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Outline

Introduction and definitions

Rational drug use and prescribing

Antimicrobial stewardship

Approaches to antimicrobial stewardship

Conclusion

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Introduction

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Definition: Antibiotic

An agent or substance that is produced by or derived from a microorganism that kills or inhibits the growth of another living microorganism.

Substances that are synthetic, semi-synthetic, or derived from plants or animals are, strictly speaking, not antibiotics

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Antibiotics vs Antimicrobials

ANTIBIOTIC is a low molecular substance produced by a microorganism that at a low concentration inhibits or kills other microorganisms.

ANTIMICROBIAL is any substance of natural, semisynthetic or synthetic origin that kills or inhibits the growth of microorganisms but causes little or no damage to the host

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Definition: Rational Use of Drugs

Rational means “based on or in accordance with reason or logic”

“Rational use of drugs means the right drug for the right patient, in the right dose, at right time, by the right route and should be economical.”

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Rational drug use and prescribing

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Definition: Rational use of drugs

“ The safe, effective, appropriate and economic use of drugs.”

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WHO Definition

Patients receiving medication appropriate to their clinical needs, in appropriate doses, for an adequate period of time and at the lowest cost to them and their community”

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Aims of rational prescribing

Maximize effectiveness

Minimize risks

Minimize costs

Respect patient's choices

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Criteria for rational prescribing 1

Appropriate diagnosis (Depend upon clinical and lab investigations)

Appropriate indication (Drug therapy is safe and effective)

Appropriate drug

Appropriate patient (hypersensitivity, contraindicated drugs in certain patients)

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Criteria for rational prescribing 2

Appropriate dosage (pediatric, geriatric, or having concomitant disease)

Appropriate duration

Appropriate route of administration

Appropriate information

Appropriate monitoring (both by patient & prescriber)

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“To learn how to use antibiotics, one must first learn how not to use antibiotics.”

-Unknown

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Common Irrational use of antibiotics 1

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Common Irrational use of antibiotics 2

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Antimicrobial stewardship

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Antibiotic resistance

Antibiotics are medicines used to prevent and treat bacterial infections.

Antibiotic resistance occurs when bacteria change in response to the use of these medicines.

Bacteria, not humans or animals, become antibiotic-resistant.

These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.

Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality.

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Causes of antibiotic resistance

Over-prescription of antibiotics

Patients not finishing the entire antibiotic course

Overuse of antibiotics in livestock and fish farming

Poor infection control in health care settings

Poor hygiene and sanitation

Absence of new antibiotics being discovered

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Definition: Antimicrobial

An agent or substance derived from any source (microorganisms, plants, animals, synthetic or semi-synthetic) that acts against any type of microorganism, such as bacteria (antibacterial), mycobacteria (anti-mycobacterial), fungi (antifungal), parasite (anti-parasitic) and viruses (antiviral).
All antibiotics are antimicrobials, but not all antimicrobials are antibiotics

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Antimicrobial resistance

Antimicrobial resistance happens when microorganisms (e.g.bacteria, fungi, viruses, and parasites) change when they are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics).

As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.

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Drivers of antimicrobial resistance

Use of antibiotics in humans, animals, plants and environment
Travel, recent hospitalization or previous microbiology findings of resistant bacteria are factors that predispose to colonization/infection with a resistant pathogen.

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Approaches to Antimicrobial stewardship

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Approaches to Antimicrobial stewardship

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Definition: Antimicrobial stewardship

A coherent set of actions which promote the responsible use of antimicrobials.

Can be applied to actions at the individual level as well as the national and global level, and across human health, animal health and the environment.

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Rational use of antibiotics: WHO AWaRe groups and essential antibiotics on the WHO EML

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Rational use of antibiotics: WHO AWaRe groups and essential antibiotics on the WHO EML

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Rational use of antibiotics: WHO AWaRe groups and essential antibiotics on the WHO EML

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INTERVENTION	WHAT IT IS
Persuasive (education)	• Educational meetings (e.g. basics on antibiotic use, case-based discussions, morbidity and mortality, significant event analysis, lectures on specified topics) • Distribution of and training on educational material (e.g. clinical practice guidelines) • Using local key opinion leaders (champions) to advocate for key messages • Reminders provided verbally, on paper or electronically • AMS e-learning resources made available to all health-care personnel • AMS education as part of continuing medical education

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INTERVENTION	WHAT IT IS
Persuasive (feedback)	• Audit with feedback to prescribers on their prescribing practice • AMS as a component of ward rounds (real-time feedback with educational component) • Patient handover meetings between two shifts with real-time feedback by consultants • Local consensus processes for changes in antibiotic treatment or surgical prophylaxis

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INTERVENTION	WHAT IT IS
Restrictive	• Formulary restrictions • Restricted prescribing of identified antibiotics (expert approval prior to prescription) (see Annex V) • Compulsory order forms for targeted antibiotics • Automatic stop orders (e.g. after a single dose of surgical prophylaxis) • Selective susceptibility reporting from the lab

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INTERVENTION	WHAT IT IS
Structural	• Rapid laboratory testing made available • Therapeutic drug monitoring

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