AntimicrobialsUsageand

A
i i bi l U
d
Antibiotic Policy
AntibioticPolicy

Dr.MuhammadA.Halwani
SupervisorofInfectionControland
CentralSterilisationintheMakkahArea
ConsultantinInfectionControlfortheCentralBoardofAccreditationfor
HealthCareInstitutions(CBAHI)

Overview
Antimicrobialsincludingantibioticsareverygoodagentsthatare
very effective in treating infections
veryeffectiveintreatinginfections

Overuseandmisuseofthem;however,ledtotheemergenceof
Overuse and misuse of them; however, led to the emergence of
resistancemicroorganismsthataredifficulttotreatandhighly
transmissible
Theinfectioncontroldoctorshouldcontribute,advice,andhelp
treatingphysiciansbecomemorefocusedbefore,during,andafter
subscriptionrelease
b
l
Considerableskillsandknowledgeisnecessarytomakethebest
Considerable skills and knowledge is necessary to make the best
ofthewiderangeofantibioticsandthiscanbegivenbymedical
microbiologistinthehospital

AntimicrobialResistance
Thetermresistancecanbedescribedtoaparticularantibioticif
its growth was not inhibited by the used concentration of the tested
itsgrowthwasnotinhibitedbytheusedconcentrationofthetested
drug
Thetermsensitivecanbedescribedtoaparticularantibioticifits
growthwasinhibitedorbytheusedconcentrationofthetested
drug
Itmustbenotedthatthemicrobiologylabresultsarenot100%
preciseandmanyfactorscaninterferewithwhatisseeninvitro
d
f
f
h h
Thisconceptshouldbeexplainedtotreatingphysicianstomake
This concept should be explained to treating physicians to make
themmoreawareofthepossibilityofthetreatmentfailurethat
mighthappen

TypesofResistance
Naturalresistance
Bacteriamayhavenaturalresistancetodifferent
antibioticswhichisusuallytheresultoftheinabilityofthe
drugtopenetratethecells
Acquiredresistance:
p
y
g
Thepermeabilitychangeofthecellmembrane
Alterationinthetargetsite
Production of enzymes that inactivate the antibiotic
Productionofenzymesthatinactivatetheantibiotic
Expellingofthedrugfromthecell

CausesofResistanceDevelopment
Theheavyuseofantimicrobialagents
Unnecessaryprescribingofantimicrobialagents
Inappropriateusesuchasgivinganincorrectagent,
dose or duration
dose,orduration
Uncontrolledsaleofantimicrobialagentswithout
Uncontrolled sale of antimicrobial agents without
prescription

TransmissionofResistance
Crosstransmissionofhospitalinfectionsbetween
patients
Resistantstrainsspreadinthesameregionwithpatient
R i
i
di h
i
ih
i
transfer
Admissionofoutsidetheborderpatientswhoare
p
colonisedorinfectedwithdifferentstrains

StrategiesforPreventingAntimicrobialResistance
Educateintakinganappropriatespecimens
Improvementsinprescribingpractice
Simpleeducationtojuniordoctorsandsomeother
physicians
h i i
Makesurethatwidespectrumantibioticsareusedonly
M k
h
id
ibi i
d l
whenrequiredwiththerightdoseandduration
Surveillanceforresistancestrains

StrategiesforPreventingAntimicrobialResistance
cont.,
Isolationofinfected&colonisedpatients
Drugutilizationreview
Controlandimprovinginthelaboratorytesting
Limitthecontactbetweenphysiciansand
pharmaceuticalrepresentatives
h
i l
i
Preparationandapplicationofantibioticpolicy&
P
i
d
li i
f
ibi i
li &
procedures

AntibioticPolicy
Themainideaofthemakingantibioticpolicyis:
g
p y
todiscouragetheindiscriminateuseofantibioticsin
to discourage the indiscriminate use of antibiotics in
hospitals
tominimizethedevelopmentofantibioticresistant
strains
toreducethecostofantibioticprescribing

AntibioticPolicycont.,
Antibioticpolicydemonstratesacommitmenttorational
andsensibleuseofantibiotics
d
ibl
f
ibi i
Thepolicyshouldconsidertheuseofthenarrowest
Th
li h ld
id h
f h
spectrum,whichhastheminimaltoxicityandtheleast
impact on the development of resistance
impactonthedevelopmentofresistance
Policiesshouldalwaysconsiderthelocalantibiotic
Policies should always consider the local antibiotic
biogramsbeforepreparations
Policyshouldbepreparedbyagroupofspecialised
workersinthehospitalorintheregion

AntibioticPolicyCommitteeMembers
Clinicalpharmacist
Aninfectiousdiseasesdoctor
ect ous d seases docto
Microbiologist
Infectioncontroldoctor
Infection control doctor
Selectedseniorconsultantcouldbeinvolvedfor
f
consultationsandsuggestions

CommitteeMembersRoles
Allthemembersshouldcontributeinputtingthepolicy
andinreviewingitwithcare,inparallelwiththe
di
i i it ith
i
ll l ith th
internationalstandards
Auditingofprescribingisrequiredbyaclinical
pharmacistwithmonthlyreportingtothecommittee

TheIdealPolicy
Listoftheantibioticsinthehospitalandnoantibiotic
List of the antibiotics in the hospital and no antibiotic
outsidethelistshouldbeused
Guidelinesshouldbeprovidedforempirictreatment
andtargetedtreatmentofthemostfrequentinfections
dt
t dt t
t f th
tf
t i f ti
includingdosageanddurationoftreatment
Protocolforsurgicalprophylaxisandwhentheyshould
begivenandwhentheyshouldbestoppedmustbe
provided

TheIdealPolicycont.,
Protocolforthereservedantibioticsandwhoandwhen
they can be prescribed
theycanbeprescribed
Specialformsincaseanewantibioticneedtobeadded
oranantibioticneedtobereplaced,evaluatedor
eliminatedtobediscussedonthecommitteemeeting

TheIdealPolicycont.,
Infectioncontroldoctorshaveanimportantroletoplayin
p
p y
administrating,andmonitoringthedrugsprescribed,andin
discussingthetreatmentwiththephysicianswhentherapyseems
unnecessary
Infectioncontroldoctorsshouldalwaysdirectphysicianstothe
factthatisolationofmicroorganismsdoesnotnecessarilyindicate
an infection
aninfection
Afterantibioticinitiation,doctorsshouldbeadvisedtofollowup
After antibiotic initiation doctors should be advised to follow up
thecourseandthatthesusceptibilityoftheorganismisolatedor
switching to a narrower spectrum is recommended
switchingtoanarrowerspectrumisrecommended

RoleofInfectionControlinProphylaxis
Antibioticsarealsoimportanttoprotectpatientsinsituationsthat
markedlyincreasetheirvulnerabilitytoinfection
k dl
h
l
bl
f
Theyshouldbeappliedbeforesurgicaloperationsorwhen
Th
h ld b
li d b f
i l
ti
h
subsequentinfectioncouldhaveveryseriousconsequencessuchas
valvereplacement
p
Surgeonsinanygrade(specialists,seniorspecialist,or
consultants)shouldfollowthelocallyapprovedorinternationally
knownpolicyinselectingproperantibiotics
Apointthatshouldbeconsideredalwaysisthatprophylactic
therapyshouldnotbecontinuedformorethan24hours
py

So,whatisrequiredfromusasIC?
,
q
Applicationofsimplerestrictionpolicy
Minimizetheuseofsomewidespectrumantibioticsandotherfinalhope
treatment
Donotallowforprophylaxismisuse
Suchagroupofantibioticsshouldbesubscribedonlybyconsultantsandwith
h
f
b
h ld b
b b d l b
l
d
h
thesupportandagreementofthemedicalmicrobiologist
Pharmacyshouldmonitorsuchapplicationandshouldnotdispenserestricted
h
h ld
i
h
li i
d h ld
di
i d
antibioticstojuniordoctors
Educationalsessionorcirculationoftheideaofsuchanapplicationisusefuland
Ed
i
l
i
i l i
f h id
f
h
li i i
f l d
mandatory

AntibioticControl
Antibioticsthatmustbecontrolledinthehospital:
Vancomycin/teicoplanin
Third&fourthgenerationcephalosporins(ceftazidime,
ceftriaxone&cefepeme)
Carbepenems(meropenem&imipenem)
Tazocin
Ciprofloxacin

Any Questions?
AnyQuestions?