View
225
Download
0
Embed Size (px)
Citation preview
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 1/67
Dr.T.V.Rao MD
Dr.T.V.Rao MD 1
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 2/67
Virus
Common cold
Diarrhea (99%)
Acute Bronchitis Influenza (flu)
Measles
Chicken Pox AIDS
Rabies
Hepatitis
Bacteria
Urine infections
Strep Throat
Boils/abscesses Gangrene
Some pneumonia
Ear infections (half) Sinus infections (< half)
Bubonic Plague
TuberculosisDr.T.V.Rao MD 2
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 3/67
Bacteria are the cause of the vast
majority of deaths due to infection
in the United States: sepsis,meningitis, pneumonia
Most viral infections get better all by
themselves in 1-3 weeks; nomedications are required: colds, flu,stomach virus
Dr.T.V.Rao MD 3
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 4/67
They don’t help the patient at all
Expense: 75% of outpatient antibiotics are
used for respiratory infections Patient expectations: why no better?
Side effects: diarrhea, rash, allergy
Development of resistance: the
antibiotic won’t work when you really DOneed it for a bacterial infection
Dr.T.V.Rao MD 4
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 5/67
ANTIMICROBIAL AGENT
• Any chemical or drug
used to treat an infectiousdisease, either by
inhibiting or killing thepathogens in vi vo
Dr.T.V.Rao MD 5
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 6/67
The discovery of penicillin has beenattributed to Scottishscientist Alexander
Fleming in 1928 andthe development of penicillin for use as amedicine is attributed
to the Australian NobelLaureate HowardWalter Florey
Dr.T.V.Rao MD 6
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 7/67Dr.T.V.Rao MD 7
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 8/67
The term"antibiotic" wascoined by Selman
Waksman in 1942to describe anysubstanceproduced by a
microorganism thatis antagonistic tothe growth of othermicroorganisms in
high dilutionDr.T.V.Rao MD 8
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 9/67
Antimicrobialagents – that areproduced
synthetically buthave actionsimilar to that of antibiotics andare defined aschemotherapeutic agents
Eg Sulphonamides,uinolones.
Dr.T.V.Rao MD 9
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 10/67
Substancesderived from amicroorganism
or producedsynthetically,that destroys or
limits the growthof a livingorganism
Dr.T.V.Rao MD 10
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 11/67
Bacteriostatic - Antimicrobialagents that reversibly inhibitgrowth of bacteria are called as
bacteriostic ( Tetracyclnes,Chloramphenicol )
Bactericidal – Those with an
irreversible lethal action onbacteria are known as bactericidal( Pencillin, Isoniazid )
Dr.T.V.Rao MD 11
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 12/67
1920 1930 1940 1950 1960 1970 1980 1990 2000
ertapenem tigecyclin
daptomicin
linezolidtelithromicin
quinup./dalfop.cefepime
ciprofloxacin
aztreonamnorfloxacinimipenem
cefotaximeclavulanic ac.
cefuroximegentamicin
cefalotina
nalidíxico ac.ampicillinmethicilin
vancomicinrifampin
chlortetracyclinstreptomycin
pencillin G
prontosil
The development
of anti-infectives …
Development of anti-infectives
Dr.T.V.Rao MD 12
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 13/67
Antimicrobial agents are widelyemployed to cure bacterial diseases
Definition of Antibiotic – Antibiotics
are substances that are derived from avarious species of microorganismsand are capable of inhibiting the
growth of other microorganism evenin small concentrations.
Dr.T.V.Rao MD 13
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 14/67
ANTIBIOTICS – Sources
1. Natural
a.Fungi–
penicillin, griseofulvinb.Bacteria – Bacillus sp. (polymixin,
bacitracin) ; Actinomycetes
(tetracycline, chloramphenicol,streptomycin)
2. SyntheticDr.T.V.Rao MD 14
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 15/67
ANTIMICROBIAL AGENT
Ideal Qualities:
1. kill or inhibit the growth of pathogens
2. cause no damage to the host
3. cause no allergic reaction to the host
4. stable when stored in solid or liquid form
5. remain in specific tissues in the body long enough
to be effective
6. kill the pathogens before they mutate and becomeresistant to it
Dr.T.V.Rao MD 15
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 16/67
Although a large number of antibiotics exist, they fall into
only a few classes with an even more limited number oftargets.
–β-lactams (penicillins) –cell wall biosynthesis
–Glycopeptide (vancomycin) –cell wall biosynthesis
–Aminoglycosides (gentamycin) –protein synthesis
–Macrolides (erythromycin) –protein synthesis
–Quinolones (ciprofloxacin) –nucleic acid synthesis
–Sulfonamides (sulfamethoxazole) –folic acid metabolism
Dr.T.V.Rao MD 16
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 17/67
Is an antibiotic necessary ?
What is the most appropriate
antibiotic ?What dose, frequency, route and
duration ?
Is the treatment effective ?
Dr.T.V.Rao MD 17
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 18/67
Useful only for the treatment of bacterialinfections
Not all fevers are due to infection
Not all infections are due to bacteriaThere is no evidence that
antibiotics will prevent
secondary bacterial infection inpatients with viral infection
Dr.T.V.Rao MD 18
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 19/67
Oral vs parenteralTraditional view “serious = parenteral”
previous lack of broad spectrum oralantibiotics with reliable bioavailability
Improved oral agents higher and more persistent serum and
tissue levels for certain infections as good as
parenteral
Dr.T.V.Rao MD 19
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 20/67
Eliminates risks of complications associated
with intravascular linesShorter duration of hospitalstay
Savings in nursing timeSavings in overall costs
Dr.T.V.Rao MD 20
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 21/67
New Resistant Bacteria
Susceptible Bacteria
Resistant Bacteria
Resistance Gene Transfer
Dr.T.V.Rao MD 21
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 22/67
Mechanisms of Resistance
Enzymatic
degradation
Decreased entry
Efflux pump
Altered target site
Bypass pathway
Dr.T.V.Rao MD 22
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 23/67
Antimicrobial Resistance:
Key Prevention Strategies
Optimize Use
Prevent
Transmission
Prevent
Infection
Effective Diagnosis & Treatment
PathogenAntimicrobial-Resistant Pathogen
AntimicrobialResistance
Antimicrobial Use
Infection
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
Susceptible Pathogen
Dr.T.V.Rao MD 23
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 24/67
Antibiotic resistance isa consequence of evolution via naturalselection. Theantibiotic action is an
environmentalpressure; thosebacteria which have amutation allowingthem to survive willlive on to reproduce.
They will then pass thistrait to their offspring,which will be a fullyresistant generation.
Dr.T.V.Rao MD 24
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 25/67
Dr.T.V.Rao MD 25
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 26/67
Dr.T.V.Rao MD 26
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 27/67
Dr.T.V.Rao MD 27
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 28/67
48% of all antibiotics by weight is added toanimal feeds to promote growth. Results in low,sub therapeutic levels which are thought to
promote resistance. Farm families who own chickens feed
tetracycline have an increased incidence of tetracycline resistant fecal flora
Chickens at Spanish supermarkets have >90% of cultured campylobacter resistant to quinolones
39% of enterococci in the fecal flora of pigsfrom the Netherlands is resistant to vancomycinvs 0% in Sweden. (Sweden bans antibioticadditives in animal feed) Dr.T.V.Rao MD 28
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 29/67
Several studies havedemonstrated thatpatterns of antibioticusage greatly affect the
number of resistantorganisms whichdevelop. Overuse of broad-spectrumantibiotics, such as
second- and third-generationCephalosporins,generate resistant
strains. Dr.T.V.Rao MD 29
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 30/67
The resistant strains arise eitherby mutation and selection or bygenetic exchange in which
sensitive organisms receive thegenetic material ( part of DNA)from the resistant organisms and
the part of DNA carries with it theinformation of mode of inducingresistance against one or multiplen imi r i l n . Dr.T.V.Rao MD 30
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 31/67
RESISTANCE
ACQUISITION OF BACTERIAL RESISTANCE
ACQUIRED RESISTANCE
Species develop ability to resist an
antimicrobial drug to which it is as awhole naturally susceptible
Two mechanisms:
1. Mutational – chromosomal
2. Genetic exchange – transformation, transduction,
conjugation Dr.T.V.Rao MD 31
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 32/67
The greatest possibility of evil in self-medication is the use of too small doses sothat instead of clearing up infection, themicrobes are educated to resist penicillinand a host of penicillin-fast organisms isbread out which can be passed to otherindividuals and from them to other until
they reach someone who gets a septicemiaor a pneumonia which penicillin cannotsave.
. Sir AlexanderFlemming
Dr.T.V.Rao MD 32
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 33/67
1980s –ESBL producing GN bacteria 1990 Vancomycin resistantEnterococci emerged
2000 VISA (intermediate levelresistance)
2002-VRSA (high level resistance)
2002- Linezolid resistant enterococciand Staphylococci reported
Dr.T.V.Rao MD 33
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 34/67
Evolution of b-LactamasePlasmid-Mediated TEM and SHV Enzymes
AmpicillinThird-GenerationCephalosporins
1963
1965
TEM-1E coli S paratyphi
1970s
TEM-1Reported in28 Gram-NegativeSpecies
1980s1983
ESBLinUnitedStates
1987
ESBL inEurope
2000
>120 ESBLsWorldwide
Dr.T.V.Rao MD 34
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 35/67
Resistance to Antibiotics
•Bacteria (and viruses) are very resourceful creatures and they havedeveloped resistance mechanisms to essentially every antibiotic that hasbeen developed.
•Moreover, increased use of antibiotics results in increased resistance (th
paradox of antibiotics).
•The basic resistance mechanisms are quite simple:
1.Modify the antibiotic
2.Modify the target of the antibiotic
3.Destroy the antibiotic
4.Make it more difficult for the antibiotic to get into the cell
Dr.T.V.Rao MD 35
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 36/67
Plasmid seem to be ubiquitous inbacteria, May encode geneticinformation for properties
1 Resistance to Antibiotics2 Bacteriocins production3 Enterotoxin production4 Enhanced pathogen city
5 Reduced Sensitivity tomutagens
6 Degrade complex organic
molecules Dr.T.V.Rao MD 36
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 37/67
Plasmids – helps to spread multiple drugresistance
Discovered in 1959 Japan
Infections caused due to Shigella spreadresistance to following Antibiotics
Sulphonamides
Streptomycin
Choramphenicol,Tetracycline
Dr.T.V.Rao MD 37
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 38/67
Shigella + E.coli
excreted in thestool resistant to
several drugs invivo and vitro
Plasmid mediated –transmitted by
Conjugation Episomes spread
the resistance
Dr.T.V.Rao MD 38
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 39/67
R forms may have evolved as a collection of
Transposons Each carrying Genes that confers resistance
to one or several Antibiotics Seen in Plasmids,
MicroorganismsAnimals
Laboratory Manipulations are called asGenetic Engineering
Dr.T.V.Rao MD 39
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 40/67
Sulphonamides --- Reduce permeability
Erythromycin ---- Modification of ribosome's
Tetracyclnes ----- Reduced permeability
Chloramphenicol ---- Acetylation of drug
Streptomycin ----- Adenylation of drug
Pencillin ----- Hydrolysis of lactum ring
Dr.T.V.Rao MD 40
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 41/67
Therapeutic failures and relapse Facilitates spread in the hospitalunder “antibiotic pressure”
Need to use more costly andtoxic agents
The emergence of untreatablepathogens
Dr.T.V.Rao MD 41
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 42/67
RESISTANCE
ACQUIRED RESISTANCE – EXAMPLES:
1. Resistance (R) plasmids
Transmitted by conjugation
2. mecA gene
Codes for a PBP with low affinityfor -lactam antibiotics
Methicillin-resistant S. aureus
Dr.T.V.Rao MD 42
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 43/67
RESISTANCEORIGIN OF DRUG RESISTANCE
NON-GENETIC
1. Metabolically inactive organisms maybe phenotypically resistant to drugs
– M. tuberculosis
2. Loss of specific target structure for adrug for several generations
3. Organism infects host at sites whereantimicrobials are excluded or arenot active – aminoglycosides (e.g.Gentamicin) vs. Salmonella entericfevers intracellular
Dr.T.V.Rao MD 43
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 44/67
RESISTANCE
GENETIC
1. Chromosomal
Occurs at a frequency of 10-12 to 10-7
2
0
to spontaneous mutation in a locusthat controls susceptibility to a givendrug due to mutation in gene thatcodes for either:
a. drug targetb. transport system in the membrane
that controls drug uptake
Dr.T.V.Rao MD 44
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 45/67
RESISTANCEGENETIC
2. Extrachromosomal
a. Plasmid-mediated
Occurs in many different species, esp. gram(-) rods
Mediate resistance to multiple drugs
Can replicate independently of bacterialchromosome many copies
Can be transferred not only to cells of thesame species but also to other species andgenera
Dr.T.V.Rao MD 45
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 46/67
1Smith TL et al. N Engl J Med. 1999;340:493-501. 2Martone WJ. Infect Control Hosp Epidemiol . 1998;19:539-545.3Hiramatsu K et al. J Antimicrob Chemother . 1997;40:135-136. 4CDC. MMWR Morb Mortal Wkly Rep. 2002;51:565-567.
1975 1995 1990 1985 1980 P a t h
o g e n s R e s i s t a n t t o A n t i b i o t i c s ( % )
10090
80
70
60
5040
30
20
10
1996 2000
MRSA = methicillin-resistant Staphylococcus
aureus
VRE = vancomycin-resistant enterococci
GISA = glycopeptide-intermediate S aureus
VRSA = vancomycin-resistant S aureus MRSA1
VRE2
GISA3
Year 2002
VRSA4
Dr.T.V.Rao MD 46
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 47/67
< Inappropriate specimen selection and
collection
< Inappropriate clinical tests
< Failure to use stains/smears
< Failure to use cultures and
susceptibility tests
Practices Contributing to
Misuse of Antibiotics
Dr.T.V.Rao MD 47
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 48/67
RESISTANCELIMITATION OF DRUG RESISTANCE
1. Maintain sufficiently high levels of thedrug in the tissues inhibit original
population and first-step mutants.
2. Simultaneous administration of twodrugs that do not give cross-resistance
delay emergence of mutants resistantto the drug (e.g. INH + Rifampicin)
3. Limit the use of a valuable drug avoid
exposure of the organism to the drug Dr.T.V.Rao MD 48
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 49/67
What Is Antimicrobial Stewardship?
• A combination of infection control and antimicrobial
management• Mandatory infection control compliance • Selection of antimicrobials from each class of drugsthat does
the least collateral damage• Collateral damage issues include – MRSA– ESBLs– C difficile
– Stable derepression– MBLs and other carbapenemases– VRE• Appropriate de-escalation when culture results are
available Dr.T.V.Rao MD 49
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 50/67
IDSA Guidelines – Definition ofAntimicrobial Stewardship
• Antimicrobial stewardship is anactivity that promotes
– The appropriate selection of antimicrobials
– The appropriate dosing of
antimicrobials
– The appropriate route and durationof antimicrobial therapy
Dr.T.V.Rao MD 50
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 51/67
The Primary Goal of
Antimicrobial Stewardship• The primary goal of antimicrobial stewardship is to
– Optimize clinical outcomes while minimizing unintendedconsequences of antimicrobial use
• Unintended consequences include the following – Toxicity
– The selection of pathogenic organisms, such as C difficile
– The emergence of resistant pathogens
Dr.T.V.Rao MD 51
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 52/67
The Primary Goal of
Antimicrobial Stewardship• The primary goal of antimicrobial stewardship is to
– Optimize clinical outcomes while minimizing unintendedconsequences of antimicrobial use
• Unintended consequences include the following – Toxicity
– The selection of pathogenic organisms, such as C difficile
– The emergence of resistant pathogens
Dr.T.V.Rao MD 52
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 53/67
< Inappropriate specimen selection and
collection
< Inappropriate clinical tests
< Failure to use stains/smears
< Failure to use cultures and
susceptibility tests
Practices Contributing to
Misuse of Antibiotics
Dr.T.V.Rao MD 53
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 54/67
Use of antibiotics with noclinical indication (eg, for
viral infections)Use of broad spectrumantibiotics when notindicated
Inappropriate choice of
empiric antibiotics
Inappropriate Antibiotic Use
Dr.T.V.Rao MD 54
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 55/67
Inappropriate dose - ineffectiveconcentration of antibiotics at siteof infection
Inappropriate route - ineffectiveconcentration of antibiotics at siteof infection
Inappropriate duration
Inappropriate Drug Regimen
Dr.T.V.Rao MD 55
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 56/67
If a bacterium carries severalresistance genes, it is calledmultiresistant or, informally, a
superbug. The termantimicrobial resistance issometimes use to explicitly
encompass organisms otherthan bacteria
Dr.T.V.Rao MD 56
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 57/67
Antibiotic resistance has become aserious problem in both developedand underdeveloped nations. By
1984 half of those with activetuberculosis in the United States hada strain that resisted at least one
antibiotic.In certain settings, such ashospitals and some childcare location
Dr.T.V.Rao MD 57
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 58/67
Dr.T.V.Rao MD 58
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 59/67
Fischbach MA and Walsh CT Science 2009
Dr.T.V.Rao MD 59
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 60/67
Other clinicians
Patients
Optimize patient evaluationAdopt judicious antibioticprescribing practicesImmunize patients
Optimize consultations withother cliniciansUse infection control measuresEducate others about judicioususe of antibiotics
Dr.T.V.Rao MD 60
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 61/67
Bacteria evolve resistance toantibiotics in response toenvironmental pressure exerted by the
use of antibiotics. Many of these bacteria are significantpathogens.
Our responsibility to our community isto use antibiotics prudently, forappropriate indications.
Dr.T.V.Rao MD 61
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 62/67
12 Steps to Prevent
Antimicrobial Resistance
12 Break the chain11 Isolate the pathogen10 Stop treatment when cured
9 Know when to say “no” to vanco 8 Treat infection, not colonization
7 Treat infection, not contamination6 Use local data
5 Practice antimicrobial control4 Access the experts
3 Target the pathogen2 Get the catheters out
1 Vaccinate
Prevent Transmission
Use Antimicrobials Wisely
Diagnose & Treat
Effectively
Prevent Infections
Dr.T.V.Rao MD 62
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 63/67
Antibiotic resistance is a majorproblem world-wide
Resistance is inevitable with use
No new class of antibioticintroduced over the last twodecades
Appropriate use is the only way ofprolonging the useful life of anantibiotic
Dr.T.V.Rao MD 63
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 64/67
Dr.T.V.Rao MD 64
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 65/67
Surveillance
Prevention and
Control
Research
Product
Development
Agency forHealth Care Research and
QualityDepartment of
Defense
EnvironmentalProtection
Agency
Health CareFinancing
Administration
Health Resources andServices
Administration
Department ofAgriculture
Department ofVeterans Affairs
Dr.T.V.Rao MD 65
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 66/67
Think before
prescribing Are
we using Right
drug for the
Right bug ?
Dr.T.V.Rao MD 66
8/3/2019 Antibiotics, Misuse and Consequences
http://slidepdf.com/reader/full/antibiotics-misuse-and-consequences 67/67
Created by Dr.T.V.Rao MD for
Medical Professionals in the
Developing WorldEmail