2. Background
All drugs have adverse effects
Antibiotics have an ‘additional effect’
Known as ‘collateral damage’
Refers to the impact of the antibiotic on the
colonising bacterial flora
Selection of antibiotic resistant
microorganisms
Patient becomes colonised with resistant
organisms
3. The dilemma...
Antibiotics are one of the most important
discoveries in modern medicine..
However, inappropriate use of
antimicrobials may lead to ‘collateral
damage’
On the other hand..
Severe restriction of antibiotics (inadequate
therapy) in seriously ill patients is associated
with increased mortality
4. ??.. Solution
The role of the Antibiotic Stewardship Program is to
strike a balance between appropriately treating
the patient and avoiding the selection of
antibiotic resistant organisms
5. Role of antimicrobial
stewardship programs (ASP)
Aim to
Optimise antimicrobial therapy (PRIORITY)
Improve overall patient outcome
Minimise adverse events
Decrease the risk of development of
antimicrobial resistance
Reduce treatment related costs
6. How is this achieved?
To optimise therapy
Improve selection/choice of antimicrobial – refer
to microorganism, susceptibilities, resistance
patterns, antibiotic spectrum
Duration (eg: t1/2), overall therapy duration
Dose – site of infection, drug factors (Vd, Cl,
bioavailability)
Route of administration (IV vs po)
7. How is this achieved?
Reduce antimicrobial costs
Limit overuse
Narrow spectrum chosen (avoid inappropriate use)
Promote active IV to po switch
Reduce hospital length of stay (minimising
infections due to resistant organisms)
Minimise adverse events
TDM
Dosage adjustments (individualise therapy)
9. How did SCGH fare in 2009…?
Cefepime
Clindamycin
Ciprofloxacin
Azithromycin
Meropenem
Timentin/Tazocin
Augmentin DF
The podium of shame
10. Outcome of this high usage..
Implementation of an Antimicrobial
Stewardship Program (February 2010)
HAPI (Healthy Antimicrobial Prescribing
Initiative)
‘ward-side’ review of restricted antimicrobial
therapy
Written recommendations documented in notes
12. HAPI rounds
Consists of
ID Pharmacist
ID Physician/Clinical Microbiologist
+/- ID Registrar
+/- Microbiology Registrar
Review of patients on
Restricted antimicrobials
Prolonged course/s of antimicrobials
13. HAPI rounds
The team will provide advice to the treating
team in regards to most appropriate
antimicrobial therapy
Eg
Cessation of therapy
Change in therapy
Narrow therapy
Broaden therapy
Switch to oral de-escalation
Referral for ID consult
14. Why we need AMS?
Broad spectrum antimicrobials
commenced
Appropriate therapy
initially
Micro results return
Pathogen identified
Susceptibility results
available
Patient improves..
But still on broad spectrum
antimicrobials
Infection resolved.
Patient still on broad
spectrum antimicrobials
Patient ready for discharge
Broad spectrum IV antimicrobials
changed to broad spectrum
oral antimicrobials
17. HAPI rounds
4 x week rounds on general wards
2 x week rounds in ICU and GHDU
1 weekly round with Haematology team
Soon..
eReferral option to AMS (HAPI team) for
assistance with antimicrobial choices, de-
escalation of therapy etc
22. What can YOU do?
Overuse/abuse of antimicrobials affects
everyone!
How can you help?
Request the prescribers to document
antimicrobial indication on chart
Antimicrobials warranted?
Encourage the prescriber to request ID
approval for restricted antimicrobials
Question antimicrobial duration/s
Encourage IV to oral switch
Refer patients on prolonged antimicrobials to
the HAPI team or your clinical pharmacist