Dr.Azad A Haleem AL.MezoriDCH, FIBMS

Lecturer University Of Duhok College Of Medicine

Pediatrics Department2017

azad82d@gmail.com

Antibiotic : Introduction &Stewardship Program in

children

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.

3Con…

COMMON BACTERIA BY SITE OF INFECTION

4

5

Classifications of Antibiotics Classifications of Antibiotics

Spectrum of activity

Broad

spectrum

Narrow

spectrum

Site of action Type of action

Bacteriostatic

Bactericida

l

1. Mechanism of action

9

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.

• 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

2. Type of action

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.

3. Spectrum of activity

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

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.

Drug resistance

• Factors that may contribute to the emergence and dissemination of antimicrobial resistance

o ► Inadequate infection controlo ► High antimicrobial usage per geographic

area per unit timeo ► Increased use of antimicrobial prophylaxiso ► Increased empiric polymicrobial

antimicrobial therapy.

o ► Greater severity of illness of hospitalized patients

o ► More severely immunocompromised patientso ► Newer devices and procedures in useo ► Agricultural use of antimicrobialso ► Social factorso ► International travelo ► Evolution of pathogens

Drug resistance

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

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;

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”.

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

Stewardship Team

Antimicrobial stewardship is the 8 R’s:

• Right drug, • Right time • Right dose • Right route • Right Resident • Right Documentation • Right Reason • Right Response

• 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

• 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

• 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

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 events5. Decrease or limit antibiotic resistance6. reduce healthcare costs

Why Stewardship

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

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

C-Red flag:

• Used only by infectious disease doctors (consultant) • linezolid,• daptomycin,• colistin,• Amphotericin ,• Caspofungin,• Moxifloxacin,• Pristinamycin • Tigecycline,• Voriconazole

33Con…

COMMON BACTERIA BY SITE OF INFECTION

THANKS FOR LIMITATION IN USING

OF ANTIBIOTICS