Rational use of Antibiotics - MBBS MICROBIOLOGY 2024

1. What is Rational Use of antimicrobial agents
2. Describe the right approach to prescribe antibiotics
3. Describe empirical and Targeted Therapy
4. Describe escalation & De-escalation approach
5. Describe site specific antimicrobials

1. Rational use of Antibiotics

2. Objectives 1. What is Rational Use of antimicrobial agents 2. Describe the right approach to prescribe antibiotics 3. Describe empirical and Targeted Therapy 4. Describe escalation & De-escalation approach 5. Describe site specific antimicrobials 2

3. It refers to the appropriate selection, dosage, and duration of antimicrobial treatment, with the goal of achieving the best clinical outcomes while minimizing the risk of adverse effects, drug resistance, and unnecessary costs. 3 What is Rational Use of Antimicrobial Agents

4. Indication Antimicrobials should be prescribed only when necessary, based on a confirmed or strongly suspected bacterial infection. They are ineffective against viral infections and should not be used inappropriately, as this contributes to the development of resistance. Dose optimization Antibiotics should be prescribed at the correct dose and frequency to ensure adequate drug concentrations at the site of infection. Underdosing can lead to treatment failure, while overdosing may increase the risk of side effects and contribute to resistance. Duration Unnecessarily prolonged courses of antibiotics can promote resistance and increase the risk of adverse effects, while prematurely stopping treatment may lead to treatment failure or relapse 4

5. Use the narrowes t spectrum antibiotic possible The narrowest-spectrum antibiotic possible should be used to treat the infection. This means using an antibiotic that targets the specific bacteria causing the infection, rather than using a broad-spectrum antibiotic that kills a wide range of bacteria, including beneficial bacteria. Combination therapy Combination antimicrobial therapy should be reserved for specific indications, such as severe infections or those caused by multidrug-resistant pathogens. It should not be routinely used, as it can increase the risk of adverse effects and promote resistance. 5

6. Prescribing antibiotics requires a thoughtful and evidence-based approach to ensure appropriate treatment 6 Describe the right approach to prescribe antibiotics

7. 7 1 3 5 6 4 2 Confirm the diagnosis Choose the right antibiotic Specify duration of treatment Evaluate the need for antibiotics Use appropriate dosing Monitor response to treatment

8. Prescribing antibiotics requires a thoughtful and evidence-based approach to ensure appropriate treatment 8 Empirical and Targeted Therapy

9. Empirical Therapy Empirical therapy aims to provide prompt treatment while awaiting test results or in cases where a specific diagnosis is challenging. Broad-spectrum antibiotics with a wider range of activity are often prescribed initially to cover a broad spectrum of potential pathogens. Once the test results are available, the treatment can be adjusted based on the identified pathogen and its susceptibility to specific antibiotics. Targeted Therapy Targeted therapy is a type of treatment that is based on the results of diagnostic tests that identify the specific bacteria causing the infection. It involves using a narrow-spectrum antibiotic that is effective against the specific bacteria causing the infection, rather than using a broad-spectrum antibiotic. This approach can help to reduce the risk of antibiotic resistance and minimize the risk of side effects. 9

10. 10 Escalation & De-escalation Approach

11. Escalation Approach The escalation approach involves starting with a narrow-spectrum antibiotic and then switching to a broad-spectrum antibiotic if the infection does not respond to treatment. This approach helps to reduce the risk of antibiotic resistance and minimize the risk of side effects. De-Escalation Approach The de-escalation approach involves starting with a broad-spectrum antibiotic and then switching to a narrow-spectrum antibiotic once the results of diagnostic tests are available and a specific bacterial infection has been identified. This approach helps to reduce the risk of antibiotic resistance and minimize the risk of side effects. 11

12. Site-specific antimicrobials refer to antibiotics or antimicrobial agents that are used to target specific infection sites or areas of the body. These medications are designed to provide localized treatment and minimize systemic exposure. 12 Site Specific Antimicrobials

13. 13 Topical antimicrobials These are applied directly to the skin or mucous membranes to treat localized infections e.g., povidone-iodine for wound care Inhalational antimicrobials These are delivered via inhalation to target respiratory infections. Inhalational antibiotics, such as tobramycin or colistin, can be used to treat chronic respiratory infections in individuals with cystic fibrosis or bronchiectasis Intravitreal antimicrobials These are injected into the eye to treat severe intraocular infections, such as endophthalmitis. Examples include intravitreal antibiotics like vancomycin or ceftazidime. Intraventricular antimicrobials : These are administered directly into the spinal canal or cerebral ventricles to treat central nervous system infections, such as meningitis. Antibiotics like vancomycin or amphotericin B can be used in this way.

14. THANK YOU ANANT RAM MBBS 2021 14