Antibiotic Policy in Medical Care

Dr.T.V.Rao MD

Discovery Of Penicillin changes the History of Medicine

Why we Need Antibiotics

Nearly One half of the Hospitalized patients receive antimicrobial agents. are valuable Discoveries of the Modern Medicine.  All current achievements in Medicine are attributed to use of Antibiotics  Life saving in Serious infections.
 Antibiotics

What went wrong with Antibiotic Usage

   

Treating trivial infections / viral Infections with Antibiotics has become routine affair. Many use Antibiotics without knowing the Basic principles of Antibiotic therapy. Many Medical practioners are under pressure for short term solutions. Commercial interests of Pharmaceutical industry pushing the Antibiotics, more so Broad spectrum and Newer Generation antibiotics. as every Industry has become profit oriented.

Poverty encourages drug resitance due to under utilization of appropriate Antibiotics.

Drug usage = Drug resistance

Basis of Antibiotic Resistance

  

The antibiotic resistance is guided by Genomic changes Spread of R plasmids among the Bacteria Do remember Antibiotics are used in Animal husbandry apart from Medical use

The discovery of antibiotic resistance was discovered with spread of R plasmids from animal sources  The Human gut forms the interconnecting area in R plasmids transmission leading ultimately to antibiotic resistance


Plasmids played a Major Role in spread of Antibiotic resistance.

Frequent, Irrational, and Indiscriminate use increases Antibiotic resistance,

Spread of Antibiotic Resistance

  

Indiscrimate use of Antibiotics in Animals and Medical practice R plasmids spread among co-inhabiting Bacterial coflora in Animals ( in gut ) R plasmids may be mainly evolved in Animals spread to Human commensal, - Escherichia coli followed by spread to more important human pathogens Eg Shigella spp.

Why we Need Antibiotic Policy

Aim of Antibiotic Policy

 

  

Reduce the Antimicrobial resistance Initiate best efforts in the hospital area as many resistance Bacteria are generated in Hospital areas and in particular critical care areas. Initiate good hygienic practices so these bacteria do not spread to others Practice best efforts, these resistance strains do not spill into critically ill patients in the Hospital To prevent spill into Society, as they present as community associated infections..

Objectives of Antibiotic Policy. Policy.

  

Antibiotics should not be used casually Policy emphasizes, avoiding the use of powerful Antibiotics in the Initial treatments. We should create awareness that we are sparing the powerful Broad spectrum Drugs for later treatment Patient saves Money Doctors save Lives. Lives.

Policy Deals with

discuss on the Broad basis  Clinicians / Microbiologists / Pharmacists and Nurses do take part. part.  Policies are framed on demands of the Clinical areas, depending on recent Infection surveillance data contributed from Microbiology Departments.
 We

Aims of the Antibiotic Policy

 

Create awarness on Antibiotics as misuse is counterproductive. More effective treatments in serious Infections. Reduce Health care associated infections spilling to society and increase of Community associated Infections.
( A growing concern in Devloping world )

Antibiotic working Group Monitors

Formulate Optimal guidelines in Treatment of Infections with minimal risk of Health care associated Infections. Create a plan for monitoring the Use of Antibiotics across the Hospital

Education On Antibiotic policy

     

Acton plan for Education to all concerned clinical staff on Antibiotic prescriptions. Evaluate the feed back of success and failures of the policy. Create Infection surveillance Data Developing facilities in Microbiology departments for auditing data and guidance Restrictions in prescribing and Antibiotic availability. A continuous education to Junior Doctors

Sample collection


 

Proper specimen collection is combined responsibility of Clinical and Microbiological Departments. Continuous training of junior staff on sample collection, and is most neglected necessity A good clinical history is greatly helpful in differentiating community acquired infections from hospital acquired infections.

Pitfalls in Specimen collection



A proper specimen collection is most neglected area of Microbiology. Scientific approaches in Sample collection is concern for successful Microbiological evaluations,

Microbiology Services


Constant up graduation of Microbiology departments is good investment. Quality control methods in testing of antibiotic resistance pattern is a top priority.

Role of Microbiology Department

 Microbiology

departments asses trends in development of antimicrobial resistance.  The results of sensitivity/resistance patterns should be correlated with Antimicrobial agents currently used in the Hospital.  Identify and forecast that nature of relation between antibiotic use and resistance.

Better services from Microbiology Departments.



Basic infrastructure should be updated for detection of MRSA and ESBL producers. Documentation of all Opportunistic infections. and Hospital infection outbreaks

Good Microbiology practices will save the resources and reduces the Antibiotic usage

Empherical Therapy


To many drugs creates complex problems in drug resitance. The clinicians should optimize the duration of empherical treatment.

Advantages of Antibiotic Policy

 Saves

the Lives  Reduces the morbidity  Saves Health related costs  Reduces the Antibiotic related toxicity.  Patients are satisfied.

Staff Education on Antibiotic Policy

    

Staff education is most Important principle in success Draw your own plans according to nature of patients, your past experiences Induction training for new staff Continuing Medical Education to both Junior and Senior practioners. Include nursing staff, pharmacists for the success of the Programme

Our Policy is Successful

If the Staff will understand the potential hazards of Antibiotics Use of Antibiotic guidelines in teaching Under and Post graduate Medical Students, If we are united we can reduce Hospital generated infections

We will succeed with Antibiotic Policy If

Both patients and Doctors reduce their expectation on the role of Antibiotics  If the Medical profession realizes our aim is to give Right Drug for Right Bug.


Patient Education on Antibiotic Policy

  

Education of the patients and society is important in Devloping world. Educate the patients many infections are trival,viral, Do not need Antibiotics If they understand Unnecessary consumption of Antibiotics kills the Normal flora, and reduces the Immunity and makes them potential victims in future. A difficult task in Devloping countries. countries.

Proved success of Antibiotic Policies Studies Prove

1 Rapid reversal of major clinical problems of resistance to Choramphenicol ,Erythromycin, and Tetracycline in Staphylococcus aureus on withdrawal of antibiotics. 2 Out breaks of Erythromycin resistant Group A Streptococci and Penicillin resistant Pneumococci, can be controlled by major Pneumococci, reduction in prescription of Erythromycin and Penicillin. 3 Control of multiple resistant Gram ve bacteria and role played by reducing the prescription of 3rd generation of Cephalosporins
. ( I.M.Gould Review of the role of antibiotic policies in the control of antibiotic resistance, Journal of Antimicrobial Chemotherapy 1999 43, 459 465. )

Make your conclusions and contribute to Antibiotic Policy



It is true to say that there is no absolute proof of causative association between antibiotic use and resistance, But many authorities believe the association to be virtually certain. It is pragmatic and essential approach to control of antibiotic resistance with control of antibiotic use. Make every one a partner in prevention of Antibiotic resistance, and success will follow.

How to prove the Success

 Prove

your action plans with evidence based success outcomes  Senior practioners should be role models  Prove how rationalism helps, saves money, morbidity and mortality.

Why Everyone worried about Antibiotic ( misuse ) Use.

Drug resistance can reverse Medical progress The following diseases are already in the list of attaining the drug resistance, and Medical profession will find difficult to cure in future. 1. Tuberculosis 2. Malaria 3. Sore throat and Ear Infections. Infections.

Best way to keep the matters in Order

Every Hospital should have a policy which is practicable to their circumstances. Rigid guidelines without coordination will lead to greater failures The only way to keep Antimicrobial agents useful is to use them appropriately and Judiciously
(Burke A.Cunha, MD,MACP Antimicrobial Therapy. Medical Clinics of North America NOV 2006)

Working together creates Safe Hospitals

Created for Benefit of Medical and paramedical personal in Developing world

Dr.T.V.Rao MD Email ; tvraodoctor2000@yahoo.co.in