CHAPTER:1

THE RATIONAL USE OF ANTIBIOTICS

BY
Mrs. K.SHAILAJA., M. PHARM.,
LECTURER
DEPT OF PHARMACY PRACTICE,
SRM COLLEGE OF PHARMACY
 Antibiotics
ƒ One of the most commonly used
group of drugs
ƒ In USA 23 million kg used annually;
50% for medical reasons
ƒ May account for up to 50% of a
hospital’s drug expenditure
ƒ Studies worldwide has shown a high
incidence of inappropriate use
Reasons for appropriate use
ƒ Avoid adverse effects on the patient
ƒ Avoid emergence of antibiotic
resistance - ecological or societal
aspect of antibiotics
ƒ Avoid unnecessary increases in the
cost of health care
 Ecological/Societal Aspect
ƒ Antibiotics differ from other classes of
drugs
ƒ The way in which a physician and other
professionals use an antibiotic can affect
the response of future patients
ƒ Responsibility to society
ƒ Antibiotic resistance can spread from
ƒ bacteria to bacteria
ƒ patient to patient
ƒ animals to patients
 Prescribing an antibiotic
ƒ Is an antibiotic necessary ?
ƒ What is the most appropriate
antibiotic ?
ƒ What dose, frequency, route and
duration ?
ƒ Is the treatment effective ?
Is an antibiotic necessary ?
ƒ Useful only for the treatment of
bacterial infections
ƒ Not all fevers are due to infection
ƒ Not all infections are due to bacteria
ƒ There is no evidence that antibiotics will
prevent secondary bacterial infection in
patients with viral infection
Meta-analysis of 9 randomised placebo
controlled trials involving 2249 patients

Conclusions: There is not enough evidence of

important benefits from the treatment of upper
respiratory tract infections with antibiotics and
there is a significant increase in adverse
effects associated with antibiotic use.
Is an antibiotic necessary ?
ƒ Not all bacterial infections require
antibiotics
ƒ Consider other options :
ƒ antiseptics
ƒ surgery
 Choice of an antibiotic

ƒ Aetiological agent
ƒ Patient factors
ƒ Antibiotic factors
 The aetiological agent
ƒ Clinical diagnosis
ƒ clinical acumen
ƒ the most likely site/source of
infection
ƒ the most likely pathogens
ƒ empirical therapy
ƒ universal data
ƒ local data
 Importance of local antibiotic
resistance data
ƒ Resistance patterns vary
ƒ From country to country
ƒ From hospital to hospital in the same
country
ƒ From unit to unit in the same hospital
ƒ Regional/Country data useful only for
looking at trends NOT guide empirical
therapy
 The aetiological agent
ƒ Laboratory diagnosis
ƒ interpretation of the report
ƒ what is isolated is not necessarily
the pathogen
ƒ was the specimen properly
collected ?
ƒ is it a contaminant or coloniser ?
ƒ sensitivity reports are at best a
guide
 Patient factors
ƒ Age
ƒ Physiological functions
ƒ Genetic factors
ƒ Pregnancy
ƒ Site and severity of infection
ƒ Allergy
 Antibiotic factors
ƒ Pharmacokinetic/pharmacodynamic
(PK/PD) profile
ƒ absorption
ƒ excretion
ƒ tissue levels
ƒ peak levels, AUC, Time above MIC
ƒ Toxicity and other adverse effects
ƒ Drug-drug interactions
ƒ Cost
 Cost of antibiotic
ƒ Not just the unit cost of the antibiotic
ƒ Materials for administration of drug
ƒ Labour costs
ƒ Expected duration of stay in hospital
ƒ Cost of monitoring levels
ƒ Expected compliance
 Choice of regimen
ƒ Oral vs parenteral
ƒ Traditional view
ƒ “serious = parenteral”
ƒ previous lack of broad spectrum oral
antibiotics with reliable bioavailability
ƒ Improved oral agents
ƒ higher and more persistent serum and
tissue levels
ƒ for certain infections as good as
parenteral
 Advantages of oral treatment
ƒ Eliminates risks of complications
associated with intravascular lines
ƒ Shorter duration of hospital stay
ƒ Savings in nursing time
ƒ Savings in overall costs
 Duration of treatment
ƒ In most instances the optimum
duration is unknown
ƒ Duration varies from a single dose to
many months depending on the
infection
ƒ Shorter durations, higher doses
ƒ For certain infections a minimum
duration is recommended
 Recommended minimum
durations of treatment
Infection Minimum duration
Tuberculosis 4 - 6 months
Empyema/lung abscess 4 - 6 weeks
Endocarditis 4 weeks
Osteomyelitis 4 weeks
Atypical pneumonia 2 - 3 weeks
Pneumococcal meningitis 7 days
Pneumococcal 5 days
pneumonia
 Monitoring efficacy
ƒ Early review of response
ƒ Routine early review
ƒ Increasing or decreasing the level of
treatment depending on response
ƒ change route
ƒ change dose
ƒ change spectrum of antibacterial
activity
ƒ stopping antibiotic
 Campaign to Prevent Antimicrobial Resistance in Healthcare Settings

Antimicrobial Resistance:
Key Prevention Strategies
Susceptible Pathogen
Antimicrobial-Resistant
Pathogen Pathogen
Prevent Prevent
Transmission Infection

Infection
Antimicrobial
Resistance
Effective
Optimize Diagnosis
& Treatment
Use

Antimicrobial Use
 Campaign to Prevent Antimicrobial Resistance in Healthcare Settings

12 Steps to Prevent
Antimicrobial Resistance

12 Break the chain

11 Isolate the pathogen Prevent Transmission
10 Stop treatment when cured
9 Know when to say “no” to vanco
8 Treat infection, not colonization Use Antimicrobials Wisely
7 Treat infection, not contamination
6 Use local data
5 Practice antimicrobial control
4 Access the experts Diagnose & Treat Effectively
3 Target the pathogen
2 Get the catheters out
1 Vaccinate Prevent Infections