Antibiotic; introduction & stewardship program in children

2. ANTIBIOTICS
• Antibiotics can be defined as substances
capable of killing & inhibiting the growth of
micro organisms.
• The term antibiotics literally means “against
life”; in this case, against microbes.
• There are many types of antibiotics—
antibacterials, antivirals, antifungals, and
antiparasitics.

3. 3Con…
COMMON BACTERIA BY SITE OF INFECTION

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6. Classifications of Antibiotics
Classifications of Antibiotics
Spectrum of
activity
Broad
spectrum
Narrow
spectrum
Site of action
Type of
action
Bacteriostatic Bactericidal

7. 1. Mechanism of action

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10. 2. Mode of action
• Bacteriostatic vs. bactericidal drugs;
• Bacteriostatic
– arrest the growth and replication of bacteria at
serum levels achievable in the patient.
– limit the spread of infection while the body's immune
system attacks, immobilizes, and eliminates the
pathogens.
– If the drug is removed before the immune system has
scavenged the organisms, enough viable organisms
may remain to begin a second cycle of infection.

11. • Bactericidal
– kill bacteria at drug serum levels achievable in the
patient. - often drugs of choice in seriously ill
patients.
• It is possible for ATB to be bacteriostatic for
one organism and bactericidal for another.
2. Mode of action

12. 2. Type of action

13. 3. Spectrum of activity
• Narrow spectrum
• only against a single or a limited group of
microorganisms,
• e.g. INH is active only against mycobacteria.
• Broad spectrum
• affect a wide variety of microbial species.
• e.g. tetracycline and chloramphenicol
• Alter the normal bacterial flora ????
• precipitate a superinfection of an organism, e.g.,
candida.

14. 3. Spectrum of activity

15. Antimicrobial activity
• Antimicrobial activity: the ability that a drug
kills or suppresses the growth of
microorganisms.
• Minimum inhibitory concentration (MIC)
– the minimum amount of a drug required to
inhibit the growth of bacteria in vitro.
• Minimum bactericidal concentration (MBC)
– the minimum amount of a drug required to kill
bacteria in vitro

16. Drug resistance
• Growth of bacteria is not halted by the maximal level of
that antibiotic that can be tolerated by the host.
 Primary
 Some organisms are inherently resistant to an antibiotic
 e.g., gram-negative organisms are inherently resistant to
vancomycin.
 Secondary
 spontaneous mutation or acquired resistance and selection.
 Cross-resistance
 resistant to more than one antibiotic.

17. Drug resistance
• Factors that may contribute to the
emergence and dissemination of
antimicrobial resistance
o ► Inadequate infection control
o ► High antimicrobial usage per geographic
area per unit time
o ► Increased use of antimicrobial prophylaxis
o ► Increased empiric polymicrobial
antimicrobial therapy.

18. o ► Greater severity of illness of hospitalized
patients
o ► More severely immunocompromised patients
o ► Newer devices and procedures in use
o ► Agricultural use of antimicrobials
o ► Social factors
o ► International travel
o ► Evolution of pathogens
Drug resistance

19. 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

20. 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;

21. Inappropriate prescription
• In an analysis of prescribing practices in teaching
hospitals worldwide, more than 40 % of all
antimicrobials prescribed were considered inappropriate.
• Antibiotic resistance comes mainly because of
inappropriate or improper use of antibiotics by
physicians. Some 150 million prescriptions are
written annually in the USA And Of those, 50
million are absolutely unnecessary or
inappropriate”.

22. 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

23. Stewardship Team

24. Antimicrobial stewardship is the 8 R’s:
• Right drug,
• Right time
• Right dose
• Right route
• Right Resident
• Right Documentation
• Right Reason
• Right Response

25. • 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

26. • 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

27. • 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

28. 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 events
5. Decrease or limit antibiotic resistance
6. reduce healthcare costs

29. Why Stewardship

30. 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

31. 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

32. C-Red flag:
• Used only by infectious disease doctors (consultant)
• linezolid,
• daptomycin,
• colistin,
• Amphotericin ,
• Caspofungin,
• Moxifloxacin,
• Pristinamycin
• Tigecycline,
• Voriconazole

33. 33Con…
COMMON BACTERIA BY SITE OF INFECTION