Using Antibiotics Prudently 123

7/25/2019 Using Antibiotics Prudently 123

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prudentlyand Antibiotic

Stewardship

HENDRO WAHJONO

SM M!"RO#!O$O%! "$!N!"

RSU& DR "AR!AD!'()*


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Contents of this presentation

Antibiotic resistance + a patient sa,etyissue

Situation in !ndonesia

Dri-ers o, antibiotic resistance

.onse/uences o, antibioticresistance

Why inappropriate use o, antibiotics

contributes to antibiotic resistance +the 0why1

How prudent use o, antibiotics can bepro2oted in hospitals + the 0how1

Optimize Clinical Outcomes through appropriate


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WHO + World HealthDay World Health

Day is

celebratedevery year on7 April, under

thesponsorship ofthe World

Health Dr!"#ao $D %


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WARAGAINSTMICROBES

Theartofwarisdeception;thatisdeceivingthe

enemy.Butinthewaragainstmicrobeswehave

deceivedourselvesbymisusing,under-usingand

overusingantibiotics


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How do you deter2ine whichantibiotic to use3

.on4r2 presence o, in,ection

!denti,y the pathogen555Microbiology $ab5

Selecti-e e2piric therapy based onhost

and drug ,actors


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Outco2e o, the irst Su22it Meetings 6 '((7

Reco22endations ,or E2pirical 8herapy &no' your atient

"now your Drug

&no' your nviron*ent

&no' your +i*itations

Role o, the Microbiologist rovide an ecellent database of the prevalence -

susceptibility pro.les of *icroorganis*s in theCo**unity, Hospital - /C0

1e part of the /C0 tea*

AIM INDIA, 2003


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2 What3s the *ost epensive

4W antibiotics 5

A !he one that doesn3t

'or6

!


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8hin9 be,ore -Prescribing an antibiotic

Is an antibiotic necessary ?

What is the most appropriate

antibiotic ?What dose, frequency, route and

duration ? Is the treatment effective ?

Dr!"#ao $D 8


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T>MIC

Cmax/MICAminoglcosides

Fluoro!uinolones

A"C/MICAminoglcosides

Fluoro!uinolones

#inezolid

$aptomcin

Tetracclines

Concentration

MIC

Cmin%Trough

$osingisImportantConcentrationdependant

Cmax%'ea5

Time

dependant

'enicillins

Cephalosporins

Carbapenems

Macrolides

6ancomcin

Clindamcin


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How 8o .hoose Antibiotic:s;3

&A8!EN8

!n,ection8ype

M!.ROOR%AN!SM

&"


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#!O$O%!.A$

RES&ONSEMOD!!ERS

AN8!#!O8!.S

=

IMUNOMODULATO

R


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8!SSUES

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W!8H &HA%O.?8ES AND

.OM&$EMEN8S

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AN8!#!O8!..ON.EN8RA8!ON!N 8!SSUES

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What is Anti*icrobial9te'ardship An interdisciplinary tea* dedicated

to practices that i*proveappropriate selection, dosing, route,

and duration of anti*icrobial therapy

!he ulti*ate goal of anti*icrobialste'ardship is to i*prove patient

care and health care outco*es


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Antibiotic 9te'ardship

De.nition: A syste* of infor*atics, datacollection, personnel, andpolicy;procedures 'hich pro*otes theopti*al selection, dosing, and duration of

therapy for anti*icrobial agents throughoutthe course of their use

urpose:

+i*it inappropriate and ecessiveantibiotic use

/*prove and opti*ize therapy andclinical outco*es for the individual

infected patient

Ohl CA Seminar Infect Control ?>:=Ohl CA, +uther " Hosp $ed >?B:9


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/s pertinent to inpatient, outpatient, andlong@ter* care settings

/s practiced at the +evel of the patient

+evel of a health@care facility or syste*, ornet'or6

9hould be a core function of the *edicalstaF

(ie doctors and other healthcareproviders)

0tilizes the epertise and eperience of

clinical phar*acists, *icrobiologists,infection control ractitioners and

Antibiotic 9te'ardship


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Anti*icrobial 9te'ardship!ea* /nfectious Disease

hysician

Clinical har*acist

Clinical*icrobiologist

/nfor*ation 9yste*9pecialist

/nfection controlprofessional

Hospitalepide*iologist

+eadership support .!D '((B CC :)@


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arly Appropriate Antibiotics and9ource Control

Gra* positive organis*s havesurpassed gra* negatives as the*ost co**on source of sepsis

!herapy targeted to the suspectedsite (eg, CA, intra@abdo*inalsource)

Drainage, debride*ent and devicere*oval as indicated


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Resistance equation

Risk of emergence antibiotic resistance

geneticselectionAntibioticpressure

7is5of

crossinfection


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Conversion fro* parenteral to oral therapy Having a syste*atic

plan for s'itching fro*parenteral to oraltreat*ent *ay have

an added bene.t ofaiding in early hospitaldischarge planning

Develop*ent ofclinical criteria and

guidelines allo'ingconversion canfacilitatei*ple*entation


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9o*e Health@Care Associated/nfections that $ay Occur

0!/ associated 'ith oley catheters

+o'er respiratory tract infection

(post@op and ventilator dependent) 96in necrosis (s6in brea6do'n)

1lood strea* infection (and line

associated) 9urgical@site infection

4utrition@related and *alnutrition


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!herapy Across the 9epsis Continuu*

Chest1992;1011!""#

SepsisS!RSSe-ereSepsis

SepticShoc9

Antibiotics and Source .ontrol

Chest>8(>):>B

B year or PB years

9urgical;invasive procedures

$alnutrition

0se of broad@spectru* antibiotics Chronic illness

D$

C# Hepatitis

/**unode.ciency disorders


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Nicki Roderman, RN, MSN, CCRN

#is6 actors

Co*pro*ised /**une 9tatus: A/D9

0se of cytotoic and

i**unosuppressive agents Alcoholis*

$alignant neoplas*s

!ransplant /ncrease in the nu*ber of drug@

resistant *icroorganis*s


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Nicki Roderman, RN, MSN, CCRN

&eys

&eys to success:

8i2ely co22unication and

,eedbac9Ongoing i2pro-e2ents

Data@dri-en approach

Regular co22unication o, results

)OLLABORATION0

Should this patient get appropriate treatment?


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Should this patient get appropriate treatment?

>< 9teps to revent Anti*icrobial #esistance: Hospitalized Adults


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/nfectious Diseases pert#esources

/nfectious Diseases9pecialists

Opti*alatient Care

Opti*alatient Care

/nfection Controlrofessionals

Healthcarepide*iologists

Clinicalhar*acists

Clinicalhar*acologists

9urgical /nfectionperts

Clinical$icrobiologists

Step 4: Access the experts


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Reliableanswers

$east possible

ris9

Rapid diagnosisAppropriate treat2ent

$icrobiology +ab

.linician

Co**unication


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GOA+9

>atient safety


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Wor6ing together creates 9afeHospitals


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8each Hand Washing a Habit toE-eryone

Dr!"#ao $D %


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Antibioticssave +ives9ave Antibioticsfro* $isuse

Dr!"#ao $D


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Docu*ent your Antibiotic #esistanceand 9ensitivity atterns 'ith WHONE8

WHO4! is a freesoft'are developed bythe WHO CollaboratingCentre for 9urveillance

of Anti*icrobial#esistance forlaboratory@basedsurveillance of

infectious diseasesand anti*icrobialresistance

Dr!"#ao $D


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%lobal United Eorts .anReduce Antibiotic Misuse

Dr!"#ao $D B

CONCLUSION


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CONCLUSION

$ccordin% to appropriate use %uide&ines it is important to

0se antibiotics only for bacterial infections

1etter *anage anti*icrobial resistance it is critical

0se targeted antibiotics 'ith appropriate@spectru*of activity and dose

/*prove co*pliance 'ith antibiotic regi*ens

'

.D. %et S2art &rogra26


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Discussed prescribing strategies - 'here toaccess help ; infor*ation

#esistant G(@) dan G(Q) should be 'ellconsidered

#eliable Clinical $icrobiology data supportthe decision

Antibiotic ste'ardship is i*portant for

preserving eisting antibiotics and

CONCLUSION


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TERIMA KASIH

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Using Antibiotics Prudently 123