overuse and misuse of antibiotic put all of us at danger, and help to develop drug-resistant bacteria, so-called superbugs. which ultimately increase the cost of health care. so the third world countries are facing a burden of an extra charge of expenditure and unusual death

1. Antibiotic misuse
and overuse:
“No action today,
No cure tomorrow.”
Shahazaman shazu
HMO, Department of oral and maxillofacial surgery,
Dhaka medical college and hospital.

2. Welcome!!
Todays wise decision
can save our future
Antibiotic overuse
and misuse

3. Agenda
01
02
03
04
05
What will be tomorrow.
Our future in hand
Defination,pattern,causes,effect.
Over use of antibiotic:
Definition, present scenarios, background,
causes.
Misuse of antibiotic
Condition and improvement From various
aspect
Prevention of overuse and misuse
How to improve .
Prescribing pattern of dentist

4. MISUSE AND
OVER-USE OF
ANTIBIOTIC
Our time with antibiotics is running out. Since their discovery, antibiotics have served as the cornerstone of modern medicine.
However, persistent overuse and misuse of antibiotics have encouraged the emergence and spread of antibiotic resistance, which
occurs when bacteria become resistant to the drugs used to treat them. Antibiotic resistance is rising to dangerously high levels in
all parts of the world, and is threatening our ability to combat common infectious diseases and support modern medical procedures
.

5. Overuse of antibioticNo action today, No cure tomorrow.”

6. Overuse of antibiotic
Antibiotic overuse means
Access use of antibiotics
With potentially serious effect
On health, it is a contributing
Factor to the development of
Antibiotic resistance, including
The creation of multidrug
Resistance bacteria, informally
Called “super bugs”

7. disagreed with the statement.
physicians agreed with the statement, “Physicians
prescribe antimicrobial more than they actually need”;
51.9%
24.8%
71%
Prescription Contain
at least one antibiotic
Doctors in sub-district level prescribe more antibiotics
than the doctors in Dhaka urban periphery
276 229 192BDT BDT BDT
PATTERN OF OVERUSE
Severity and economical burden
Antibiotics generally are more expensive than other
medicines. cost of antibiotics is highest at sub-district
level being TK. 276.8 and lowest at Dhaka urban peri
phery being TK. 182.20. In public hospital the cost is
TK. 229.75 which appears higher than one would
expect.

8. OVERUSING OF ANTIBIOTIC
Puts us all at risk
Meaning current treatment will no
longer work
Over use of antibiotic
can causes bacteria to
become resistance
One of the biggest threats
to global health
Taking antibiotic when they are not needed
accelerates emergence of antibiotic resistance
Not the person or the animal that
becomes resistant to antibiotic .
It is the bacteria itself
Of any age, in any country.
Antibiotic resistant infection
can affects anyone
Longer hospital stays, higher
medical cost and more death.
Antibiotic resistant infection can lead to
. When bacteria become resistant to antibiotic
Common infection will no
longer be treatable

9. Cause of overuse"Antibiotic madness: A fifth of prescriptions given out to patients who do not need them,
Incentives
and gifts
Lack of self
refining
Peer
pressure
Lack of
protocol
Pharmaceutical companies provide incentives on antibiotic
prescription in contract with prescribers & with organization
s; hospitals and drug shops of Bangladesh.
peer and opinion leader perceptions and behaviors have a
strong influence on prescribing behavior than local policy
and guidelines.
patients think antibiotics as a panacea and demand them
even when those are not inevitable. When patients demand
antibiotics, doctors think it easier to prescribe antibiotics
than to explain to the patients why it is not necessary.
Fear of losing patient and incentives from pharmaceutical
companies promptly motivate prescribers to the antibiotic
prescribing decision.
Attracts
patients
They are the inadequacy of protocols and control systems
; hospital formulary, evidenced–based antibiotic guidelines
, limited permission to prescribe certain antibiotics, antibiot
ic order and stop order forms, antibiotic consultation.

10. Causes of over-use
Social and political view
healthcare
policymakers
Lack of
vigilance
Informal
health care
Biased data,
pharmaceutical
Lack of
monitoring
the major health care providers of rural areas are informal s
ector practitioners in Bangladesh; 43% traditional healers,
7% Community Health Workers (CHWs) and 16% are unqu
alified allopathic providers (village doctors and drug sellers)
At the government level, the policymakers, lawmakers and
regulators’ reluctance on enacting a law to overcome
inadequacy in rules and regulations to promote good
prescribing practices lead to the irrational use of antibiotics
in Bangladesh
Pharmaceutical companies (199 allopathic manufacturers)
are the only organizations in Bangladesh to provide
information of medicine to health personnel and produces
97% of total medicine in the local market.
the absence of prescription monitoring systems,
and patients’ overcrowding are obstacles under
social and physical opportunities to reduce the
Inappropriate antibiotic prescribing behavior
the absence of prescription monitoring systems, and patie
nts’ overcrowding are obstacles under social and physical
opportunities to reduce the Inappropriate antibiotic prescri
bing behavior

11. Misuse of antibioticNo action today, No cure tomorrow.”

12. Mis-use
0f
Antibiotics
Taking antibiotic without
prescription or not as
mentioned in prescription.
The mis-use
Of antibiotics especially taking
antibiotics even when they’re
not the appropriate treatment
or

13. MISUSE OF ANTIBIOTIC
Patient who take antibiotic
without prescription are
male.
Patient who take antibiotic
without prescription are
female.
83.57% 16.43%
The highest percentage of
self medicated antibiotics
was metronidazole
METRONIDAZOLE
The lowest percentage of self
medicated antibiotics was
tetracycline (50.49%).
TETRACYCLINE
347 (26.69%) out of 1300 participants experienced
self medication with antibiotics.
(50.43%)
(7.49%)

14. Background of misuse
28.24%
16.14%
45.82%
The key reasons for the self
medication of antibiotics was
the pre-experience (45.82%),
suggestions from others (28.
24%) and knowledgeable of
the antibiotics (16.14%). .
Cause of misuse
pre-experience
suggestion
knowledge

15. Common scenarios
The perceived symptoms to purchase the antibiotics independently
36.02%
Dysentery, Diarrhea And
Food Poisoning
9.22%
Dental Caries And
Toothache.
12.97%
Infection.
28.24%
Cold, Cough And Fever.
S e l f m e d i c a t e d a n t i b i o t i c s i n B a n g l a d e s h : a c r o s s - s e c t i o
n a l h e a l t h s u r v e y c o n d u c t e d i n t h e R a j s h a h i C i t y

16. Causes of mis-use
physician prescribe maximum antibiotics (83%)
for outpatients in Bangladesh without clinical te
st and without giving complete direction for anti
biotic use .
Inappropriate prescription
.
Doctors vs patients volume
Longevity of lab result
Lack of self refining
delayed culture sensitivity test results, and
diagnostic uncertainty cause lack of confidence
in outcome with narrow–spectrum antibiotics
drive prescribers behavior to blind or empiric
prescription. .
Lack of confidence, updating of knowledge on antibiotic re
sistance and negative self–refining attitude also contribute
to wrong antibiotic prescribing
behavior.
patient volume and limited time of prescribers both in public
and private hospital settings are another major problem area
. Average consultation time per patient in the primary care of
Bangladesh is only 54 seconds.

17. Misuse of antibiotic
Patient aspect
Asymmetry of knowledge keeps behind patients
rights and decision at drug market.
Lack of knowledge
They always remain out of reach from accountability
and do as their wish.
Existing unofficial healthcare
Open market of drug, tricky advertisement of
antibiotic evoke patient to buy antibiotic without
prescription.
Excessive availability
Poverty can make obstacle to access to
qualified doctor chamber or buy full regime of
prescribed drug .
Poverty

18. Effect of misuse
In china during 2001-2005
14738000.
Incident of moderate to severe
adverse drug reaction
yearly
Affected
150000
Patient died
Death
0.43-2.04
Billion USD are required for
treating these reaction
Increase expenditure

19. HOW AWARE WE ARE
Awareness activities in media
Pharmacology compartment of different MS examinations, 18.4%
questions were on antimicrobial and 1.2% on resistance. In different
MD examinations, 13.3% questions were on antimicrobials and 1.2%
on resistance.
In Microbiology compartment of different MS examinations, the scena
rio is, 1.4% questions were on antimicrobial and 2.1% on resistance.
In different MD examinations, 0.9% questions were on antimicrobials
and 0.9% on resistance..
In our education system
And resistance in newspaper shows that, 0.5 to 2.0% a
rea covers health related features and news; out of whi
ch, 0.0 to 0. Resistance related issues. 5% covers dru
g related features and news
Print media
In electronic media, 0.4 to 0.6% time of the total duration of pro
gram was on health related issues, 0 to 0.02% of total time dur
ation was on drug related programs. Only one channel broadc
asted a program on antimicrobial and resistance for one hour,
which covered 0.01% hour of the total time of broadcasting.
Electronics media

20. Prevention of misuse & overuse
Increase knowledge
Increase knowledge
about
Health care,
Antibiotic
And also
Antibiotic resistance

21. Prevention of misuse & overuse
Prevent infection
Prevent infection
Keep environment clean

22. Prevention of misuse & overuse
Share knowledge, not drug
NEVERShare antibiotics with others
Use left over antibiotics

23. Prevention of misuse & overuse
Stop OTC selling
NO PRESCRIPTION
NO
ANTIBIOTICSDispensing
NEEDED
When they are
With a valid
prescription

24. Prevention of misuse & overuse
Vaccination can keep us safe
VACCINE CAN REDUCE
Keep patient’s
VACCINATION
Up to date

25. Prevention of misuse & overuse
Lab test, confirmation of diagnosis
Test to confirm
And which one

26. Prevention of misuse & overuse
Proper prescription
RIGHTANTIBIOTIC,
DOSE &
DURATION.
P r e s c r i b e

27. Prevention of misuse & overuse
Give proper and detail
INSTRUCTION
FEEDBACK
Ask for proper

28. Prevention of misuse & overuse
Accurate data, strong action-plane
Conduct regular
SURVEILLANCE
DATA
TO gather accurate

29. Prevention of misuse & overuse
Guidelines for guide the prescriber
NATIONAL GUIDELINES
For prescribing antibiotic
Build up a easy accessible

30. Reality and our dilemma
National guideline for antibiotic prescription
Countries have at least an
antibiotic guideline
64%
Countries has no guideline,
most of them are third world
counties
36%
Are classified as satisfactory
i.e., including or mentioning
resistance
6.4%
partially or totally omitted data
on microbiological resistance,
27%
countries have more than 5
national guideline, all of them
are first world countries
3
G l o b a l h e a l t h R e s e a r c h
G u i d e l i n e r e c o m m e n d a t i o n s a n d a n t i m i c r o b i a l r e s i s t a n c e : t h e n e e d f o r a c h a n g e

31. Prescription pattern
0f dentist
All dental providers commonly prescribed
broad spectrum antibiotics, such as
clindamycin and amoxicillin-clavulanate.
The most common antibiotics prescribed
are amoxicillin, clindamycin, penicillin,
azithromycin, and cephalexin
Antibiotic prescribing patterns varied by
dental specialty for several antibiotics .
DOXYCYCLINEAMOXICILLIN AZITHROMYCIN

32. A step towards better world

33. Thank you
Get well soon without antibiotic