Antibiotics: Making the right choice

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Antibiotics Making the right choice

• Dr. Christian T. Felter
• Senior Medical Adviser
• Wyeth UK

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Improved Patient Outcomes Associated with
Proper Hand Hygiene
Ignaz Philipp Semmelweis (1818-1865)
Chlorinated Lime Hand Antisepsis
Adapted from CDC. Prevent Antimicrobial
Resistance A Campaign for Clinicians. April
2002.
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The Importance of Initial Empiric Antibiotic
Selection
Alvarez-Lerma F. Intensive Care Med.
199622387-394. Rello J, et al. Am J Respir
Crit Care Med. 1997156196-200. Luna CM, et al.
Chest. 1997111676-685. Kollef MH, Ward S. Chest
1998113412-420. Sanchez-Nieto JM, et al. Am J
Respir Crit Care Med. 1998157371-376. Ruiz M,
et al. Am J Respir Crit Care Med.
2000162119-125. Dupont H, et al. Intensive Care
Med. 200127355-362.
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Evolution of Antimicrobial Resistancein
Gram-positive Cocci
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Evolution and Control of Antibiotic Resistance
Among GNR in NY Hospital ICU
Class restriction of cephalosporins and
cephamycins
Contact isolation, patient cohorting, local
polymyxin B
Contact isolation, local polymyxin
Reduction of ceftazidime resistance 44 hospital
wide 87 in ICUs
Elimination of imipenem resistance 1999
Ongoing
Rahal JJ, et al. Clin Infect Dis. 200234499-503.
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What do we do?

• Rigorous infection control
• De-escalation therapy
• Start big then go small
• Choose the right antibiotic
• Avoid inappropriate therapy
• Avoid antibiotics known to lead to collateral
  damage