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CLINICAL

USE OF
ANTIMICROBIAL DRUGS
Johnmartin M. De Los Reyes, RMT MSc

Susceptibility of infecting organisms


Drug selection must be based on knowledge of its activity against
infecting microorgansims
Some organisms may be predictably susceptible to a particular agent

Host Factors
In vitro susceptibility testing does not always predict clinical outcome
Host factor plays an important role in determining outcome and this
applies particularly to circulating and tissue phagocytic activity

Pharmacological Factors
Satisfactory drug concentration
Absorption, distribution, metabolism and excretion
Presence of food, drug interactions

Drug Resistance
Natural or acquired characteristic of microorganism
Acquired mutation, adaptation, gene transfer

Multidrug resistance
Epidemics and worldwide
MRSA, Enterococcus (Van), Extended spectrum B-lactamase (ESBL)

Drug combinations
Synergism
Indifference
Antagonism

Adverse reactions
Side effects hypersensitivity
Toxicity lethal dose

Superinfection
Anti-infective drugs may also affect the normal bacterial flora of skin
and mucous membrane and this may result in microbial overgrowth
of resistant organisms with subsequent superinfection

Chemoprophylaxis
Antimicrobial agents used to prevent infection in surgery
Perioperative period first dose 1 hour before surgery

Clinical Uses
Focus on the drugs used for specific infection
See tables

Antibiotic policies
Rationale
Number of antimicrobial drugs
Excessive use of antimicrobial agents
Susceptibility of microorganisms must be monitored

Free prescribing
Greater the number of agents in use the less likely it is that drug
resistance will emerge

Restricted reporting
Tests only a limited range of agents against bacterial isolates
Allows the clinician to use such agents with greater confidence

Restricted dispensing
Unrestricted vs Restricted drugs
Pending expert approval

ANTIBIOTIC PRESCRIBING
AND ANTIBIOTIC
STEWARDSHIP

The need for antimicrobial stewardship


Increase resistant bacteria
Decrease discovery of new drugs

Components of antimicrobial stewardship


programmes
An infectious disease physician
Clinical pharmacist
Medical microbiologist
An infection control professional
Hospital epidemiologist
An information technology specialist

The effectiveness of stewardship strategies


Prospective audit reduce inappropriate use of antibiotics, achive
cost effectiveness
Formulary restriction reduce antibiotic consumption

Monitoring of antibiotic resistance


Antibiotic consumption and costs
Rates of resistance to specific antibiotics
The incidence of hospital acquired infection

The impact on resistance of antibiotic


availability to the public
Precious source or marketing tool