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Standing up to Emerging Antibiotic Resistance: How Can rational use of antibiotics help?
Ahmed F. El-YazbiBPSc, PhD, BCPS,RP (ACP)
Dalia A. HamdyBPSc, MSc, PhD, RP (ACP), MRSC
Nahla H. KandilBPSc, MSc, BCPS
I. Pharmacist Attitude and Role in the Prevention of
Antibiotic AbuseDalia A. Hamdy
BPSc, MSc, PhD, RP (ACP), MRSCAssistant professor, Faculty of PharmacyAlexandria University, Alexandria, Egypt
Outline
• Introduction to antibiotic misuse and resistance
• Identifying the knowledge and attitude (Cards game)
• Comparing our results to latest statistics in a recent study in Alexandria
• Introduction to some important terms and myths
• Employing counselling skills to educate the patientsStanding up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015) 3
4
Antibiotic misuse
• AB Self-medication:• defined as obtaining an antibiotic from any source
other than a prescription from a healthcare provider
• Patient non-compliance to therapy:• Do not finish drug therapy• Change antibiotic during treatment
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
Can antibiotics be used to cure infection caused by viruses?
YesNoI don't know
Recent Stats, Alexandria 2014. (n=400 participants)
42%
38%
20%
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
Do you think the use of antibiotics will speed up the recovery of cold, cough & other diseases?
YesNoI don't know
Recent Stats, Alexandria 2014. (n=400 participants)
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
65%
28%
7%
Have you ever heard of bacterial resistance?
YesNo
Recent Stats, Alexandria 2014. (n=400 participants)
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
44%56%
8
Antibiotic Resistance
“is the resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it “
WHO Fact Sheets, April 2014
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
9
Antibiotic Resistance
Stan
ding
up
to E
mer
ging
Anti
bioti
c Re
sista
nce
(DH/
AY/N
K/ M
arch
, 201
5)
In the past 12 months, have you ever used antibiotics without a prescription?
YesNo
Recent Stats, Alexandria 2014. (n=400 participants)
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
64%
36%
What is MRSA? methicillin resistant staphylococcus aurousmyocardial reversal stenotic atrium describes a hepatic microsomal E deficiencymedullary rays stones assessment I don't know
Recent Stats, Alexandria 2014. (n=400 participants)
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
51%
6%
40%
3%
12
MRSA
https://youtu.be/gU7hrtxBWmA
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
Aspocid infantile® can be used for children from 14-16 years?
Yes, for relieving mild fever &cold cases NO, because it may cause Reye's Syndrome for children under 18 years old Yes, it increases the immunity for children under 18 years old No, it may cause hemorrhageI don't know
Recent Stats, Alexandria 2014. (n=400 participants)
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
30%
15%42%
3%10%
14
Aspirin and Reye’s Syndrome
• Reye syndrome is an acute, non-inflammatory encephalopathy and hepatotoxicity that follows an acute viral illness. It is associated with salicylates treatment
15
Aspirin and Reye’s Syndrome
• The National Reye's Syndrome Foundation, the U.S. Surgeon General, the FDA, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics recommend that aspirin and combination products containing aspirin not be taken by anyone younger than 19 years during fever-causing illnesses.
• The British Medicines and Health-care products Regulatory Agency recommends that aspirin labels state that aspirin is not for use in children younger than 16 years unless recommended by a physician.
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
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Pharmaceutical Care Practitioner
• Pharmaceutical Care Practitioner:Job is to assure that
a. Appropriate use of patient’s drug therapy for each medical condition
b. Drug therapy used is effective and safe
c. The patient is able and willing to take the medication intended
Assessment
Care Plan
Follow-up evaluation
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
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Structured patient communication skills
• Establishing Rapport
• Listening• Posing questions
• Providing feedback
-History taking-Probing for further details regarding the problem
-Checking information and using resources-Providing a recommendation, instructions, or information to the patient- Final Recap
-Introduction
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
18
Structured patient communication skills
Data Collection
A lady is showing up at your pharmacy/ admitted to the hospital, she is looking for/ prescribed an antibiotic and is seeking your advice?
1. Collect the data from this patient using the rubrics given2. What do you think is the reason behind such symptoms?3. Do you have any other comments?
1
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
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Structured patient communication skills
20
Structured patient communication skills
Looking up information using resources
1. Can AB be administered to pregnant ladies, children, ..etc?2. Do we need dose modification for patients with CrCl < 30 mL/min?3. I am allergic to eggs, soy bean …etc . Would AB be safe?4. I am on digoxin, is it OK to take AB with my therapy?5. Do I need to change the dose of my oral contraceptive upon taking AB?
2
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
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Structured patient communication skills
Conveying Data
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
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You are educating your patient about proper antibiotic use
• Hand washingKeep you away from getting cold and flu or spreading it to other people.
• General notesDrink a lot of fluidsUse a vaporizer or humidifierSouth your internal nose with saline (otrivin and rebound congestion)
• AB instructionsWhen would the AB kick inWhen should you stop antibioticWhat are the most common side effects and how to deal with them
3 Patient Education
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
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You are educating your patient about proper antibiotic use• Allergy
Warn from penicillin allergy for first time users
• FeverHow to alleviate symptoms and deal with fever
Aspirin and Reye’s syndrome
Paracetamol max. dose per day for children
• Concomitant medication and possible Drug interactionVitamins
Thyroid hormone replacement therapy
Oral contraceptives
4 Patient Education
24
Structured patient communication skills
Stan
ding
up
to E
mer
ging
Anti
bioti
c Re
sista
nce
(DH/
AY/N
K/ M
arch
, 201
5)
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)
25
Thank You
Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)