antibiotic stewardship program in children

Dr.Azad A Haleem AL.MezoriDCH, FIBMS

Lecturer University Of Duhok College Of Medicine

Pediatrics Department2016

azad82d@gmail.com

Antibiotic Stewardship Program in

children

Introduction

• 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

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;

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

THANKS FOR LIMITATION IN USING

OF ANTIBIOTICS