Seminar on Rational use of Antibiotics for clinical medicine students

World Health Organization emphasized on access, watch and record

1. Seminar on r ational use of antibiotics and prescription writing P resenter : Hawi Ab reham (CII) Moderator: Dr. Mekdes (MD, Assistant professor in Pediatrics and child health.

2. To understand rational use of antibiotics To r ecognize diffrent issues when prescribing antibiotics Understand the cause if non reponse to antibiotics 2

3. Introduction Define r ational use Explain the importance of rational use of medicine in patient care Discuss the issues to be considered while prescribing Non-response to antibiotics Duration of different drugs with their respective pathology Antibiotics over-prescription

4. Rational use of antibiotics 4 7/19/2024

5. Antibiotics ;are chemical substance obtained from microorganisms able to inhibit the growth of, or kill,the other microorganisms. Two groups of antibiotics Bactericidal Kill microorganism Penicillin,Aminogkycoside,Rifampicin Bacterostatic Inhibit the growth of microorganism Chloramphenicol Tetracycline Clindimycin Introduction 7/19/2024 5

6. Antibiotics are one of the most commonly prescribed drugs today. Rational use of antibiotics is extremely important as injudicious use can adversely affect the patient, cause emergence of antibiotic resistance and increase the cost of healthcare. 7/19/2024 6

7. The concept of rational drug use is age old,as evident by the statement made by Alexandrian Physician Herophilus 300B.C that is ; Medicine are nothing in themselves but are the very hands of God if employed with reason and prudence . Rational use of antibiotics 7/19/2024 7

8. WHO defined The rational use of drugs requires patients recieve medicines appropriate to their clinical needs,in doses that meet their own individual requirements,for an adequate period of time ,and at the lowest cost to them and the community . Rational use of antibiotics is administration of: T he right drug For the right microorganism At the right dose At the right time Through the appropriate route For the appropriate duration 8 7/19/2024

9. Drug resistance Wastage Cost Side effects 9 7/19/2024

10. Prescribe with: Appropriate indication Appropriate drug Appropriate administration, dosage & duration Appropriate patient Appropriate patient information Appropriate evaluation 10 7/19/2024 Co…

11. Stand the acidic environment Capable of being absorbed Soluble Slowly metabolized Selective toxicity 11 7/19/2024

12. Free of inducing hypersensitive rxn Exerting no significant effect on resident micro flora Withstand microbial resistance Relatively inexpensive 12 7/19/2024

13. When prescribing an antibiotic the following issues need to be addressed: i ) Is an antibiotic necessary? ii) What is the most appropriate antibiotic? iii) What dose, route, frequency and duration are needed? iv) Is the treatment effective ? 7/19/2024 13 Factors to be considered while prescribing

14. Antibiotics are generally only useful for the treatment of bacterial infections. It is important to remember that not all fevers are due to infections and not all infections are caused by bacteria. There is no evidence thst antibiotics will prevent secondary bacterial infection in patients with viral infection 7/19/2024 14

15. The successful outcome of therapy would depend very much on the choice of the antibacterial agent. In the process of selecting an antibiotic, three main factors need to be considered; T he aetiological agent, T he patient and T he antibiotic. 7/19/2024 15

16. Determination of the aetiological agent depends on a combination of clinica l and laboratory support. In many instances an antibiotic prescription has to be made based on the clinical diagnosis (empirical therapy). Normal flora, colonisers or contaminants must be distinguished from true pathogens . 7/19/2024 16 T he Aetiological agent ,

17. Particular attention should be paid to the manner the specimen was collected and transported to the laboratory . Laboratory reports should always be viewed in the light of clinical findings . 7/19/2024 17 Cont...

18. Several patient factors have to be considered in selecting an antibiotic. Age is an important factor. Neonates have immature liver and renal functions which affect their ability to metabolise or excrete antibiotics. Antibiotics and their metabolites eg . T etracyclines and the , q uinolones may adversely affect growing tissues and organs in children. 7/19/2024 18 T he patient

19. A history of allergy to antibiotics should always be sought before administration. serious infections like meningitis and bacteraemic shock the immediate institution of the best available antibiotic for the suspected pathogen(s) is imperative as delay in treatment will increase both mortality and morbidity . 7/19/2024 19 Cont...

20. The clinician should have adequate knowledge of the pharmacokinetic properties of the antibiotic uses. The ability of the antibiotic to achieve therapeutic concentrations at the site of infection B e aware of drug-drug interactions T he cost of the antibiotic The patient's compliance to medication 7/19/2024 20 T he Antibiotic

21. Oral therapy has several advantages. Th e e limination of the need for intravenous access, an important source of bacteraemia r educes the length of hospitalisation and therefore the cost of treatment. 7/19/2024 21

22. I nfection and m inimum duration CAP -5days Health care acquired pneumonia -8 days Skin & soft tissue infection -5 days UTI Cystitis-3-5 days Pylonephritis-5-14 days Catheter associated-7 days

23. Staph- aureus bacteremia - Low risk complications-2 weeks High risk complications-4-6 weeks Intraabdominal infection- 4-7 days Surgical Antibiotic prophylaxis -1 dose

24. Infection Minimum duration Empyema /lung abscess 4 - 6 weeks Endocarditis 4 weeks

25. Osteomyelitis 4 weeks Atypical pneumonia 2 - 3 weeks Pneumococcal meningitis 7 days Pneumococcal pneumonia 5 days

26. R outine early review (3 days after commencing treatment) of the patient's response is important i ) C ontinue with the present regimen ii) I ncrease the level of treatment by changing from O ral to parenteral ; increasing the dose or changing to a broader spectrum antibiotic iii) D ecrease the level of treatment by changing from parenteral to oral, decreasing the dose or changing to a more specific narrow spectrum antibiotic iv) S topping the antibiotic if the infection has resolved 7/19/2024 26

27. v) T here is a collection of pus that should be drained surgically or a foreign body/ devitalised tissue that should be removed. vi) T here is secondary infection vii) A ntibiotic fever viii) N on-compliance of the host 7/19/2024 27

28. Causes of non-response to antibiotics Non-compliance of the host Dose /route / frequency Resistant Diagnosis Site of infection 28 7/19/2024

29. Collection of pus Foreign body/devitalized Secondary infection Antibiotic fever 29 7/19/2024

30. 1. Lack of confidence 2. Peer pressure 3. Patient pressure 4. Company pressure : 30 7/19/2024

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32. Definition Types of prescription Parts of prescription Steps in prescription writing Prescription writing in pediatrics -Dose calculation in pediatrics 7/19/2024 32

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42. Superscription : i s head of the prescription & contains - Name of the institution - Address of the instituition - Identification of the patient -name - dx (ICD code no) -age - address -sex -card no 7/19/2024 42

43. B. Inscription : -Refers to the name of the drug being ordered, the dosage form & the strength of the medication. -The symbol "℞" separates the superscription from the inscriptions sections Name- 1. chemical name - precise description of the drugs chemical composition & molecular structure.ex - N-(4-hydroxyphenyl) acetamide -Not suitable for use in prescription. 7/19/2024 43

44. 2. N on- proprietory name -adopted through a formal process of adoption b/n a manufacture & nomenclature agency. - It is concise, meaningful, cheaper, avoid confusion. ex- A pproved B rand - acetaminophen - paracetamol - diazepam - valium - metronidazole - mesil,flagyl 7/19/2024 44

45. 3.Proprietory name (brand, trade name) -Assigned by the manufacture & trade mark -Designated by superscript R -Adv. e asy to recall, short ex- Daonil ……………. Glibenclamide -Librium………….... Chlorodiazepoxide - Disadv . Expensive, make confusion,improper prescribing b/c of exaggerated advertizing 7/19/2024 45

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54. The contents of the prescription are: The patient's name the name & strength of the medication the dose the route & frequency of administration the date, time the signature of the prescriber.

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60. Oral absorption : in young infants, gastric emptying time is prolonged and only approaches adult values at around 6 months of age. Increased gastric pH: gastric acid output does not reach adult values until the second year of life. 7/19/2024 60

61. Distribution: Increased total body water: as a percentage of total body weight, Neonates require higher doses of water-soluble drugs, on an mg/kg basis, than adults. Decreased plasma protein binding: plasma protein binding in neonates is reduced as a result of low levels of albumin and globulins. -High circulating bilirubin levels in neonates may displace drugs from albumin 7/19/2024 61

62. Metabolism : Metabolic rate increases dramatically in children and is often greater than in adults. Compared with adults, children may require more frequent dosing or higher doses on an mg/kg basis. Excretion :-Complete maturation of renal function is not reached until 6-8 months of age Enzyme systems mature at different times and may be absent at birth, or present in considerably reduced amounts. 7/19/2024 62

63. Route of administration and drug regimes - Compliance in children is influenced by the formulation, taste, appearance and ease of administration of a preparation. -Whenever possible, painful intramuscular (IM) injections should be avoided in children . 7/19/2024 63

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68. 6. Body surface area rule - depend on first determining the child’s body surface area in m2. CD = S.A of child x AD/1.7m2

69. 1. Write the prescription legibly. 2. Spell the name(s) of the drug(s) correctly. 3. Write the prescription in proper English grammar. -Latin abbreviations such as q.i.d . are no longer recommended. Avoid phrases such as "as directed" or "as needed." Specify exactly.

70. 4 . Avoid ambiguities or misinterpretation. These include: Avoiding unnecessary decimal points: prescription will be written as 5  mL instead of 5.0  mL to avoid possible misinterpretation of 5.0 as 50. Always use zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation of .5 as 5. Avoiding trailing zeros on decimals: e.g. 0.5 instead of .50 to avoid misinterpretation of .50 as 50 .

71. " mL " is used instead of " cc ". cc could be misinterpreted as "c.c.", which is an uncommonly used abbreviation for "take with meals “.

72. Where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather than simply frequency (three times a day). Avoid unspecified prn or "as needed" instructions—instead, specific limits and indicators are provided e.g. "every 6 hours.

73. 5 . Medicines should be prescribed only when they are essential & in all cases the benefit of prescribing should be considered in relation to other risk involved. -This is particularly important in children, elderly, pregnant & b.feeding pt. 6. Determine child-safe dosages using the child's body weight.

74. Standard treatement guide line 2021 Up to date 21.1 Nelson 21 Edition I nternate

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