run in line with EAAD; Public Health England has established the Antibiotic Guardian pledge campaign. It calls on everyone in the UK, the public and healthcare community to become antibiotics guardian by choosing one simple pledge about how they will make better use of these vital medicines.
To ensure that the information and knowledge on Antibiotic Stewardship is disseminated to those practising healthcare across the nation, a series of awareness and educational events have been developed. These educational workshop events, to be held in Leeds, Birmingham and London, will provide guidance, resources and information for practitioners on topics associated with antibiotic awareness. The events will provide an opportunity to understand how you and your organisation can support combat the global challenge faced by antibiotic resistance whilst gaining advice, support and resources to inform patients and staff.
Antibiotic Guardian London Workshop 20164 All of Us
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Antimicrobial resistance is one of the biggest threats to human health and is rising to dangerously high levels in all parts of the world. Anyone, of any age, in any country, could be impacted. While it's normal for microbes to develop resistance to drugs, the way antimicrobials are currently being used is accelerating the process, and as a result common infections and minor injuries are becoming an increasingly greater threat to our well-being. Organizations from across the world are taking action and making progress on this issue, but is there anything patients, their families and patient advisors can do to help?
See the full presentation here: https://goo.gl/AYCsdd
Dr. James Hughes - Combating Antimicrobial Resistance: The Way ForwardJohn Blue
Combating Antimicrobial Resistance: The Way Forward - Dr. James Hughes, Professor of Medicine and Public Health with Joint Appointments in the School of Medicine and the Rollins School of Public Health at Emory University, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Tackling the U.S. Healthcare System’s Infectious Disease Management ProblemViewics
The United States healthcare system has a serious infectious disease management problem. The antibiotic resistance crisis is widespread, serious, costly, and deadly. Delays in pathogen identification lead to poor clinical outcomes, including increased mortality risk. And, optimally managing outbreaks is critical to health systems whose reimbursement is tied to the health of a population, such as ACOs.
Eleanor Herriman, MD, MBA, Chief Medical Informatics Officer at Viewics led an informative panel discussion with industry leaders on the issues surrounding the infectious disease management crisis. Margret Oethinger, MD, Ph.D., Medical Director of Providence Health & Services, and Susan E. Sharp, Ph.D., DABMM, FAAM, Regional Director of Microbiology and the Molecular Infectious Disease Laboratories, Department of Pathology, Kaiser Permanente and President-Elect, American Society for Microbiology cover the current state of infectious disease management in the U.S., and what can be done to improve it.
You’ll learn about:
• The magnitude of the U.S. health system’s infectious disease management problem
• The most serious concerns and trends for healthcare institutions and communities across the nation
• The most promising solutions to health systems’ most urgent infectious disease management challenges
Dr Sam Gharbi often found that the approach to understanding antibiotics was one of the more poorly taught subjects during medical training. This e-book in fact first started as a collection of notes that were made during medical school, and continually added to during residency and fellowship as Dr Sam Gharbi pieced together knowledge and experience that accrued on the topic over the years.
This e-book is meant to be an educational resource to help build a framework towards understanding antibiotics and building a better approach. It is important to note that this ebook is not designed for clinical decision making. In such situations, it is recommended to refer to your Sanford guide, or other center-specific resource.
In every moment, we have two options either to do what is needed or to run away from it. The right thing means nothing but to do what is necessary and feels right to us, by keeping consequences in mind. If you do the right things just because someone is going to reward you, it may make doing the right thing a selfish thing. No matter what situation you are in, you should always do what is right. Doing the right thing only for gaining attention and publicity is unethical. Irrespective of results or benefits, believe in the process, and do the right thing, give justice. Doing the right is itself a reward.
- Shubham Shukla
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Cdc get smart week resident presentation 2014
1. Dr. Brad Cut rel l ,
VANTHCS ASP
Di rector
CDC GET SMART WEEK
NOVEMBER 17-23, 2014
2.
3. DEEP IN
THE HEART
OF TEXAS
http://www.cdc.gov/drugresistance/threat-report-2013/
4. WHY CARE ABOUT ANTIBIOTIC OVERUSE?
Unintended Consequences of Antibiotic Prescribing
Adverse Drug Events
Antibiotic Drug Resistance
Clostridium difficile Infections
6. ANTIBIOTIC RESISTANCE:
WARNINGS, PAST AND PRESENT
“In such a case the thoughtless person playing with
penicillin treatment is morally responsible for the
death of the man who finally succumbs to infection
with the penicillin-resistant organism. I hope the evil
can be averted.”
1945 NY Times: Sir Alexander Fleming, Nobel laureate for
discovery of PCN
If we are not careful, we will
soon be in a post-antibiotic
era.”
2013: Dr. Tom Frieden, CDC Director
9. CDC THREAT LEVELS: “SUPERBUGS”
Clostridium difficile
Carbapenem-R Enterobacteriaceae (CRE)
Cephalosporin-R Neisseria gonorrhoeae
MDR Acinetobacter, MDR Pseudomonas, ESBL GNRs
MRSA, VRE, Drug-R pneumococcus, Drug-R Enteric GNRs
MDR and XDR TB, Azole-resistant Candida
Vancomycin-R Staphylococcus aureus
Macrolide-R group A streptococci
Clindamycin-R group B streptococci
10. DUTCH TREAT OR MY BIG FAT GREEK
MESS?
Bartlett J, et al. CID 2013.
• The dominant driver of
antibiotic resistance is
use (and overuse) of
antibiotics
• Antibiotics are the only
drug where “the more you
use them, the more you
lose them.” - - Brad
Spellberg
12. MDRO AT HOME
UHSP Acinetobacter Abx Susceptibilties
Antibiotic % Resistant
Carbapenem
Multi-drug resistant
(3 or more abx
classes)
73%
79%
- Based on first isolate from each admission
* Data courtesy of Jenny
Holmes and Dave Greenberg
16. C D C ’ S 4 C O R E S T R AT E G I E S TO F I G H T ABX RESISTANCE
http://www.cdc.gov/drugresistance/threat-report-2013/
17. PCAST REPORT ON ABX RESISTANCE
P re s i dent ’ s C o u nc i l o f Ad v is o r s o n S c i e nc e a nd Te c hno l o gy
(PCAST) released summary repor t and recommendations on
combating abx resistance, coinciding with executive order
from President Obama in Septembre 2014
Highlights of recommendations:
Establish Federal Govt Task Force and Advisory Council on Combating
Abx-resistant bacteria
Promote antibiotic stewardship in healthcare and animal agriculture
Strengthen national surveillance systems for abx resistance
Provide funding for research into novel drugs and diagnostic tools, for
clinical trials network (ARLG), and for commercial drug development
incentives
Strengthen international collaboration with WHO and EU
18. WHAT CAN YOU DO? 7 WAYS TO GET
SMART WITH ANTIBIOTICS
#1 Observe antibiotic “best practices”
http://www.cdc.gov/drugresistance/threat-report-2013/
19. WHAT CAN YOU DO? 7 WAYS TO GET
SMART WITH ANTIBIOTICS
#2 Optimize dose and route of antibiotic
administration
Therapeutic Drug Monitoring
Continuous or extended infusions
IV-to-PO Switch
ABX W/ Excellent PO Bioavailability
Fluoroquinolones
Metronidazole
Clindamycin
Linezolid
Fluconazole
Azithromycin
20. WHAT CAN YOU DO? 7 WAYS TO GET
SMART WITH ANTIBIOTICS
#3 Avoid double anaerobic coverage
Abx such as pip-tazo and carbapenems have
excellent anaerobic coverage so adding
metronidazole or clindamycin is NOT indicated,
except in rare cases
Study from national VAs found that 25% of all
metronidazole days of therapy were NOT indicated
Huttner B, et al. JAC 2012.
21. WHAT CAN YOU DO? 7 WAYS TO GET
SMART WITH ANTIBIOTICS
#4 De-escalate/stop antibiotics or shorten
duration of therapy when appropriate
Importance of reassessment of clinical status and
culture results at 48-72 hours
Multiple RCT and meta-analyses demonstrate non-inferior
outcomes with shorter Rx courses
VAP (Non-PseA)= 8 days
Cellulitis = 5 days ≈ 10 days
UTI or pyelonephritis = 7 days
CAP = 5 days (with high dose FQ)
Bartlett J, et al. CID 2013
22. WHAT CAN YOU DO? 7 WAYS TO GET
SMART WITH ANTIBIOTICS
#5 Avoid antibiotics for inappropriate
indications
Upper respiratory tract infections (colds,
acute bronchitis, non-strep pharyngitis)
Early or mild sinusitis
Asymptomatic bacteriuria
Little or no potential benefit to Abx and significantly
outweighed by potential harms!
23. WHAT CAN YOU DO? 7 WAYS TO GET
SMART WITH ANTIBIOTICS
#6 Educate your patients on when antibiotics are
and are NOT effective
Discuss indications,
appropriate use and risks of
abx
Recommend specific
symptomatic Rx and a back-up
plan
Constructively correct false
popular beliefs
www.cdc.gov GET SMART Campaign
24. WHAT CAN YOU DO? 7 WAYS TO GET
SMART WITH ANTIBIOTICS
#7 Follow and become good antibiotic
stewardship “mentors”
25. ANTIMICROBIAL STEWARDSHIP:
WHAT IS IT?
An ef for t to promote best antibiotic practices, by ensuring the
right drug is used for the right bug, at the right dose, for the
right duration. The primary goal is to improve patient
outcomes, whi le simultaneously decreasing toxicity, antibiotic
resistance, C. dif f icile infections, and cost.
Right DRUG for Right BUG,
Right TIME and Right DOSE
for the Right DURATION
26. OUTCOMES WITH ANTIMICROBIAL
100
90
80
70
60
50
40
30
20
10
0
RCT of ASP Intervention vs. Usual Practice at Hosp of U Penn
Appropriate
Abx
Cure Failure Abx
Resistance
HUP
UP
STEWARDSHIP TEAMS
Percent
Fishman, N. Am J Med, 2006.
Clinical Outcome Measure
27. WHAT CAN ASP DO FOR YOU?
http://www.cdc.gov/drugresistance/threat-report-2013/
This week is the annual Get Smart Week developed by the CDC to highlight concerns regarding increasing abx resistance and the need for more effective stewardship of antibiotics in the medical community. I think increasingly this is a hot topic that is getting a lot of attention in the media and public. However, as practitioners in IM we are on the frontlines of preventing and treating infections and I think that we should really be leading the way in the efforts of abx stewardship to stem the tide of resistance. I wanted to take this brief time to sketch some of the highlights of the current situation, and then highlight what you can do as medical students, residents and clinicians to make a difference—and how we are here to help as your antibiotic stewardship team.
Want to start with this slide that shows that here in the United States, we use a lot of antibiotics and many of those antibiotics are not needed or inappropriately prescribed.
Startling Facts:
-- U.S makes up 5% of the world’s population but we use almost 50% of the total antibiotics used worldwide
-- Estimates are that 2/3 of all inpatients receive an antibiotic during their hospital stay, and 50% are receiving one at any given point-- Up to 50% of antibiotics prescribed are either inappropriate or improperly given (Leading reasons—inappropriate duration, Rx of colonization or contamination, Rx for viral or non-infectious conditions) Where else in medicine would we tolerate this performance?
Here in Texas, we are also on the wrong end of the curve as well for antibiotic prescribing. Have one of the higher rates of abx prescriptions per 1000 persons of any of the states.
There are many potential unintended consequences of abx prescribing but I want to highlight the following 3
We worry about the rare, life-threatening adverse events like SJS, anaphylaxis, fulminant hepatic failure, QTc prolongation leading to torsades and sudden cardiac death. Although extremely rare, some of our highest risk patients are the most likely to receive abx.
Per CDC Report, Antibiotics cause 1 out of 5 ADEs causing ED visits : 140,000 visits/yr and majority (80%) of these are allergic reactions
And on the wards or in the clinics, we all see many antibiotic adverse events as well – allergic reactions, interstitial nephritis, C.diff, leading to prolonged hospital stays.
And the list of potential ADE grows every day; FDA recently changed Quinolone labeling update to warn of Risk for Nerve Damage
Sir Alexander Fleming, the Nobel prize winner for the discovery of PCN, warned in his Nobel address and a NYT article of the dangers associated with indiscriminate abx use. The full quote is this:” The public will demand the drug and then will begin an era of abuses. The microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out which can be passed to others and perhaps from there to others until they reach someone who gets a septicemia or a pneumonia which penicillin cannot save.”
Comprehensive report from CDC released on 9/16/2013 really grabbed media’s attention to become aware of this issue and problem. Was then followed up shortly after that with a PBS Frontline hour long special describing the crisis of MDR Gram negative infections
Best estimates from the limited data, most likely conservative in their numbers:
-- Over 2 million infections from drug resistant bacteria and Candida that account for 23,000 deaths / year (more than the number of patients that die annually from AIDS in this country)
-- Leads to prolonged hospital stay and costs - $18-29,000 (CID 2013;56:1445) per hospital stay, in aggregate as high as $35 billion dollars in direct excess healthcare costs
-- C. diff infection is now epidemic in this country and the primary driver of this is directly related to antibiotic use. C.diff cases – 250,000 / year and 14,000 attributable deaths…. Huge increases in costs of care
Here is the list of the 3 Threat levels and the pathogens that are listed in each category. They are categorized based on their prevalence, their potential to spread among patients and in the healthcare environment, and the severity of illness that they cause as well as the available antibiotics to treat them.
Slide illustrates the striking correlation between antibiotic usage and rates of antibiotic resistance. Both of these countries are part of the EU, which has a very sophisticated tracking mechanism for abx usage and resistance patterns. But the data is really quite striking with KPC strains and MRSA strains. The question is: are we more like the Dutch or the Greeks in our abx prescribing practices? I think that we all know the answer to that.
The problem of drug resistant organisms is particularly problematic with Gram negative bacteria because we increasingly have little to no options for treatment. The most concerning emerging threats are the carbapenem-resistant enterobacteriaceae or CRE. You have probably heard of the NDM-1 strain that was isolated first in India, and there have been several imported cases to the US as well as around the world.
However, the more widespread problem is with KPC or Klebsiella producing carbapenemase strains. These are US home-grown strains that started in the 1990s in North Carolina and since then have spread to 44 states. We have had a couple of cases at Parkland and University hospital, but fortunately no sustained outbreaks so far.
However, the NIH Clinical Center in Bethesda, MD, widely regarded as one of the top hospitals in the country, was almost brought to its knees from an outbreak of KPC in its ICU. The index patient was transferred in June 2011 already colonized with the bacteria. Despite attempted strict infection control measures, over the next 6 months, 18 patients were found to be infected or colonized with KPC and 6 directly attributable deaths. They shut down one whole ICU, started an entire separate ward just for KPC patients and literally were in serious discussions of shutting down the entire hospital before the outbreak finally ended.
We have significant problems with MDR gram negatives of our own here in Dallas. I chose just one example, Acinetobacter baumanii to illustrate this issue. You can see the national trend of carbapenem resistance which almost doubled in the span of 2 years. Based on data from a retrospective review of AcB isolates at UHSP (252 isolates from 2008-2011) found that our local rates of carbapenem resistance are even higher, which probably would be mirrored in national data as well. We would see similar data at our other institutions if we looked.
What do all of these have in common? Heart and bone marrow transplant, LVAD, prosthetic joints, TNF inhibitors or other monoclonal therapies. You cannot use any of them, if you don’t have antibiotics that work. They are too risky if your patients are at high risk for developing infections that you subsequently have no options to treat. So, not only are we threatening to lose abx, but we are jeopardizing many of our other greatest medical advances.
--No longer are we going to be able to depend on the Big Pharma and the Abx pipeline to bail us out
--Statistics are sobering
Prior to 2013, only 2 new antibiotics approved in last 5 years (telavancin and ceftaroline); one is already not available on the market due to toxicity and neither are active against resistant GNB. However, starting to see an increase in abx approvals thanks to the GAIN legislation and other incentive programs.
Only 2 new abx with novel drug targets since 1998 (linezolid and daptomycin); no new abx classes for GNR in last 4 decades
Well, just tell Big Pharma to make more; Won’t happen unless the market changes drastically, 16 of 18 largest pharmaceutical companies have completely abandoned the abx market because it is economically unsustainable. Study from London School of Economics reported that the net ROI for a new neuromuscular drug is $1 billion dollars while a new abx would be expected to lose $50 million dollars
These are the 4 core strategies that the CDC has proposed to fight this problem. Obviously, all of these are critically important but I am going to focus on #3, which they single out as perhaps the single most important action needed to slow the development of drug resistance. Infection control, preventing infections, surveillance for drug resistance, developing better diagnostics and drugs are all important. But, improving our ability to effectively and wisely use and be stewards of the abx we have will play a central role.
The first thing that we can all do is get back to the basics—the so-called antibiotic best practices.
Every antibiotic you prescribe should have the right dose, should have a planned duration even if it ends up changing and an indication for why you are giving it. At UHSP and PMH, you have to specify your indication in the EMR and regulatory bodies are moving toward requiring this nationally.
Get cultures before starting antibiotics. I don’t have time to talk about some of the micro and diagnostic advances that are coming, because the reality is that our culture methods are imperfect. But the yield really goes down if you don’t get them before abx! It is kind of like giving thrombolytics before you do a CT scan, you will never know what you are treating.
Take an “abx timeout” after 48-72 hours to reassess, particularly if the abx you started were empiric therapy…more on this in a minute
This is an area where the input of our pharmacists are invaluable. We are truly fortunate that at all of the hospitals we train at, we have outstanding pharmacists with ID training who know more about abx than most of us, and have a lot to teach and to help with. TDM for drugs like vancomycin or aminoglycosides is critical for safe administration of these drugs. CI or EI help to optimize the PK/PD parameters, particularly with the beta-lactams and in some cases, have been shown to have superior outcomes in serious infections. But, for most of us, our pharmacists will need to help us with this.
**I want to highlight something that we can all do which is switch from IV-to-PO antibiotics with great po bioavailability in patients who have an intact GI tract. If you are giving one of the abx listed here and your patient is eating a diet and taking other po meds, you should give the abx po as well. It is a win-win because the abx levels are essentially the same, it helps you remove lines quicker, the patient is not tied down to an IV pole in bed and you can get them out of the hospital faster. Plus, the po abx is substantially cheaper, for the patient and the hospital.
This next one is a pet peeve of ASP teams, particularly Dr. Frankie Lee and myself so we will call you about this. Many of the broad spectrum abx that commonly as used have excellent anaerobic coverage like zosyn or carbapenems. So if you are treating an infection with possible anaerobes (lung abscess, abdominal infection) there is NO need to add flagyl or clindamycin. It adds nothing but it is done very commonly as shown in this recent VA study.
There are essentially only 2 scenarios where one of those drugs should be added to zosyn or carbapenems. What are they? GAS Necrotizing SSTI where you might add clinda for toxin inhibition; Severe complicated CDI where you might give IV flagyl, but hopefully you are trying to stop the other abx.
We already mentioned this but it is important to emphasize again. Usually, the residents are great at choosing the correct empiric regimens for HCAP or sepsis or meningitis or whatever. But then, at 72 hours, no one looks at the cultures and de-escalates, they just say well they are getting better on this vanc/zosyn/levaquin so I guess I will continue it. Now it can be difficult sometimes to de-escalate if your cultures are negative or the patient is worsening, but it is a skill that you can and should try to learn.
The other thing this slide emphasizes is that we frequently treat most infections for too long. Some of this is because of a lack of good data on how long to treat infections—this is why everything in ID seems to be in intervals of 7 days or 1 week. 2 weeks for this, 4 weeks for that, 6-8 weeks for that. But, where we do have data, we should use it and almost every RCT or meta-analysis that has looked at shorter courses have shown non-inferior outcomes to longer Rx courses. I have listed a few of the diagnoses. It is important to understand that most of these had clinical criteria the patient met to show an appropriate response, so you have to take that into account. But you will find that many of your patients will do just as well with shorter courses. If we can treat a VAP in 8 days, why do we need to treat pyelonephritis or cellulitis for 14 days?
This applies somewhat to the inpatient side, but also to the outpatient arena which is really a critical area where we need better stewardship. I have listed 3 of the most common infections where we have good evidence and guidelines that state abx should NOT be routinely given.
60% of all abx are given for outpt respiratory infections and almost all of them don’t need abx. 70% of patients with URI and > 90% of patients with acute sinusitis are given abx, but essentially 100% of URIs are viral and 70-80% of uncomplicated bronchitis is as well with no benefit from abx.
In journal club, we talk about NNT to benefit a patient. For these conditions, the NNT is > 4000 patients to benefit 1 patient. But in the meantime think of all the potential risks and side effects to the patient, not to mention drug resistance.
One course of an abx doubles a patient’s risk for a drug-resistant infection and this risk persists for up to a year after the abx is given. Think of the patients with simple cystitis who have to get admitted to the hospital for a PICC line and carbapenem because of their MDR organisms. The only indications for treating asymptomatic bacteriuria is in pregnancy and in patients preparing to undergo a urologic procedure. Presence of pyuria or “smelly urine” is not a symptom either, just like greenish nasal discharge or phlegm doesn’t equal a bacterial RTI
This is the key step in the outpt clinic, but it is a skill that you have to learn. I think the key is that you have to have a plan and a systematic approach. There are some good resources on the CDC website, one in particular that I like called the Viral Rx pad, which is a preprinted sheet where you can check the boxes for symptomatic relief Rx for viral colds, decongestants, etc. This gives you something to give the patient to walk out of your office with so they don’t leave empty-handed.
There are also a lot of false messages floating around in the general public and social media that we as clinicians have to correct. My favorite example is a Twitter message that said “Finally over my cold and thank God for Z-pack” which had over 850,000 followers. We have our work cut out for us.
I think this one is often overlooked but is really important, particularly at a teaching institution. Every time we prescribe an abx, someone is watching us and learning from us. May be our patient, may be a resident, an intern, a medical student. Ultimately, the only way that we can change abx prescribing is to change the culture and attitudes about antibiotics and how they should be used.
Example: Why does everyone who gets admitted, whether with septic shock or toenail fungus, get put on Vanc and zosyn? It is not because you had a pharmacology lecture in medical school called the Vanc and zosyn empirically for everything lecture. It is because we learn from what we see done and what is modeled for us. There are times when vanc and zosyn is a great choice, but there are other times when it is not. Find someone—an attending, a fellow, a resident, an intern– that takes a little bit of time to thoughtfully decide, What is my diagnosis? What am I treating? What bacteria am I trying to cover? How long am I going to treat for? If you find someone who thinks about and can articulate answers to these questions, watch and learn from them.
So, we have talked about what you can do. Now in the last few minutes, I want to talk about what the ASP can do to help you be successful. I borrowed this definition from Dr. Lee, who modified it from the IDSA guidelines and also an article which coined the phrase at the bottom. It is a pithy way of remembering what ASP is all about. Even though it may seem like it sometimes, we are NOT the Abx police. We want your patients to have the best outcome possible, for the abx that you give to be maximally effective and to minimize the potential harms along the way, to your patient and to future patients at our hospitals.
This is an older but classic RCT performed at U Penn just showing that ASP do in fact work. This compared two groups of about 65 patients each and found statistically significant superior outcomes in all of these measures in the patients where the ASP gave input to the clinicians on appropriate abx therapy.
Our goal as an ASP is to be your partner for your patients. Nothing makes us happier than for your patients to get better and walk out of the hospital, even if we play a very small part in that. Our goal is to improve quality of care and patient outcomes while reducing abx resistance, CDI and costs if possible. Multiple studies have consistently shown these improvements accrue with a comprehensive ASP team. Interestingly, in the hospital from the Univ of Maryland, after 8 years of successful savings, the administrators cut the ASP out and said we are just going to hire more ID physicians. Over the next two years, abx costs increased by 32%, almost 2 million dollars.
Finally, I included this picture, not because we are going to take you out to the lake fishing (Maybe Dr. Lee and Bhavan will). It is meant to remind me of the proverb that says Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime. At the heart of what we do as an ASP team, is education. We want to teach and empower you to handle abx effectively and wisely so that you are able to make the right decisions for your patients on your own.
This slide just shows you where on the VA homepage you can find our website, with a variety of helpful resources—antibiograms, guidelines for C. diff Rx, vancomycin and AG dosing, all kinds of great stuff.
This is who we are and how you can contact us. During normal business hours M-F at the VA or UTSW, you should call the pharmacist first or the attending physician second with questions. At night and on the weekends at the VA or UTSW and all of the time at Parkland, the first call should be to the on-call ID provider. However, all of us are happy to talk to you and help with any questions that you have and none of us is going to get upset if you call us for help to do the right thing for your patient in terms of antibiotics.
Thanks for your attention, I can take any questions you may have.