antibiotic; introduction & stewardship program in children
Post on 19-Mar-2017
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Dr.Azad A Haleem AL.MezoriDCH, FIBMS
Lecturer University Of Duhok College Of Medicine
Pediatrics Department2017
azad82d@gmail.com
Antibiotic : Introduction &Stewardship Program in
children
ANTIBIOTICS
• Antibiotics can be defined as substances capable of killing & inhibiting the growth of micro organisms.
• The term antibiotics literally means “against life”; in this case, against microbes.
• There are many types of antibiotics—antibacterials, antivirals, antifungals, and antiparasitics.
3Con…
COMMON BACTERIA BY SITE OF INFECTION
4
5
Classifications of Antibiotics Classifications of Antibiotics
Spectrum of activity
Broad
spectrum
Narrow
spectrum
Site of action Type of action
Bacteriostatic
Bactericida
l
1. Mechanism of action
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2. Mode of action
• Bacteriostatic vs. bactericidal drugs;• Bacteriostatic – arrest the growth and replication of bacteria at
serum levels achievable in the patient.– limit the spread of infection while the body's immune
system attacks, immobilizes, and eliminates the pathogens.
– If the drug is removed before the immune system has scavenged the organisms, enough viable organisms may remain to begin a second cycle of infection.
• Bactericidal – kill bacteria at drug serum levels achievable in the
patient. - often drugs of choice in seriously ill patients.
• It is possible for ATB to be bacteriostatic for one organism and bactericidal for another.
2. Mode of action
2. Type of action
3. Spectrum of activity • Narrow spectrum • only against a single or a limited group of
microorganisms,• e.g. INH is active only against mycobacteria.• Broad spectrum • affect a wide variety of microbial species.• e.g. tetracycline and chloramphenicol • Alter the normal bacterial flora ???? • precipitate a superinfection of an organism, e.g.,
candida.
3. Spectrum of activity
Antimicrobial activity
• Antimicrobial activity: the ability that a drug kills or suppresses the growth of microorganisms.
• Minimum inhibitory concentration (MIC) – the minimum amount of a drug required to inhibit
the growth of bacteria in vitro. • Minimum bactericidal concentration (MBC) – the minimum amount of a drug required to kill
bacteria in vitro
Drug resistance • Growth of bacteria is not halted by the maximal level of
that antibiotic that can be tolerated by the host. Primary Some organisms are inherently resistant to an antibiotic e.g., gram-negative organisms are inherently resistant to
vancomycin. Secondary spontaneous mutation or acquired resistance and selection. Cross-resistance resistant to more than one antibiotic.
Drug resistance
• Factors that may contribute to the emergence and dissemination of antimicrobial resistance
o ► Inadequate infection controlo ► High antimicrobial usage per geographic
area per unit timeo ► Increased use of antimicrobial prophylaxiso ► Increased empiric polymicrobial
antimicrobial therapy.
o ► Greater severity of illness of hospitalized patients
o ► More severely immunocompromised patientso ► Newer devices and procedures in useo ► Agricultural use of antimicrobialso ► Social factorso ► International travelo ► Evolution of pathogens
Drug resistance
Bad Bugs, No Drugs: No ESKAPE!• Over past 30 years at least one new infectious
disease discovered /year• Very few new antibiotics during that time• Future currently not looking very promising• Antibiotics considered to be one of the 5
most important medical developments• Without antibiotics medicine as we know it
will changeforever
What is Misuse of Antibiotics?: • When antibiotics are prescribed unnecessarily;• When antibiotic administration is delayed in critically ill
patients;• When antibiotic treatment is not given according to
microbiological culture data results.• When the dose is lower or higher than appropriate for
the specific patient; and route of administrations [IV vs. oral] not appropriate
• When the duration of treatment is too short or too long;
Inappropriate prescription • In an analysis of prescribing practices in teaching
hospitals worldwide, more than 40 % of all antimicrobials prescribed were considered inappropriate.
• Antibiotic resistance comes mainly because of inappropriate or improper use of antibiotics by physicians. Some 150 million prescriptions are written annually in the USA And Of those, 50 million are absolutely unnecessary or inappropriate”.
Stewardship Programs• Is an organized antimicrobial management program
that can be undertaken to improve antimicrobial usage in order to achieve optimal outcomes to cure or prevent infection, and while minimizing toxicity and emergence of resistance.
• One overarching programme of policies, management programmes, control programmes directed at improving antimicrobial use, resistance and clinical outcomes
Stewardship Team
Antimicrobial stewardship is the 8 R’s:
• Right drug, • Right time • Right dose • Right route • Right Resident • Right Documentation • Right Reason • Right Response
• Right drug – Check the medication label, check the order • Right time – Check the frequency of ordered medication – Confirm when last dose was given • Right dose
• Right route – Check order for appropriateness of route
ordered(IV/IM/oral) – Confirm resident can take or receive med by
the ordered route • Right resident – Check name on the order and the resident
• Right documentation – Document administration after giving med – Chart the time, route, and other necessary information • Right reason why medication ordered • Right response – Desired response achieved
Goals of Antibiotic Stewardship Programs
1. Reduce antibiotic consumption and inappropriate us
2. Improve patient outcomes & decrease morbidity and mortality
3. Increase adherence/utilization of treatment guidelines
4. Reduce adverse drug events5. Decrease or limit antibiotic resistance6. reduce healthcare costs
Why Stewardship
Classification of Antibiotic According to steward ship program
• A-Green flag : prescribed by all doctors• Amoxil, ampicilline,Ampiclox, • Gentamycine, Amikacin• Aciclovir IV• Ceftriaxone / Cefotaxime• Clarithromycin• Amikacin• Azithromycin• Keflex,suprax and others…..etc
which can be prescribed with the permission of infectious disease comitte
• Vancomycin • meropenem,imipeme
m,cefepime,• levofloxacine• Itraconazole• levofloxacine• Piperacillin +
Tazobactam (Tazocin®)• Ribavirin
• Teicoplanin• Terbinafine• Ticarcillin + Clavulanate
(Timentin)• Valganciclovir• Fluconazole IV• Sodium Fusidate
B-Orange flag continue
C-Red flag:
• Used only by infectious disease doctors (consultant) • linezolid,• daptomycin,• colistin,• Amphotericin ,• Caspofungin,• Moxifloxacin,• Pristinamycin • Tigecycline,• Voriconazole
33Con…
COMMON BACTERIA BY SITE OF INFECTION
THANKS FOR LIMITATION IN USING
OF ANTIBIOTICS
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