Antibiotic resistance is a Global Threat, Antibiotic prescription practices are varied and rationalization of usage can find a way to reduce! Understanding ideal prescription practice for antibiotics shall help clinician improvise outcomes.
Rational use of antibiotics & problem of antibiotic resistenseVirendra Hindustani
Rational use of antibiotics and combating antibiotic resistance is important. [1] Unnecessary antibiotic use creates selective pressure for bacteria to become resistant. [2] Fleming warned in 1945 about antibiotic resistance developing from exposure to sublethal drug doses. [3] Factors like environmental conditions, drug properties, patient factors, and prescribing practices influence antibiotic resistance.
This document provides guidelines for antibiotic use, including for severe sepsis, septic shock, and other infections. It discusses evaluation of systemic inflammatory response syndrome and organ dysfunction. Choice of antibiotics depends on the suspected causative organism and its susceptibility. Reserve antibiotics like carbapenems and linezolid require meeting certain criteria. The document recommends measures to control multi-drug resistant organisms and emphasizes rational antibiotic use to reduce antimicrobial resistance.
This document discusses the rational use of antibiotics. It notes that 50% of antibiotics are used inappropriately and that many infections like diarrhea and bronchitis are viral, not bacterial. It provides details on selecting antibiotics based on the infection severity, likely bacteria, patient factors, and cost. Empiric antibiotic choices are outlined for various infections. The side effects and costs of common antibiotics are also reviewed. The document emphasizes using antibiotics appropriately only for bacterial infections.
1. Opportunistic infections associated with HIV can affect the gastrointestinal, respiratory, neurological, and mucocutaneous systems. Common gastrointestinal infections include Cryptosporidium, Microsporidia, and Cytomegalovirus, presenting with diarrhea, abdominal pain, and weight loss.
2. Frequent respiratory infections are Pneumocystis jirovecii pneumonia and bacterial pneumonias. Pneumocystis presents with cough and difficulty breathing, while bacterial pneumonias cause more acute symptoms.
3. Common neurological opportunistic infections are Toxoplasmosis, Cryptococcosis, and HIV-associated dementia. Toxoplasmosis and Cryptococcos
Rational use of antibiotics by Dr. Basil TumainiBasil Tumaini
Dr. Basil Tumaini presented a document on rational use of antibiotics. He discussed that antibiotics are commonly misused and overprescribed. Some key points included defining appropriate vs inappropriate antibiotic use, describing different antibiotic classes, and providing guidelines on rational prescribing like only using antibiotics for bacterial infections and avoiding unnecessary combinations. The document concluded with recommendations to only use antibiotics judiciously according to clinical guidelines and provide proper patient education.
Antibiotic stewardship programme hiht final 3nov2012Vikas Kesarwani
The document discusses antimicrobial stewardship and its importance. It provides 3 key goals of antimicrobial stewardship programs: [1] Ensuring each patient receives the most appropriate antimicrobial, [2] Preventing overuse, misuse and abuse of antimicrobials, and [3] Minimizing the development of resistance. It also outlines some core strategies for antimicrobial stewardship programs, including formulary restrictions, preauthorization requirements, and prospective audit and feedback of antimicrobial usage.
Rational use of antibiotics & problem of antibiotic resistenseVirendra Hindustani
Rational use of antibiotics and combating antibiotic resistance is important. [1] Unnecessary antibiotic use creates selective pressure for bacteria to become resistant. [2] Fleming warned in 1945 about antibiotic resistance developing from exposure to sublethal drug doses. [3] Factors like environmental conditions, drug properties, patient factors, and prescribing practices influence antibiotic resistance.
This document provides guidelines for antibiotic use, including for severe sepsis, septic shock, and other infections. It discusses evaluation of systemic inflammatory response syndrome and organ dysfunction. Choice of antibiotics depends on the suspected causative organism and its susceptibility. Reserve antibiotics like carbapenems and linezolid require meeting certain criteria. The document recommends measures to control multi-drug resistant organisms and emphasizes rational antibiotic use to reduce antimicrobial resistance.
This document discusses the rational use of antibiotics. It notes that 50% of antibiotics are used inappropriately and that many infections like diarrhea and bronchitis are viral, not bacterial. It provides details on selecting antibiotics based on the infection severity, likely bacteria, patient factors, and cost. Empiric antibiotic choices are outlined for various infections. The side effects and costs of common antibiotics are also reviewed. The document emphasizes using antibiotics appropriately only for bacterial infections.
1. Opportunistic infections associated with HIV can affect the gastrointestinal, respiratory, neurological, and mucocutaneous systems. Common gastrointestinal infections include Cryptosporidium, Microsporidia, and Cytomegalovirus, presenting with diarrhea, abdominal pain, and weight loss.
2. Frequent respiratory infections are Pneumocystis jirovecii pneumonia and bacterial pneumonias. Pneumocystis presents with cough and difficulty breathing, while bacterial pneumonias cause more acute symptoms.
3. Common neurological opportunistic infections are Toxoplasmosis, Cryptococcosis, and HIV-associated dementia. Toxoplasmosis and Cryptococcos
Rational use of antibiotics by Dr. Basil TumainiBasil Tumaini
Dr. Basil Tumaini presented a document on rational use of antibiotics. He discussed that antibiotics are commonly misused and overprescribed. Some key points included defining appropriate vs inappropriate antibiotic use, describing different antibiotic classes, and providing guidelines on rational prescribing like only using antibiotics for bacterial infections and avoiding unnecessary combinations. The document concluded with recommendations to only use antibiotics judiciously according to clinical guidelines and provide proper patient education.
Antibiotic stewardship programme hiht final 3nov2012Vikas Kesarwani
The document discusses antimicrobial stewardship and its importance. It provides 3 key goals of antimicrobial stewardship programs: [1] Ensuring each patient receives the most appropriate antimicrobial, [2] Preventing overuse, misuse and abuse of antimicrobials, and [3] Minimizing the development of resistance. It also outlines some core strategies for antimicrobial stewardship programs, including formulary restrictions, preauthorization requirements, and prospective audit and feedback of antimicrobial usage.
Asthma is a chronic inflammatory disease of the airways characterized by airway inflammation, airflow obstruction, and bronchial hyperresponsiveness. It cannot be cured but can be well controlled through pharmacological treatment including inhaled corticosteroids and bronchodilators. Inhaled corticosteroids are the most effective long-term controller medication for asthma and help reduce exacerbations and mortality when used appropriately. Proper inhaler technique and regular monitoring of symptoms and lung function are important to achieve optimal asthma control.
This document discusses the problem of increasing antimicrobial resistance and outlines strategies for antimicrobial stewardship programs. It recognizes antimicrobial resistance as a serious global problem that requires immediate action. Antimicrobial stewardship is defined as optimizing antibiotic use through selecting appropriate treatment duration, dose, and spectrum of coverage. The document recommends establishing multidisciplinary stewardship teams and implementing interventions like guidelines, audit and feedback, and streamlining of therapy to improve antibiotic use and slow the development of resistance. Physicians are identified as key players that can help address the problem through their antibiotic prescribing practices.
This document discusses the rational use of antibiotics. It begins with definitions of antibiotics and infection, noting that infection is a major cause of morbidity and mortality. The introduction emphasizes the importance of rational antibiotic use to avoid unnecessary harm. The document then covers the history of chemotherapy and antimicrobial discovery. It describes antibiotic classes, mechanisms of action, administration, and principles of use like appropriate patient/drug selection. The document discusses problems like resistance, adverse effects, and irrational use. It emphasizes the importance of diagnosis, optimal dosing, and restricting newer antibiotics to promote prudent long-term use.
This document discusses factors to consider when selecting an antimicrobial regimen. It covers obtaining microbiology samples before initiating therapy, host and drug factors, and the pros and cons of combination therapy. Key signs of infection discussed include fever, white blood cell count, local signs, and organ-specific symptoms. Gram stain results are provided for 3 example patients presenting with respiratory infection. Host factors like age, pregnancy status, organ function, genetic factors, concomitant diseases and medications must all be considered when selecting the appropriate antimicrobial regimen.
General principles of antimicrobial therapyAbialbon Paul
This document outlines several key principles of antimicrobial therapy, including:
- Selecting drugs based on their selective toxicity to pathogens, pharmacokinetics, and whether they are bacteriostatic or bactericidal.
- Considering concentration-dependent vs. time-dependent killing and the post-antibiotic effect.
- Using combination therapy appropriately to enhance effects and delay resistance.
- Choosing drugs based on the infection's spectrum, risk of superinfections, and empirical vs. prophylactic use.
- Accounting for microbial sensitivity, mechanisms of resistance development, and host factors like disease states and organ function.
- Managing adverse effects, drug interactions, and cost considerations.
General Principles of Antimicrobial Selection - 2018Arwa M. Amin
Module: Pharmacology and Therapeutics III, (Therapeutics part)
Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Undergraduate, B.Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value associated with it
This document discusses tuberculosis (TB) globally and in Pakistan. It notes that TB infects over 1 billion people worldwide and causes millions of deaths each year. Pakistan has a high burden of TB, ranking 8th globally. The document then covers diagnosis and treatment of TB, including different regimens for new cases, re-treatment cases, and special populations like pregnant women, infants, and those with renal impairment or HIV/AIDS. It discusses managing TB in patients with conditions like silicosis or hepatitis induced by anti-TB treatment. The goal is to provide guidance on treating TB in complex situations.
This document provides an overview of upper respiratory tract infections including classification, common diseases, symptoms, diagnosis, and treatment. Upper respiratory tract infections involve the areas above the vocal cords such as the nose, sinuses, throat, and voice box. Common illnesses discussed are the common cold, acute rhinosinusitis, pharyngitis, and acute otitis media. The document outlines symptoms, causative agents, diagnostic approaches, and antibiotic treatment recommendations for each condition.
Tuberculosis is treated with a combination of drugs over several months. The standard treatment is isoniazid, rifampicin, pyrazinamide and ethambutol for two months, followed by isoniazid and rifampicin alone for four months. For latent tuberculosis, isoniazid alone is given for six to nine months. Several drugs are available as second and third line treatments if the bacteria develops resistance. Special considerations are needed for treating tuberculosis in patients with conditions like pregnancy, liver disease, epilepsy or kidney disease due to potential drug interactions and side effects.
This document discusses the approach to a child with recurrent or persistent pneumonia. It begins by defining recurrent pneumonia as 2 or more episodes in a year or 3 or more episodes ever, with radiological clearing between occurrences. Persistent pneumonia is defined as symptoms and radiological abnormalities persisting for over 1 month despite treatment. Potential underlying causes include congenital malformations, aspirations, defects in airway clearance, and disorders of local or systemic immunity. A detailed clinical history and preliminary investigations can provide clues to the underlying illness in many cases. The approach involves obtaining a thorough history, performing physical examinations and initial tests, and considering possible etiologies.
1) Antimicrobial stewardship programs aim to optimize antibiotic use and prevent resistance by coordinating actions to improve prescribing. They promote appropriate use through guidelines, education, and monitoring of antibiotic use and outcomes.
2) In NICUs, antimicrobial stewardship faces unique challenges due to non-specific signs of infection in neonates and difficulties obtaining cultures. Programs seek to minimize broad-spectrum antibiotic exposure and duration to reduce resistance and side effects.
3) Effective strategies for neonatal antimicrobial stewardship include developing unit-specific treatment guidelines, prospectively auditing antibiotic use, educating providers, streamlining therapy based on culture results, and implementing bundles to prevent infections.
Management of severe asthma an update 2014avicena1
This document discusses the management of severe asthma. It begins by defining several phenotypes of severe asthma, including refractory asthma and steroid-dependent asthma. It then reviews the diagnostic criteria for severe asthma established by the American Thoracic Society and European Respiratory Society, which requires one or more major criteria and two or more minor criteria. The document further discusses approaches to diagnosing and treating severe asthma, including evaluating for alternative diagnoses, assessing treatment compliance and triggers, addressing comorbidities, and considering immunotherapy options. It emphasizes the importance of phenotyping and endotyping asthma to enable personalized treatment approaches.
Diagnosis and Management of Malaria (in brief )Milan Kharel
This document discusses the diagnosis and management of malaria. It outlines the various laboratory tests used to diagnose malaria, including microscopy of blood films and rapid diagnostic tests. Common laboratory findings in malaria include anemia, elevated inflammatory markers, and thrombocytopenia. Uncomplicated malaria presents with nonspecific flu-like symptoms like fever, while severe falciparum malaria can involve life-threatening complications such as cerebral malaria, respiratory distress, hypoglycemia and bleeding disorders. Treatment involves antimalarial drugs for uncomplicated cases and intensive care for severe malaria, while control relies on vector control methods and intermittent therapy.
Pneumococcal vaccine in adults “Clinical Scenarios”Ashraf ElAdawy
This document provides information about Streptococcus pneumoniae (pneumococcus), including its transmission, colonization, clinical syndromes, risk groups, and vaccines for prevention. Some key points:
- Pneumococcus is a gram-positive bacterium commonly found in the respiratory tract. It has a polysaccharide capsule that helps it evade the immune system.
- Transmission occurs via respiratory droplets from carriers or those infected. Colonization often occurs without symptoms.
- It can cause pneumonia, bacteremia, and meningitis with varying case fatality rates. Those at highest risk are young children, older adults, and those with underlying conditions.
- The vaccines are PCV13
Pharmacotherapy of Lower respiratory tract infectionsTsegaye Melaku
This document provides information on lower respiratory tract infections. It discusses the epidemiology, etiology, pathogenesis and management of common lower respiratory tract infections. It compares different lower respiratory tract infections based on their clinical presentations. It also classifies pneumonia based on microbiology and setting. The document outlines appropriate management strategies and treatment outcomes for lower respiratory tract infections. Host defenses of the respiratory tract and factors that can interfere with defenses are described. Common lower respiratory infections like pneumonia, bronchitis and bronchiolitis are also discussed.
1. The document provides guidelines for antibiotic treatment of common infections in New Zealand, including respiratory infections like COPD, pneumonia and pertussis, as well as ear, nose and throat infections including otitis externa, otitis media and sinusitis.
2. It emphasizes the importance of antimicrobial stewardship to limit antibiotic use and slow the development of antibiotic resistance. First-line antibiotic options are provided for each condition.
3. Individual circumstances may alter treatment choices, and local resistance patterns should be checked with the local laboratory. The guidelines are intended as a consensus guide for typical patients commonly seen in general practice.
Pneumonia can be lobar, affecting an entire lung lobe, bronchopneumonia with multiple inflammatory foci around bronchioles, or interstitial affecting alveolar walls. Common causes are bacteria like Streptococcus pneumoniae, viruses such as respiratory syncytial virus, or atypical organisms. Symptoms vary from fever, cough, difficulty breathing to chest pain. Treatment involves antibiotics, oxygen, and addressing predisposing factors. Complications can include empyema, abscesses, or respiratory failure. Proper diagnosis and management are needed to prevent long-term pulmonary damage.
This document discusses multi-drug resistant tuberculosis (MDR TB). It begins with an introduction to TB and definitions of key terms like MDR and XDR TB. It then describes first and second line anti-TB drugs, mechanisms of drug resistance, and factors contributing to acquired resistance. The document outlines methods for diagnosing drug resistance including genetic detection and drug sensitivity testing. It concludes with a brief overview of treatment approaches for MDR TB.
Neisseria meningitidis is a leading cause of bacterial meningitis worldwide. It commonly causes epidemics in sub-Saharan Africa and sporadic cases elsewhere. Clinical features include sudden onset of fever, headache, and neck stiffness. Diagnosis is made by identifying the bacteria in spinal fluid. Antibiotics like penicillin and ceftriaxone are effective treatments but prevention through vaccination is important for controlling outbreaks.
Pneumonia in pregnancy april2018 pmm_aogsParthiv Mehta
The document discusses pneumonia in pregnancy. It notes that pneumonia can occur either upon arrival in pregnant patients (community acquired) or can arise during a hospital stay (nosocomial). The symptoms, methods for confirming infection, treatment approaches, complications, and prevention of pneumonia during pregnancy are covered. Misdiagnosis is common and a chest radiograph is needed to make a firm diagnosis of pneumonia. Treatment involves supportive care as well as antibiotics, with choices dependent on severity, co-morbidities, and other factors.
Pulmonary tuberculosis
The bacterium Mycobacterium tuberculosis causes tuberculosis (TB), a contagious, airborne infection that destroys body tissue. Pulmonary TB occurs when M. tuberculosis primarily attacks the lungs. However, it can spread from there to other organs.
New treatment regimen is mentioned here.
Asthma is a chronic inflammatory disease of the airways characterized by airway inflammation, airflow obstruction, and bronchial hyperresponsiveness. It cannot be cured but can be well controlled through pharmacological treatment including inhaled corticosteroids and bronchodilators. Inhaled corticosteroids are the most effective long-term controller medication for asthma and help reduce exacerbations and mortality when used appropriately. Proper inhaler technique and regular monitoring of symptoms and lung function are important to achieve optimal asthma control.
This document discusses the problem of increasing antimicrobial resistance and outlines strategies for antimicrobial stewardship programs. It recognizes antimicrobial resistance as a serious global problem that requires immediate action. Antimicrobial stewardship is defined as optimizing antibiotic use through selecting appropriate treatment duration, dose, and spectrum of coverage. The document recommends establishing multidisciplinary stewardship teams and implementing interventions like guidelines, audit and feedback, and streamlining of therapy to improve antibiotic use and slow the development of resistance. Physicians are identified as key players that can help address the problem through their antibiotic prescribing practices.
This document discusses the rational use of antibiotics. It begins with definitions of antibiotics and infection, noting that infection is a major cause of morbidity and mortality. The introduction emphasizes the importance of rational antibiotic use to avoid unnecessary harm. The document then covers the history of chemotherapy and antimicrobial discovery. It describes antibiotic classes, mechanisms of action, administration, and principles of use like appropriate patient/drug selection. The document discusses problems like resistance, adverse effects, and irrational use. It emphasizes the importance of diagnosis, optimal dosing, and restricting newer antibiotics to promote prudent long-term use.
This document discusses factors to consider when selecting an antimicrobial regimen. It covers obtaining microbiology samples before initiating therapy, host and drug factors, and the pros and cons of combination therapy. Key signs of infection discussed include fever, white blood cell count, local signs, and organ-specific symptoms. Gram stain results are provided for 3 example patients presenting with respiratory infection. Host factors like age, pregnancy status, organ function, genetic factors, concomitant diseases and medications must all be considered when selecting the appropriate antimicrobial regimen.
General principles of antimicrobial therapyAbialbon Paul
This document outlines several key principles of antimicrobial therapy, including:
- Selecting drugs based on their selective toxicity to pathogens, pharmacokinetics, and whether they are bacteriostatic or bactericidal.
- Considering concentration-dependent vs. time-dependent killing and the post-antibiotic effect.
- Using combination therapy appropriately to enhance effects and delay resistance.
- Choosing drugs based on the infection's spectrum, risk of superinfections, and empirical vs. prophylactic use.
- Accounting for microbial sensitivity, mechanisms of resistance development, and host factors like disease states and organ function.
- Managing adverse effects, drug interactions, and cost considerations.
General Principles of Antimicrobial Selection - 2018Arwa M. Amin
Module: Pharmacology and Therapeutics III, (Therapeutics part)
Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Undergraduate, B.Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value associated with it
This document discusses tuberculosis (TB) globally and in Pakistan. It notes that TB infects over 1 billion people worldwide and causes millions of deaths each year. Pakistan has a high burden of TB, ranking 8th globally. The document then covers diagnosis and treatment of TB, including different regimens for new cases, re-treatment cases, and special populations like pregnant women, infants, and those with renal impairment or HIV/AIDS. It discusses managing TB in patients with conditions like silicosis or hepatitis induced by anti-TB treatment. The goal is to provide guidance on treating TB in complex situations.
This document provides an overview of upper respiratory tract infections including classification, common diseases, symptoms, diagnosis, and treatment. Upper respiratory tract infections involve the areas above the vocal cords such as the nose, sinuses, throat, and voice box. Common illnesses discussed are the common cold, acute rhinosinusitis, pharyngitis, and acute otitis media. The document outlines symptoms, causative agents, diagnostic approaches, and antibiotic treatment recommendations for each condition.
Tuberculosis is treated with a combination of drugs over several months. The standard treatment is isoniazid, rifampicin, pyrazinamide and ethambutol for two months, followed by isoniazid and rifampicin alone for four months. For latent tuberculosis, isoniazid alone is given for six to nine months. Several drugs are available as second and third line treatments if the bacteria develops resistance. Special considerations are needed for treating tuberculosis in patients with conditions like pregnancy, liver disease, epilepsy or kidney disease due to potential drug interactions and side effects.
This document discusses the approach to a child with recurrent or persistent pneumonia. It begins by defining recurrent pneumonia as 2 or more episodes in a year or 3 or more episodes ever, with radiological clearing between occurrences. Persistent pneumonia is defined as symptoms and radiological abnormalities persisting for over 1 month despite treatment. Potential underlying causes include congenital malformations, aspirations, defects in airway clearance, and disorders of local or systemic immunity. A detailed clinical history and preliminary investigations can provide clues to the underlying illness in many cases. The approach involves obtaining a thorough history, performing physical examinations and initial tests, and considering possible etiologies.
1) Antimicrobial stewardship programs aim to optimize antibiotic use and prevent resistance by coordinating actions to improve prescribing. They promote appropriate use through guidelines, education, and monitoring of antibiotic use and outcomes.
2) In NICUs, antimicrobial stewardship faces unique challenges due to non-specific signs of infection in neonates and difficulties obtaining cultures. Programs seek to minimize broad-spectrum antibiotic exposure and duration to reduce resistance and side effects.
3) Effective strategies for neonatal antimicrobial stewardship include developing unit-specific treatment guidelines, prospectively auditing antibiotic use, educating providers, streamlining therapy based on culture results, and implementing bundles to prevent infections.
Management of severe asthma an update 2014avicena1
This document discusses the management of severe asthma. It begins by defining several phenotypes of severe asthma, including refractory asthma and steroid-dependent asthma. It then reviews the diagnostic criteria for severe asthma established by the American Thoracic Society and European Respiratory Society, which requires one or more major criteria and two or more minor criteria. The document further discusses approaches to diagnosing and treating severe asthma, including evaluating for alternative diagnoses, assessing treatment compliance and triggers, addressing comorbidities, and considering immunotherapy options. It emphasizes the importance of phenotyping and endotyping asthma to enable personalized treatment approaches.
Diagnosis and Management of Malaria (in brief )Milan Kharel
This document discusses the diagnosis and management of malaria. It outlines the various laboratory tests used to diagnose malaria, including microscopy of blood films and rapid diagnostic tests. Common laboratory findings in malaria include anemia, elevated inflammatory markers, and thrombocytopenia. Uncomplicated malaria presents with nonspecific flu-like symptoms like fever, while severe falciparum malaria can involve life-threatening complications such as cerebral malaria, respiratory distress, hypoglycemia and bleeding disorders. Treatment involves antimalarial drugs for uncomplicated cases and intensive care for severe malaria, while control relies on vector control methods and intermittent therapy.
Pneumococcal vaccine in adults “Clinical Scenarios”Ashraf ElAdawy
This document provides information about Streptococcus pneumoniae (pneumococcus), including its transmission, colonization, clinical syndromes, risk groups, and vaccines for prevention. Some key points:
- Pneumococcus is a gram-positive bacterium commonly found in the respiratory tract. It has a polysaccharide capsule that helps it evade the immune system.
- Transmission occurs via respiratory droplets from carriers or those infected. Colonization often occurs without symptoms.
- It can cause pneumonia, bacteremia, and meningitis with varying case fatality rates. Those at highest risk are young children, older adults, and those with underlying conditions.
- The vaccines are PCV13
Pharmacotherapy of Lower respiratory tract infectionsTsegaye Melaku
This document provides information on lower respiratory tract infections. It discusses the epidemiology, etiology, pathogenesis and management of common lower respiratory tract infections. It compares different lower respiratory tract infections based on their clinical presentations. It also classifies pneumonia based on microbiology and setting. The document outlines appropriate management strategies and treatment outcomes for lower respiratory tract infections. Host defenses of the respiratory tract and factors that can interfere with defenses are described. Common lower respiratory infections like pneumonia, bronchitis and bronchiolitis are also discussed.
1. The document provides guidelines for antibiotic treatment of common infections in New Zealand, including respiratory infections like COPD, pneumonia and pertussis, as well as ear, nose and throat infections including otitis externa, otitis media and sinusitis.
2. It emphasizes the importance of antimicrobial stewardship to limit antibiotic use and slow the development of antibiotic resistance. First-line antibiotic options are provided for each condition.
3. Individual circumstances may alter treatment choices, and local resistance patterns should be checked with the local laboratory. The guidelines are intended as a consensus guide for typical patients commonly seen in general practice.
Pneumonia can be lobar, affecting an entire lung lobe, bronchopneumonia with multiple inflammatory foci around bronchioles, or interstitial affecting alveolar walls. Common causes are bacteria like Streptococcus pneumoniae, viruses such as respiratory syncytial virus, or atypical organisms. Symptoms vary from fever, cough, difficulty breathing to chest pain. Treatment involves antibiotics, oxygen, and addressing predisposing factors. Complications can include empyema, abscesses, or respiratory failure. Proper diagnosis and management are needed to prevent long-term pulmonary damage.
This document discusses multi-drug resistant tuberculosis (MDR TB). It begins with an introduction to TB and definitions of key terms like MDR and XDR TB. It then describes first and second line anti-TB drugs, mechanisms of drug resistance, and factors contributing to acquired resistance. The document outlines methods for diagnosing drug resistance including genetic detection and drug sensitivity testing. It concludes with a brief overview of treatment approaches for MDR TB.
Neisseria meningitidis is a leading cause of bacterial meningitis worldwide. It commonly causes epidemics in sub-Saharan Africa and sporadic cases elsewhere. Clinical features include sudden onset of fever, headache, and neck stiffness. Diagnosis is made by identifying the bacteria in spinal fluid. Antibiotics like penicillin and ceftriaxone are effective treatments but prevention through vaccination is important for controlling outbreaks.
Pneumonia in pregnancy april2018 pmm_aogsParthiv Mehta
The document discusses pneumonia in pregnancy. It notes that pneumonia can occur either upon arrival in pregnant patients (community acquired) or can arise during a hospital stay (nosocomial). The symptoms, methods for confirming infection, treatment approaches, complications, and prevention of pneumonia during pregnancy are covered. Misdiagnosis is common and a chest radiograph is needed to make a firm diagnosis of pneumonia. Treatment involves supportive care as well as antibiotics, with choices dependent on severity, co-morbidities, and other factors.
Pulmonary tuberculosis
The bacterium Mycobacterium tuberculosis causes tuberculosis (TB), a contagious, airborne infection that destroys body tissue. Pulmonary TB occurs when M. tuberculosis primarily attacks the lungs. However, it can spread from there to other organs.
New treatment regimen is mentioned here.
This document discusses pediatric bacterial meningitis in the Philippines. It notes that bacterial meningitis is a leading cause of mortality in children ages 0-4 in the Philippines. Treatment recommendations must be tailored to the pathogens and susceptibility patterns identified in the Philippine setting. Signs and symptoms of meningitis vary by age, and lumbar puncture is essential for diagnosis. Empiric antibiotic therapy should cover the most likely causative organisms based on local data. Routine use of dexamethasone as an adjuvant therapy is not recommended in the Philippine setting. Ongoing surveillance of antimicrobial resistance is needed to guide treatment.
Managing MDR/XDR Gram Negative infections in ICUVitrag Shah
The document discusses antimicrobial resistance and multidrug-resistant organisms. It notes certain organisms like Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species have developed resistance to multiple drug classes and have high mortality rates. It defines multidrug resistance, extensive drug resistance, and pan drug resistance based on the number of antimicrobial categories an organism is resistant to. Treating such infections requires less effective, more toxic, and expensive drugs. Combination therapy and optimizing dosing is important to prevent further resistance development.
Its INC initiates to educate with services of all nurse working in clinical case management of AIDS, Malaria, Filaria, Tuberculosis,other leading infectoious diseases to prevent and control aspect of health of individual/community/society.
The document discusses TB-HIV co-infection, including that TB is the leading cause of death for those with HIV worldwide. It covers symptoms of TB, treatment guidelines including first and second line regimens, and considerations for treating TB-HIV co-infected patients. It also addresses management of other conditions like malaria, filariasis, and sexually transmitted diseases. Nursing care involves monitoring patients and ensuring proper treatment, counseling on adherence, and preventing transmission.
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
The National TB Elimination Programme has changed its nomenclature from the Revised National TB Control Programme to the National TB Elimination Programme from January 2020. India has the highest burden of both TB and MDR-TB globally. An estimated 71,000 cases of MDR-TB emerge annually from notified pulmonary TB cases in India. The objectives of the programme are to improve case detection and ensure complete treatment for all TB patients. The document outlines case definitions, diagnostic tools, treatment regimens, and follow-up procedures for both drug sensitive and drug resistant TB cases under the new programme.
Tetanus is a neurological disease caused by Clostridium tetani bacteria. It causes painful muscle spasms and can be fatal. It occurs worldwide but is more common in developing nations. Neonatal tetanus is a major cause of death in infants. Prevention relies on immunizing mothers during pregnancy through tetanus toxoid vaccines. Treatment involves managing spasms and complications through supportive care like mechanical ventilation. Strict clean delivery practices and ensuring mothers receive tetanus vaccines can eliminate neonatal tetanus globally.
The document provides information on antitubercular agents used to treat tuberculosis (TB) including their mechanisms of action, pharmacokinetics, adverse effects, and monitoring considerations. It discusses the types and risk factors of TB as well as diagnostic testing and treatment guidelines including directly observed therapy. Key drugs covered are isoniazid, rifampin, pyrazinamide, and ethambutol.
This document provides guidance on occupational exposure to tuberculosis (TB) for healthcare workers. It discusses latent TB infection, including what it is, who should be screened, and how to treat it. It also compares latent TB to active TB disease. The document recommends screening high-risk groups for latent TB with tuberculin skin tests. It provides criteria for determining positive skin test reactions and guidelines for treating latent TB infection with medications like isoniazid. The document concludes with recommendations from CDC and WHO on preventing TB transmission in healthcare settings through administrative, environmental and personal protective equipment controls.
This document provides guidance on diagnosing and treating tuberculosis (TB) and latent TB infection. It discusses diagnostic tests like chest x-rays, sputum smears and cultures, and recommends thinking TB in the differential diagnosis for those with persistent cough, fever or weight loss. Standard TB treatment involves 4 first-line drugs for 2 months followed by 2 drugs for 4 more months, with longer treatment for drug-resistant cases. Treatment of latent TB typically involves 9 months of isoniazid. Close monitoring is needed when treating TB in patients with conditions like HIV, liver disease or malnutrition.
Staph aureus
Strep pneumoniae
Toxicity:
Hepatotoxicity
QT prolongation
GI upset
Clarithromycin
Similar spectrum to erythromycin
Better absorption and tolerability
Used for:
H pylori eradication
Mycobacterium avium complex
Legionella
Toxicity:
Hepatotoxicity
QT prolongation
Drug interactions
No IV formulation
Azithromycin
Similar spectrum to clarithromycin
Once daily dosing
Used for
Community acquired pneumonia 2015 part 2samirelansary
1. The document discusses treatment strategies for hospital-acquired pneumonia (HAP), healthcare-associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). Initial empiric antibiotic therapy should be selected based on risk factors for multidrug-resistant pathogens and bacteriology patterns.
2. Cultures of respiratory specimens should be obtained to identify the pathogen before and during antibiotic treatment. Therapy can then be de-escalated based on culture results and clinical response.
3. Antibiotic treatment duration should be long enough for efficacy but avoid excessive use by prescribing the minimum needed. Therapy for VAP due to Pseudomonas or Acinetobacter may require 15 days instead of the usual 8 days
Community acquired pneumonia 2015 part 2samirelansary
1. The document discusses treatment strategies for hospital-acquired pneumonia (HAP), healthcare-associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). Initial empiric antibiotic therapy should be selected based on risk factors for multidrug-resistant pathogens and bacteriology patterns.
2. Cultures of respiratory specimens should be obtained to identify the pathogen before and during antibiotic treatment. Therapy can then be de-escalated based on culture results and clinical response.
3. Antibiotic treatment duration should be long enough for efficacy but minimized to avoid overuse. Most patients can be treated for 7-8 days, but longer courses may be needed for certain multidrug-resistant pathogens.
India has the largest burden of tuberculosis. The disease is gradually extending its storm into the paediatric age group, the manifest in which is severe and tortous. So a preventive approach is always better than a curative approach
This document discusses the approach to new onset fever in the pediatric intensive care unit (PICU). It notes that fever is commonly assumed to be due to infection, but there can be other causes. Differential diagnoses for new fever are reviewed, including both infectious and non-infectious etiologies. Guidelines are provided on proper temperature measurement for intubated patients. The document advocates evaluating each case individually and considering various differential diagnoses rather than automatically assuming infection and escalating antibiotics. It also discusses the appropriate strength of indication for fever control depending on factors like fever height and underlying condition. The goal is to present a more nuanced approach to new fever than a "one size fits all" response.
Similar to Parthiv Mehta Rational Use of Antibiotics 20180722 (20)
The document reviews several studies on chronic obstructive pulmonary disease (COPD) in India and clinical trials of various COPD medications:
- An estimated 12.36 million Indian adults have COPD, with higher prevalence in males (5%) than females (2.7%).
- Recent trials show new long-acting bronchodilators like umeclidinium and glycopyrronium improve lung function, dyspnea, and quality of life in COPD. Combinations of long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) provide benefits over monotherapies.
- Studies provide evidence for the use of LAMAs in
Pre operative pulmonary evaluation 2019Parthiv Mehta
Comprehensive over view of identification of risk factors and its assessment. understanding basics and specialized investigations, its interpretation and methodical use of algorithm.targeted to enhance identification of risks and prevention of complications
Lymphadenitis is one of the common problem faced; at least once; during life time. Acute self limiting are mostly seen during childhood. As age progress, Chronic and Difficult to diagnose and treat category adds on. This presentation is targeting to make it simple to understand Lymph-adenitis - Granulomatous especially.
COPD; a chronic, progressive airway obstruction; is directly linked with persistent inflammation and high oxidative stress. Airway obstruction is added on by plugging of airways with thick mucus. Role and efficacy of N-acetyl cysteine is reviewed with clinical cases.
Reactive airway obstruction in children detection management_2018_pmmParthiv Mehta
Airways are too sensitive in children. Its reactivity may be incidental or occasional. if that remains repetitive, it becomes a concern for child, family and treating team. Addressing here spectrum of Reactive Airway Obstruction in Children from a Pulmonologist's view
This document summarizes a presentation on acute and chronic bronchitis. It begins by defining acute bronchitis as inflammation of the large bronchi caused by bacterial or viral infection. It then compares acute and chronic bronchitis, noting their differences in pathogens, onset, duration, age groups affected, and clinical presentation. The document discusses the epidemiology and risk factors of acute bronchitis. It covers the infectious and non-infectious causes, pathophysiology, clinical presentation, diagnosis, treatment including pharmacological and non-pharmacological approaches, patient education, and prognosis. The presentation aims to provide an overview of acute and chronic bronchitis for healthcare professionals.
Treatment of tb afpa rdmc_06_dr. amit thaker_20180422Parthiv Mehta
Tuberculosis a common disease to come across in family practice is addressed with clarity on salient features that help Family Physicians to deal with Tb Treatment efficiently
The document discusses oxygen therapy for respiratory diseases. It covers when long-term oxygen therapy is recommended based on arterial oxygen levels and symptoms. It describes how an oxygen prescription should be written and the different systems available to provide supplemental oxygen at home, including compressed oxygen cylinders, liquid oxygen, and oxygen concentrators. It also discusses oxygen-conserving devices that aim to maximize the efficiency of oxygen delivery, such as reservoir nasal cannulas and demand delivery systems.
Inhalation Therapy forms foundation of Ashtma and COPD treatments. Understanding Inhalation Devices makes it easy for Family Physicians to accept and choose appropriate device.
Acute exacerbation of bronchial asthma dr. mukesh bhatt afpa_rdmc_06_20180422Parthiv Mehta
Exacerbation of Bronchial Asthma can be simple and easy to difficult and life threatening. This presentation is a point of view of a Family Physician with practical aspects to understand
Breathlessness is a common symptom or complain received by a family practitioner. This presentation is intended to provide important basic information on Breathlessness
Surgery in thoracic diseases afpa rdmc_06_20182204Parthiv Mehta
Thoracic Surgery other hen Cardiac Surgery is not well understood in Family Practice. This module takes care of fundamental understanding of diseases that may require surgical intervention.
Respiratory Diseases management Course consists of topics of Pulmonary Medicine for Family Physicians. This MCQ Session is targeted to revisit topics and revise it through questionnaire
Ali to ards in pregnancy parthiv mehta_2018_aogsParthiv Mehta
Acute Lung Injury (ALI) condition commonly encountered by every specialty can worsen to ARDS. Specifically with pregnancy it has very high mortality and complication rate.
The document discusses pneumonia that requires admission to the intensive care unit (ICU). It notes that community-acquired pneumonia (CAP) can range from mild to severe, and involve multiple pathogens and antibiotic exposures. Viruses are detected in about 27% of CAP cases, with human rhinovirus and influenza being most common. Bacteria are found in 14% of cases, led by Streptococcus pneumoniae. The outcomes of patients with severe pneumonia admitted to the ICU have improved in recent years due to early administration of combination antibiotics and awareness of multidrug-resistant organisms and respiratory viruses as common causes. However, pneumonia remains associated with high mortality, especially if complications like septic shock or acute respiratory distress syndrome occur.
Traditional medicines in respiratory system 2018 pmmParthiv Mehta
Integrated approach for disease management is need of time. Modern science of developing synthetic drugs; if complemented by traditional medicines of natural sources; can provide benefits in synergistic effects
Airway diseases presenting with behavior of Reaction to any trigger have been in increase. We intend to visit available resources for better understanding of RAD - in Children and adults
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- 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
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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Background :
Antibiotic Resistance
• Since 1998, spread of concerns on
resistance
• Loss of once-good and cheap
treatment for infections
• Increasing mortality in ICU set up
for infection resistance to first line
empirical therapy.
• Increase in the cost of treatment
and hospital stay.
• Emerging pathogens
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Background :
Irrational Use of Medicines
Examples of irrational use of medicines:
• No drug needed e.g. unnecessary & ineffective
antimicrobials or anti-diarrhoeals given instead of Oral
Rehydration Solution.
• Unsafe drugs e.g. Analgin (Dipyrone) banned in most
developed countries, is used in many developing countries.
• Under use of available effective drugs e.g. ORS not used
effectively.
• Ineffective drugs & drugs with doubtful efficacy e.g.
unnecessary excessive use of tonics & multivitamin
preparations
• Incorrect use of drugs e.g. overuse of Injections
Drugs used in unwarranted situations
Dr. Parthiv Mehta
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Background :
Irrational Use of Antibiotics
• Overuse, under-use, and misuse of medicines
- antimicrobials remains a world wide hazard.
• Over 15 billion injections per year,
– Half unsterile, many unneeded,
– 25-75% of antibiotic prescriptions inappropriate,
– 50% of people worldwide fail to take medicines
correctly
(Health quick 2003)
Dr. Parthiv Mehta
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Background :
Irrational Use of Antibiotics
• Misuse and overuse of antibiotics, overuse
and unsafe use of injections has been
reported in Southeast Asian countries.
– All over the world 30-60% of PHC patients receive
antibiotics which may be twice as high as it may
be clinically required.
– Large number of viral URTI and diarrhoea are
treated with antibiotics in the world and
inappropriate use is also being used in teaching
hospitals all over the world.
Dr. Parthiv Mehta
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Rational Use of Antibiotic..
Checklist
Indicated?
Appropriately identified?
What organism?
Which agent?
Combination?
Host factor?
Route of administration?
Dose?
Modification?
Duration?
Dr. Parthiv Mehta
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Rational Use of Antibiotic..
Checklist
Indicated?
Appropriately identified?
What organism?
Which agent?
Combination?
Host factor?
Route of administration?
Dose?
Modification?
Duration?
Dr. Parthiv Mehta
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Antimicrobial therapy - Goal
• Rapid eradication of infecting
organism
– Empiric coverage of common pathogens
Culture
Selective coverage for specific pathogens
• Avoid major organ systemic side
effects
Unfortunately, goal is OUR safety
Dr. Parthiv Mehta
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Conditions in which AB Prophylaxis
had been proved to be of value
Conditions Antimicrobial agents
GAS in children with Rheumatic Fever Penicillins
Endocarditis in children with CHD Amoxicillin
GBS in neonates Penicillin or Ampicillin
Gonococcal Ophthalmia in neonates Silver nitrate or Erythromycin
TB in household contacts Rifampicin + Isoniazid
Recurrent UTI Trimethoprim-Sulfamethoxazole
Sepsis in Asplenia Penicillin
PCP in transplants recipients or AIDS Trimethoprim-Sulfamethoxazole
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Rational Use of Antibiotic..
Checklist
Indicated?
Appropriately identified?
What organism?
Which agent?
Combination?
Host factor?
Route of administration?
Dose?
Modification?
Duration?
98250 31615
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Determining Anti-microbial
Susceptibility - Culture
• Disk diffusion
– Simple, cheap
• E-test
– Diffusion of continuous conc. gradient from plastic
strip into agar medium
• Minimal inhibitory conc. (MIC)
– no visible growth
• Minimal bactericidal conc. (MBC)
– >99.9% suppression after subculture to agar
Local susceptibility pattern - Antibiogram
Unfortunately,
To Culture is NOT OUR CULTURE
Dr. Parthiv Mehta
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Rational Use of Antibiotic..
Checklist
Indicated?
Appropriately identified?
What organism?
Which agent?
Combination?
Host factor?
Route of administration?
Dose?
Modification?
Duration?
Dr. Parthiv Mehta
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Rational Use of Antibiotic..
Checklist
Indicated?
Appropriately identified?
What organism?
Which agent?
Combination?
Host factor?
Route of administration?
Dose?
Modification?
Duration?
Dr. Parthiv Mehta
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Antimicrobial agents of choice
Community-Acquired Pneumonia
Age Drug of choice Pathogens
<2m Ampicillin + Aminoglycoside GBS, E. coli
2m-2y Amoxicillin + Clavulanic Acid Pneumococcus
2º cephalosporins Haemophilus influenzae
2y-5y Amoxicillin + Clavulanic Acid Pneumococcus, H. influenzae
2º cephalosporins Mycoplasma, Chlamydia
± Macrolides
5y- 18y Penicillin Macrolides Pneumococcus
Mycoplasma
>18y 3º Cephalosporins Pneumococcus
Macrolides Mycoplasma
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Antimicrobial agents of choice
Bacterial Meningitis
Age Pathogens Drug of choice
Neonate, early-onset GBS, L. monocytogenes,
enterococci,
GNB
Ampicillin and
cefotaxime
Aminoglycoside
Neonate, late-onset S. aureus, GNB,
P. aeruginosa
Oxacillin, Vanco and
Ceftazidime
1-3 months infant All of above Ampicillin and
Cefotaxime
Child N. meningitides,
S. pneumoniae,
H. influenzae
Ceftriaxone or
Cefotaxime
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Antimicrobial agents of choice
Pathogen Specific
• P. aeruginosa
• Salmonella
• Acinetobacter
• Brucella
• Enterobacter
• Proteus
- Ticarcillin + Genta,
Ceftazidime
- Ceftriaxone,
Fluoroquinolone
- Imipenem
- Doxycycline
- Imipenem
- Ampicillin, 3rd Ceph.
Dr. Parthiv Mehta
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Fluoroquinolones - WARNING
• Paul Auwaerter – Professor, Infectious
Diseases at Johns Hopkins University School of
Medicine.
– US Food and Drug Administration (FDA) recently
announced[1] upgrade of its package warnings on
fluoroquinolones. To include instructions that they
should not be used for routine respiratory tract
infections or uncomplicated urinary tract
infections unless there is no suitable alternative
agent.
Dr. Parthiv Mehta
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Rational Use of Antibiotic..
Checklist
Indicated?
Appropriately identified?
What organism?
Which agent?
Combination?
Host factor?
Route of administration?
Dose?
Modification?
Duration?
Dr. Parthiv Mehta
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Irrational Fixed Dose Combinations
• For instance, there are at least 100 brands of
combination of norfloxacin or ciprofloxacin
(antibiotics) with metronidazole or tinidazole
(anti-diarrhoeal drugs) in the Indian market.
• The Indian Journal of Pharmacology had in 2006
reported that these combinations were
irrational because a patient suffers only from one
type of diarrhoea and using this combination
adds to costs, adverse effects and may encourage
drug resistance. But these combinations are still
sold in the market.
Dr. Parthiv Mehta
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Irrational Fixed Dose Combinations
• The Indian pharmaceutical market has about
2,000 brands of fixed-dose combinations in
the antibiotics segment alone.
• Of these, at least 1,800 brands are irrational
in terms of wrong or unnecessary
composition of multiple drugs, according to
market data compiled by CDSCO for a
proposed ban on such combination brands
manufactured by both small and large drug
makers.
Dr. Parthiv Mehta
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Rational Use of Antibiotic..
Checklist
Indicated?
Appropriately identified?
What organism?
Which agent?
Combination?
Host factor?
Route of administration?
Dose?
Modification?
Duration?
Dr. Parthiv Mehta
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Host Factors
H/O previous usage
H/O adverse reactions to antibiotics
• Chloramphenicol -- poor gluc-uronylation in
neonates --> Gray syndrome (shock, collapse,
death)
• Sulfonamide compete albumin binding with
bilirubin --> Kernicterus
• Tetracycline bind developing bone and tooth -->
purplish or brown Discoloration of teeth, Enamel
Hypoplasia
Dr. Parthiv Mehta
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Host Factors
Liver & Renal function
• Tetracycline contraindicated in impaired
renal function except Doxycycline,
Minocycline
• Aminoglycoside in renal impairment
Consideration of Creatinine Clearance is
MUST
Dr. Parthiv Mehta
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Host Factors
Sites of infection
• Dose of choice of antibiotics
– Local conc. > MIC
• Vegetation, bone, devitalized tissue
– Inaccessible to antibiotic
– High dose, prolonged treatment
• Purulent material
– Inactivate Aminoglycoside, Polymyxin
Dr. Parthiv Mehta
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Host Factors
Sites of infection
• CNS penetration
– Good
• Rifampicin, chloramphenicol, trimethoprim,
sulfamethoxazole
– Good when Meninges inflammed
• Penicillin G, Ampicillin, Cefotaxime, Ceftriaxone,
Ceftazidime, Imipenem, Meropenem
– Unreliable
• Amikacin, Gentamicin, Tobramycin, Vancomycin
Dr. Parthiv Mehta
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Host Factors
Sites of infection
• Low local oxygen tension
– O2 required for transport of Aminoglycoside into
bacterial cell
• Low local pH (abscess, lysosome)
– Poor activity of Aminoglycoside
• Foreign body
– Protect bacteria
Dr. Parthiv Mehta
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Rational Use of Antibiotic..
Checklist
Indicated?
Appropriately identified?
What organism?
Which agent?
Combination?
Host factor?
Route of administration?
Dose?
Modification?
Duration?
Dr. Parthiv Mehta
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S 98250 31615
Route of Administration
• Oral or parenteral?
– Higher and consistent serum concentrations of
drugs are achieved by parenteral route
– Parenteral-oral
• Pneumonia, Pyelonephritis, Skeletal infection
• Push? Drip?
– Side effect if infused too rapidly
• Aminoglycosides, cephalosporins, F.Q.
– Deteriorate of activity if kept long
• Penicillin, Amoxycillin + Clav
Inhaled AB has an important place
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Rational Use of Antibiotic..
Checklist
Indicated?
Appropriately identified?
What organism?
Which agent?
Combination?
Host factor?
Route of administration?
Dose?
Modification?
Duration?
Dr. Parthiv Mehta
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Duration
• According to indication
– LRTI : 5 – 7 - 14 days
– URTI : 3 – 5 - 7 days
– UTI : 5 – 7 – 14 days
– S & STI : 7 – 14 – 28 days
• Must to use According labelled directive
and guidelines
– Aminoglycosides : 5-7 days
– Cephalosporins: 7-14 days
– Macrolides: 3 – 5 – 7 days
– MOX/Clav: 7-10 days
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The determinants of irrational
antibiotic use
• Very short consultation time - does not allow
proper diagnosis
• Prescription of antibiotics for non-bacterial
infections: Clinicians prescribe antibiotics to
patients with non-bacterial infections, a practice
that has important repercussions
• Polypharmacy - Too many medicines are
prescribed per patient (Lack of trust in or delayed
lab results, fear of clinical failure)
• Antibiotic injections - are used where oral
formulations would be more appropriate
Dr. Parthiv Mehta
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The determinants of irrational
antibiotic use
• Prolonged empiric antimicrobial treatment
without clear evidence of infection
• Failure to narrow antimicrobial therapy when
a causative organism is identified
• Prescriptions do not follow clinical guidelines
• Patients self-medicate inappropriately
• Patients do not adhere to prescribed
treatment
Dr. Parthiv Mehta
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Optimization of Antibiotic Use
• Evidence based prescribing through effective,
rapid, low-cost diagnostic tools are needed to
optimize use of antimicrobials.
• In addition to better prescribing practices, the
global community must restrict inappropriate
and unregulated use / dispensing of
antimicrobial agents.
Dr. Parthiv Mehta
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Optimization of Antibiotic Use
• Stronger compliance to antibiotic treatment
regimes, quality assurance measures to
prevent consumption of substandard
medications, and restrictions of non-
therapeutic uses of antibiotics will provide a
foundation for antimicrobial stewardship.
• Regulations for antibiotic distribution,
quality, and use could preserve the
effectiveness of antibiotics as a public good.
Dr. Parthiv Mehta