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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
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
Antibiotic
Resistance
Emergence of Antibiotic
Resistance
Susceptible
Bacteria
Resistant Bacteria
Mutations
XX
Resistant Strains
Dominant
5. Pray LA Insight Pharma Reports 2008, in Looke D The Real Threat of Antibiotic Resistance 2012
Excess length of
stay
Increased morbidity/
mortality
Impact of
resistance
Selection of drug
resistant organisms
Increased
side effects
Increased costs
Immune compromised
patients e.g.
ICU
Oncology unit
Dialysis unit
Rehabilitation unit
Transplantation unit
Burn unit
Antibiotic
policy
Objectives of Antibiotic
Policy
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
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
Antimicrobial Resistance:
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.
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YOU