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Antibiotic guidelines

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Title: Antibiotic guidelines


1
Antibiotic guidelines
  • Tony Elston
  • Consultant Microbiologist

2
Group 1
  • 7 ways in which antibiotics are different

3
Group 2
  • The prescribing of antibiotics is the single
    most abused privilege that doctors enjoy. Doctors
    know little if anything about the scientific
    rationale for antibiotic prescribing yet have the
    arrogance to prescribe freely without a hint of a
    definite diagnosis and without consideration of
    the consequences
  • ( Scott, 1997 ).

4
Group 3
  • Antibiotic policies are written for the failure
    of the educational process (Scott 1997 )

5
Group 4
  • When and how to prescribe in Colchester

6
Group 5
  • General bar/coffee shop/pick up joint chat to
    non-medic about antibiotics

7
7 ways in which antibiotics are different
  • Have a go !

8
7 differences
  • Most people take at some time
  • Efficacy determined by previous population use
  • Patients expectations
  • Resistance is inevitable
  • Veterinary use
  • Growth promoter use
  • Our efforts may be hindered by other countries

9
Principles of infection
  • Balance between organisms and host
  • Host factors
  • Non-specific
  • Specific
  • Pathogenic factors

10
Host factors
  • Non-specific
  • Physical
  • Chemical
  • Cellular
  • Specific
  • Antibodies
  • Complement
  • Cellular

11
Pathogen factors
  • Adhesion
  • Capsule
  • Toxins

12
Why infection ?
  • Normal
  • a balance
  • Chaos theory
  • Effects of inflammation
  • Cytokines, swelling, spread
  • Cascade
  • Self perpetuating

13
Where are antibiotics used?
  • 50 man, 50 animals
  • 50,000,000 prescriptions/year
  • Hospitals vs community
  • Up to 2 fold variation between districts

14
Why worry ?
  • Abs have allowed huge advances
  • Better outcomes
  • Abs select for resistance
  • Resistant bacteria spread
  • Resistance leads to clinical problems
  • Costs

15
The antimicrobial tug of war
  • Clinical judgement vs guidelines
  • Expectations vs reassurance
  • Termination
  • Prescription of an Ab should be seen as a serious
    step, similar to the prescription of steroids ..

16
Dont keep taking the tablets
  • How long ?
  • How much ?

17
Better prescribing
  • Stop unnecessary use
  • Shorten courses
  • Avoid inappropriate broad spectrum use
  • Avoid repeat prescriptions without evidence
  • Avoid telephone prescribing
  • Faster diagnosis

18
Promoting better prescribing
  • Evidence based guidelines
  • Computer assisted prescribing
  • Swifter diagnosis
  • NICE guidelines
  • Prescribing of antibiotics for self-limiting
    respiratory tract infections in adults and
    children in primary care
  • http//guidance.nice.org.uk/CG69

19
Educating public
  • Antimicrobials cure serious diseases- not colds,
    coughs and sneezes
  • Cherish your flora

20
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21
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22
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23
Resistance
  • The battle between man and the microbe is
    escalating and the microbe is winning
  • ( Burget and Burke, 1994 ).

24
Resistance
  • International problem
  • WHO report
  • House of Lords
  • US UK governments have action plans
  • Specialist Committee on Antimicrobial Resistance

25
Increase in drug resistance
  • More extensive use of antimicrobial agents
  • Advancing medical procedures
  • Increase in critically ill patients
  • Animal feeds and aquaculture

26
Prevention
  • Basic infection control measures
  • Ward cleaning
  • Rational use of antibiotics
  • Avoid patient overcrowding
  • Minimise inter-ward transfers
  • Adequate levels of staff
  • Audit of policies
  • Surveillance
  • Hand washing
  • Protective clothing
  • Patient isolation
  • Careful handling of linen
  • Careful waste disposal
  • Aseptic technique

27
Department of Health Advisory Committee on
Antimicrobial Resistance and Healthcare
Associated Infection (ARHAI)
  • November 2011 Start Smart Then Focus

28
Start Smart is
  • Do not start antibiotics in the absence of
    clinical evidence of bacterial infection
  • If there is evidence/suspicion of bacterial
    infection, use local guidelines to initiate
    prompt effective antibiotic treatment
  • Document on drug chart and in medical notes
    clinical indication, duration or review date,
    route and dose
  • Obtain cultures first

29
Then focus is
  • Review the clinical diagnosis and the continuing
    need for antibiotics by 48 hours and make a clear
    plan of action - the Antimicrobial Prescribing
    Decision
  • The five Antimicrobial Prescribing Decision
    options are Stop, Switch IV to Oral, Change,
    Continue and Outpatient Parenteral Antibiotic
    Therapy (OPAT).
  • It is essential that the review and subsequent
    decision is clearly documented in the medical
    notes.

30
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31
National initiatives
  • https//www.gov.uk/government/uploads/system/uploa
    ds/attachment_data/file/244058/20130902_UK_5_year_
    AMR_strategy.pdf
  • https//www.gov.uk/government/uploads/system/uploa
    ds/attachment_data/file/138331/CMO_Annual_Report_V
    olume_2_2011.pdf
  • http//www.rcgp.org.uk/clinical-and-research/targe
    t-antibiotics-toolkit.aspx
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