ANTIBIOTIC

POLICY
Iman M. Fawzy; MD, MSc, PhD
Consultant of Clinical Pathology

Rational Use of
Antibiotics
The conference of experts on the rational use of drugs, by the
WHO in 1985 defined that

Rational use of drugs requires that

patients
receive
medications
appropriately to their clinical needs, in
doses that meet their own individual
requirements for an adequate period
of time, at the lowest cost to them
and their community

Reaso
ns for
Patient Concerns
Want clear
explanation
Green nasal
discharge
Need to return to
work

Antibiot
ic
Overuse
Physician Concerns
Patient expects
antibiotic
Diagnostic
uncertainty
Time pressure

Antibiotic Prescription

What is inappropriate use ?

Unnecessary prescription of antibiotics, such as
for viral infections or for prolonged prophylaxis
Using broad-spectrum antibiotics when narrowspectrum antibiotics are effective
Prescribing too low or too high dose

Continuing treatment for longer than necessary

What is inappropriate use ?

Not prescribing according to microbiology results

Omitting or delaying administration of doses

Prescribing intravenous therapy when oral
therapy is known to be effective and clinically safe

Not taking antibiotics as prescribed

Antibiotic
Resistance

Emergence of Antibiotic
Resistance

Susceptible
Bacteria

Resistant Bacteria
Mutations

XX

Resistance Gene Transfer

New Resistant Bacteria

Selection for Antibiotic-Resistant

Strains
Resistant
Strains
Rare
Antimicrobial
Exposure

Resistant Strains
Dominant

Antimicrobial resistance has emerged

as a major public health problem all
over the world

Emergence of antibiotic resistance

5. Pray LA Insight Pharma Reports 2008, in Looke D The Real Threat of Antibiotic Resistance 2012

Resistance spreads rapidly

Interference with Untreatable infections

patients normal flora.

Excess length of
stay
Increased morbidity/
mortality

Impact of
resistance
Selection of drug
resistant organisms

Increased
side effects

Increased costs

Settings that favor

antimicrobial
resistance

Immune compromised
patients e.g.
ICU
Oncology unit
Dialysis unit
Rehabilitation unit
Transplantation unit
Burn unit

Antibiotic
policy

Aim of Antibiotic Policy

Objectives of Antibiotic
Policy

Scope of hospital antibiotic

policy
prophylaxis, empirical and definitive therapy.
high-risk/special groups e.g. immune compromised
hosts;
hospital-associated
infections
and
community-associated infections.
The hospital antibiotic policy shall be based upon:
spectrum of antibiotic activity
pharmacokinetics/pharmacodynamics
of
antibiotic s
adverse effects
potential to select resistance
cost
special needs of individual patient groups.

Surveillance of antimicrobial
resistance
Use standards
Generate reliable numerator: only the first
positive culture from the patient for each disease
episode should be reported for surveillance
purposes.
Express resistance as incidence rate
Participate in external quality assessment
schemes
Prediction of evolution of antimicrobial
resistance
Surveillance of antimicrobial consumption

Cumulative antibiogram
Analyses of data regularly, at least
annually.
Inclusion of diagnostic isolates.
It is useful to stratify results by specimens
type or infection site, by nursing unit or
site of care, by organisms resistance
characteristics, by clinical service or
patient population.
Reviewing the cumulative antibiogram
data if clinical failure occurs after empiric
therapy.

Development of standard
treatment guidelines
Should be based on local antibiograms.
Should be syndrome/diseased based.
Should specify type of clinical setting
Outpatient clinics, Inpatient units, ICU
setting.
Should involve treating physicians to bring
ownership to the guidelines

Direction of antibiotic policy

Frame the hospital own list of therapeutic antibiotic
categories:
First-line
Reserved agents
Restricted agents
Withdrawn agents
for example, first choice antibiotics can be prescribed by all
doctors
while restricted choice antibiotics can only be prescribed after
consulting the head of the department or the antimicrobial
team (AMT) representative.
Reserve antibiotics, are prescribed only by designated
experts.

Minimizing selection of resistant

organisms

What should not be done

Treat non-infectious or nonbacterial
syndrome.
Treat colonization or contamination.
Treat longer than necessary.
Fail to make adjustment in a timely
manner.
Prescribe antibiotic with spectrum of
activity not indicated.

Interventions
Continuous surveillance of bacterial
infections.

Interventions
Prohibiting the sale of antibiotics
without medical prescription.

Development of regulations by
Ministries
of
Health
regarding
responsible
prescription
of
antibiotics.
Prohibition
of
advertising
of
antibiotics in the community by
industry
and
pharmaceutical
representatives.

Community pharmacist
Pharmacist should be able to prescribe
certain antibiotics in appropriate
circumstances to patients needing
treatment for particular conditions
Advice to patients to ensure that the
patient understands that:
Antibiotic must be used properly
Help and encourage Health Authorities.
Ensure the implementation of the policies

Prevent Antimicrobial
Resistance
Clinicians hold the solution
12 Contain your contagion
11 Isolate the pathogen
10 Stop treatment when cured
9 Know when to say no to antibiotic
8 Treat infection, not colonization
7 Treat infection, not contamination
6 Use local data
5
Practice antimicrobial control
4 Access the experts
3 Target the pathogen
2 Get the catheters out
1 Vaccinate

Prevent Transmission
Use Antimicrobials
Wisely

Diagnose and Treat

Effectively
Prevent Infection

Antimicrobial Resistance:

Key Prevention Strategies

Antimicrobial-Resistant
Susceptible Pathogen
Pathogen
Pathogen
Prevent
Infection

Prevent
Transmission

Antimicro
bial
Resistanc
e

Infection
Effective
Diagnosis
and Treatment

Optimize
Use

Antimicrobial
Use

ANTIMICROBIAL PRESCRIBING:
GOOD PRACTICES
Send for appropriate investigations in all
infections.
All antibiotic initiations would be done after
sending appropriate cultures
Follow
Hospital
policy
when
choosing
antimicrobial therapy whenever possible.
Check for factors which will affect drug choice,
eg, renal function, interactions, allergy.
Check that the appropriate dose is prescribed.
The need for antimicrobial therapy should be
reviewed on a daily basis.
Once culture reports are available, the physician
shall step down to the narrowest spectrum, most

Empiric Therapy
Where delay in initiating therapy to await
microbiological results would be life
threatening or risk serious morbidity,
antimicrobial therapy based on a clinically
defined infection is justified.
Where empiric therapy is used, the accuracy
of diagnosis should be reviewed regularly
and
treatment
altered/stopped
when
microbiological results become available.

Empiric Therapy
Side effects empirical antibiotics :
Development of resistance in pathogens
infecting the patient.
Risk for spread of resistance.
Suppression of normal flora.
Development of resistance in normal flora.
Risk for super infection.

Hand Washing is Important

Because
Hand hygiene compliance rates of
10%-40% have been observed in
the developed countries.

THANK
YOU