This document discusses the growing threat of antibiotic resistance and the role of general practitioners in addressing this issue. It notes that antibiotic resistance has emerged due to overuse and misuse of antibiotics in healthcare, agriculture, and other settings. While consumption of antibiotics in Ireland is high compared to other European countries, there are some signs of improvement in recent years. The document provides recommendations for GPs to optimize antibiotic prescribing practices including adhering to treatment guidelines, prescribing narrow over broad-spectrum antibiotics, and educating patients on appropriate antibiotic use. A multifaceted effort is needed across healthcare systems and with public involvement to curb antibiotic resistance.
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.
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.
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.
• 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
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 Leeds 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.
Dr Kathleen Holloway specialised in the public health of pharmaceuticals in low and middle-income countries and with a special interest in promoting more rational use of antibiotics.
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
In order to ensure the control, eradication and elimination of diseases, routine immunization is extremely important. Since the Indian climatic condition is extremely disease-prone, one needs to embrace the latest advancements which have ushered into the vaccine and immunization arena. Vaccination initiatives can be made more effective through a routine immunization program in India.
via : https://www.itsu.org.in/
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.
• 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
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 Leeds 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.
Dr Kathleen Holloway specialised in the public health of pharmaceuticals in low and middle-income countries and with a special interest in promoting more rational use of antibiotics.
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
In order to ensure the control, eradication and elimination of diseases, routine immunization is extremely important. Since the Indian climatic condition is extremely disease-prone, one needs to embrace the latest advancements which have ushered into the vaccine and immunization arena. Vaccination initiatives can be made more effective through a routine immunization program in India.
via : https://www.itsu.org.in/
3 Things Every Sales Team Needs to Be Thinking About in 2017Drift
Thinking about your sales team's goals for 2017? Drift's VP of Sales shares 3 things you can do to improve conversion rates and drive more revenue.
Read the full story on the Drift blog here: http://blog.drift.com/sales-team-tips
How to Become a Thought Leader in Your NicheLeslie Samuel
Are bloggers thought leaders? Here are some tips on how you can become one. Provide great value, put awesome content out there on a regular basis, and help others.
‘Antibiotic Ireland’ Antimicrobial Resistance A Major Cause for ConcernImproper Prescribing or Patient’s Misconceptions, Expectation and Pressure on Dr’s to prescribe ?
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.
‘Antibiotic Ireland'. Antimicrobial Resistance: A Major Cause for Concern. I...Theresa Lowry-Lehnen
‘Antibiotic Ireland’: Antimicrobial Resistance A Major Cause for Concern. Improper Prescribing or Patient’s Misconceptions, Expectation and Pressure on Dr’s to prescribe ?
For decades microbes, in particular bacteria, have become increasingly resistant to various antimicrobials.
The World Health Assembly’s endorsement of the Global Action Plan on Antimicrobial Resistance (AMR) in May 2015, and the Political Declaration of the High-Level Meeting of the General Assembly on AMR in September 2017, both recognize AMR as a global threat to public health.
These policy initiatives acknowledge overuse and misuse of antimicrobials as a main driver for development of resistance, as well as a need to optimize the use of antimicrobials.
The Global Action Plan on AMR sets out five strategic objectives as a blueprint for countries in developing national action plans (NAPs) on AMR:
Objective 1: Improve awareness and understanding of AMR through effective communication, education and training.
Objective 2: Strengthen the knowledge and evidence base through surveillance and research.
Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.
Objective 4: Optimize the use of antimicrobial medicines in human and animal health.
Objective 5: Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Antimicrobial stewardship programmes optimize the use of antimicrobials, improve patient outcomes, reduce AMR and health-care-associated infections, and save health-care costs amongst others.
Today, AMS is one of three “pillars” of an integrated approach to health systems strengthening. The other two are infection prevention and control (IPC) and medicine and patient safety.
Linking all three pillars to other key components of infection management and health systems strengthening, such as AMR surveillance and adequate supply of quality assured medicines, promotes equitable and quality health care towards the goal of achieving universal health coverage
CDC has defined “Antimicrobial stewardship” as-
The right antibiotic
for the right patient,
at the right time,
with the right dose, and
the right route, causing
the least harm to the patient and future patients
Why AMSP is needed?
Antimicrobial Resistance (AMR)
Misuse and Over-use of Antimicrobials
Widespread Use of Antimicrobials in Other Sectors
Poor Antimicrobial Research
IMPLEMENTATION OF ANTIMICROBIAL STEWARDSHIP PROGRAM
Administrative Support (Leadership)
Formulating AMS Team
Infrastructure Support
Framing Antimicrobial Policy
Implementing AMS strategies
Education and Training
Should be publicly committed to the program.
Provide necessary funding and infrastructure support.
Multidisciplinary committee - responsible for framing, implementing and monitoring the compliance to antimicrobial policy of the hospital.
Led by the antimicrobial steward - infectious disease physician or infection control officer or clinical microbiologist.
Other members of AMS team - stewardship nurses
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
1. Tackling Antibiotic Resistance -
The GP’s Role
Why should all of you be
worried ?
What can you do ?
DR Nuala O Connor ICGP Lead HCAI AMR
Health Care Associated Infections and Antimicrobial Drug Resistance
National Primary Care Conference Kilkenny November 2014
2. “WHO’s first global report on antibiotic resistance reveals
serious, worldwide threat to public health” APRIL 2014
“Without urgent, coordinated action by many stakeholders, the world
is headed for a post-antibiotic era, in which common infections and
minor injuries which have been treatable for decades can once again
kill,” BBC WORLD NEWS
3. E.coli resistant to 3rd generation
Cephalosporins
2002 2012
Overall consumption of antibiotics is less/ use more narrow spectrum than broad spectrum
4. Antimicrobial resistance trends:
Bloodstream infections in Ireland: 2002-2012
Data source: HPSC/EARS-Net
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Proportion resistance
Year
Meticillin-Resistant
Staph. aureus
Vancomycin-Resistant
Enterococcus faecium
Penicillin-Resistant
Strep. pneumoniae
Erythromycin-Resistant
S. pneumoniae
Cephalosporin-
Resistant E. coli
Quinolone-Resistant
E. coli
Multiple-Resistant
E. coli
4
5. 25,ooo deaths from
multi-drug resistant
organisms each year in
Europe
HCAI from resistant bacteria-
Difficult to treat, prolonged
illness, hospital stays, risk of
death
“SUPERBUGS “
6. Why has this problem of Antibiotic resistance emerged?
Multifactorial
Increasing complexity of
healthcare
Ageing population
Concerns about ‘missing sepsis’
Overuse of broad spectrum
agents
Failure to de-escalate from broad
spectrum to narrow spectrum
Not sending specimens to lab
Not acting on lab reports
Overly lengthy treatment
courses
Lack of awareness about the
issue of resistance among HCW
Lack of patients awareness
about the issue of resistance
Patient compliance issues
Time pressure
Patient pressure
High antimicrobial use in
veterinary sector
Lack of regulation of
antimicrobial dispensing in some
countries
Poor sanitation in developing
world
7. How can general practioners help?
What’s different about countries with low
rates AMR
• Overall consumption of
antibiotics is less.
• Greece and Cyprus use 3
times more antibiotics
per head of population
than Netherlands
• Use more narrow
spectrum Antibiotics than
broad spectrum.
Primary Care Antibiotic Consumption
Rates
8. Ireland DDD’s
Year Rate
2003 20.34
2004 20.19
2005 20.50
2006 21.09
2007 22.03
2008 21.00
2009 20.23
2010 19.75
2011 22.55
2012 22.80
2013 23.66
Primary Care Antibiotic
Consumption Rates
80 % of antibiotics
Community
9. Antimicrobial Use % Prevalence HALT
Ireland V Europe
If you are resident in an Irish nursing home, you are more than twice
as likley to be on an antibiotic than in any other European Country
39% prophylaxis
Majority
prescribed
within
LTCF by
GPs and
directly-employed
doctors
10. Demystify Antibiotic
Stewardship
Ensuring you prescribe the
right antibiotic for the patient
in front of you at the right time
with the right dose duration
and route for the condition you
are treating causing the least
amount of harm to that
patient and future patients
11. Every time we consider
prescribing GP’s need
to ask themselves …….
Is this antibiotic really necessary ?
12. If you decide to
prescribe ask the
following questions ?
What do I tend to prescribe for a
particular condition?
Is it the right drug for this condition ?
Is it the right dose for the patient
sitting in front of me ?
How long do I tend to prescribe it
for?
What investigations, if any, do I use
to support my decisions?
Do I know about the Irish primary
care prescribing guidelines and am I
using them?
13. Narrow versus broad-spectrum
Penicillin V for strep throat Co amoxiclav for strep throat
GP’s need to think more scientifically – what are you treating ?
14. Am I keeping my patients Safe
from Antibiotic Side-effects
Nausea vomiting , diarrhoea ,rashes
Toxicity from prolonged use – nitrofurantoin for UTI
prophylaxis and pneumotoxicity
Toxicity from idiosyncratic reactions –liver failure with co
amoxiclav
Toxicity when dose not reduced or incorrect antibiotic
used for patients with chronic kidney disease
Interaction with other medicines – statins and macrolides
C. diff overgrowth leading to serious infection after few
doses of antibiotic
Serious Allergic reactions
15. Every time we consider
prescribing GP’s need
to ask themselves …….
Have I consulted the antibiotic
guidelines recently?
www.antibioticprescribing.ie
17. 1. Community Resistance Data Tool
2.Antibiotic prescriber feedback
mechanism for all Patients
Gp owns the Data -used for Quality
Improvement
Collaboration between iPCRN, ICGP,
Primary Care Directorate, Patient
Quality and Safety , HCAI AMR
Clinical Care Programme
Improve patient care
Audit requirements for medical
council
18. Public Antibiotic Awareness Campaign
Explain why we need to need to preserve this
Taking antibiotics
for colds and flu?
There’s no point.
A cold or flu is caused by a
virus and antibiotics do not
work on viruses.
talk to your GP or pharmacist or visit www.hse.ie
precious resource
Antibiotics can kill bacteria.
They have no effect on viruses
such as head cold, flu, chickenpox.
They will not reduce a fever
They will not relieve pain.
Rest, fluids and TLC important
part of recovery from all
infections.
Do they know how to take them
correctly?
20. Things you can do now to help
reduce Antimicrobial Drug resistance
Do not prescribe antibiotics unless
there is a definite clinical
indication to do so
Prescribe first line recommended
antimicrobials – 5 antibiotics
Co-amoxiclav is not a first-line drug
for the common conditions
encountered in General Practice
Prescribe phenoxymethylpenecillin
for tonsillitis unless the patient is
truly allergic to penicillin.
Restrict macrolides to patient with
true penicillin allergy or definite
clinical indication e.g mycoplasma
Review any patients in LTCF on
prophylactic treatment for UTI
Develop simple antibiotic
prescribing policy for your
practice and for nursing home
residents based on
www.antibioticprescribing.ie
Possible idea for audit
requirement's 2014/2015 cycle
21. Mutltifactorial
Global Strageties
National Strageties
Healthcare workers
Professional Respsonsibility
Public recognise they role they
must play
Stop the spread of infections
Promote immunisation
Encourage appropriate use of
antibiotics in humans and
agriculture
Support development of new
WHAT CAN WE DO ? antimicrobial agents
22. Some signs of improvement 2014
Community Antibiotic
Consumption first half 2014 Use of co amoxiclav
23. Keeping Antibiotics Safe And Effective
For Future Generations …
Dept of
Health
HSE
Pharmacists
Surgeons
Dept of
Agriculture
gp
Patients
Vets
Physicians
..it’s
everyone's
responsibility
Editor's Notes
In april this year the who published its first global report on antibiotic resistance . I will read a quote form one of the Headlines around the world that day ….there is a real sense of urgency among world experts that time is running put. The antibiotic's we have now are probably the best we will ever have . We cannot expect a steday supply of novel antibitocs and we must all act now to preserve this precious resource for future generations .
These are 2 maps showing e. coli resistance to 3rd generation cephalsporins in blood stream isolates collected by EARRs which is european wide reporting system . There are a fe things I want o draw your attention too . Green is good meaning low levels of résistance red is bad meaning high levels of resistance and orange and yellow in between. Look at the rise in résistance in the 10 year time frame. I could show you another 20 maps different bug different antibiotc but the same pattern apart form MRSA which is the only good news story . Id also like to draw your attention to the northern southern europen divide with ne countries less reistance than soutern euoprean . There are 2 main reason for this ……..
Why should we worry abut theses multi drug resistant organisms or the suberbugs as I like to call them . Well it is estimated they are responsible for 25,000 deaths each year in europe . While I in no way mean to belittle the enormous tragedy west aftica is facing with EBOLA when you compare the few deaths in europe form ebola to the silent growing epidemic of superbugs it is something we cannot ignore. The world is a very different place . Irish people are travelling all the tiem . The demographics of ireland are changing , we have peole resident here form all over the world and they travel home for weddings, funerals and holidays and the bugs are hitching a ride.
If you are resident in an Irish nursing home you are more than twice as likley to be on an antibiotic than in any other european country
Emphasize that most antibiotics are prescribed and consumed in the community not hospitals, not vetinary so community prescribers have a very signifgant role to play in the fight against AMR
There is no indication to prescribe anything other than penicillin v for strep throat even with invasive group B strep
Co amoxilcav most commonly prescribed antibiotic in our nursing homes and in general practice Uti studies yet not first line drug
We prescribe far more macrolides that our European counterpart but no evidence we are more allergic
Apart from unnecessary antibiotic use contributing to the growing problem of antimicrobial drug resistance they can also cause harm to patients and we need to think carefully before we prescribe them . Many antibiotics cause nausea vomiting or diarrhea especially infants and younger children . All have toxicity potential interact with other medicines sometime with very serious consequence's e.g prolongation of Qt interval macrolides and statins leading to increased risk od sudden cardiac death and of course we all know that serious anaphylaxis can occur
Prescribing guidelines for primary care are updated as appropriate and widely distributed to all community settings.
Feedback on individual prescribing data to GPs is established to encourage targeted prescribing of narrow spectrum antimicrobials.
An audit tool for prescribing which meets professional competence requirements is considered.
Timely national/local antimicrobial resistance data is fed back to GP’s
There is adequate access to microbiological laboratory services with quick turnaround time, electronic feedback of results and microbiology consultant advice .
Most common infections don’t need antibiotics – they get better by themselves.
Taking antibiotics when you don’t need them puts your health and the health of your family at risk.
If your doctor decides that you do need an antibiotic, make sure you take it exactly as prescribed and complete the course. “By the time I am sick enough to contact or visit a doctor because of a cold I usually expect to get a prescription for antibiotics”
48% of the public disagreed with this statement so as GP’s we are probably in a stronger position to to reassure our patients when an antibiotic is not needed than we realise .