penggunaan antimikroba

7/23/2019 Penggunaan antimikroba

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nt m cro a s

sage

an

Dr.

Muhammad

A.

HalwaniSupervisor of Infection Control and

Central Sterilisation in the Makkah Area

Consultant in Infection Control for the Central Board of Accreditation for

Health

Care

Institutions

(CBAHI)



Overview

Antimicrobials including antibiotics are very good agents that are

resistance microorganisms that are difficult to treat and highly

transmissible

The infection control doctor should contribute, advice, and help

treating physicians become more focused before, during, and after su scription re ease

of the wide range of antibiotics and this can be given by medical microbiologist in the hospital



Antimicrobial Resistance

The term resistance can be described to a particular antibiotic if

drug

The term ‘sensitive’ can be described to a particular antibiotic if its

growth was inhibited or by the used concentration of the tested

It must be noted that the microbiology lab results are not 100%

precise an many actors can inter ere wit w at is seen in vitro

them more aware of the possibility of the treatment failure that might happen



Types of Resistance

Natural resistance

Bacteria may have natural resistance to different

antibiotics which

is

usually

the

result

of

the

inability

of

the

drug to penetrate the cells

Acquired

resistance:

The ermeabilit chan e of the cell membrane

Alteration in the target site

Expelling of the drug from the cell



Causes of Resistance Development

The heavy use of antimicrobial agents

Unnecessary prescribing of antimicrobial agents

Inappropriate use such as giving an incorrect agent, ,

prescription



Transmission of Resistance

Cross‐transmission of hospital infections between

es stant

stra ns

sprea

n

t e

same

reg on

w t

pat ent

transfer

Admission of

outside

the

border

patients

who

are

colonised or infected with different strains



Strategies for Preventing Antimicrobial Resistance

Educate in taking an appropriate specimens

Improvements in

prescribing

practice

Simple education to junior doctors and some other

p ys c ans

a e sure t at w e spectrum ant ot cs are use on y

when required with the right dose and duration

Surveillance for resistance strains



Strategies for Preventing Antimicrobial Resistance

cont.,

Isolation of infected & colonised patients

Drug utilization

review

Control and improving in the laboratory testing

Limit the contact between physicians and

p armaceut ca representat ves

reparat on an app cat on o ant ot c po cy

procedures



Antibiotic Policy

The

main

idea

of

the

makin

antibiotic

olic

is:The

main

idea

of

the

makin

antibiotic

olic

is:

hospitals

to minimize the development of antibiotic resistant

strains

to reduce the cost of antibiotic prescribing



Antibiotic Policy cont.,

Antibiotic policy demonstrates a commitment to rational an sensi e use o anti iotics

e po cy s ou cons er t e use o t e narrowest spectrum, which has the minimal toxicity and the least

biograms before preparations

Policy should be prepared by a group of specialised

workers in the hospital or in the region



Antibiotic Policy Committee Members

Clinical pharmacist

An infectious

diseases

doctor

Selected senior consultant could be involved for consultations and suggestions



Committee Members Roles

All

the

members

should

contribute

in

putting

the

policy

an n rev ew ng w care, n para e w e

international standards

Auditing of prescribing is required by a clinical

pharmacist with monthly reporting to the committee



The Ideal Policy

List of the antibiotics in the hos ital and no antibiotic

outside the list should be used

Guidelines should be provided for empiric treatment

an

arge e

rea men

o

e

mos

requen

n ec ons

including dosage and duration of treatment

Protocol

for

surgical

prophylaxis

and

when

they

should

be given and when they should be stopped must be

provided



The Ideal Policy cont.,

Protocol for the reserved antibiotics and who and when

Special forms

in

case

a new

antibiotic

need

to

be

added

or an antibiotic need to be replaced, evaluated or

eliminated to be discussed on the committee meeting



The Ideal Policy cont.,

Infection control doctors have an important role to play in

administrating, and monitoring the drugs prescribed, and in

discussing the

treatment

with

the

physicians

when

therapy

seems

unnecessary

Infection

control

doctors

should

always

direct

physicians

to

the

fact that isolation of microorganisms does not necessarily indicate

, ‐

the course and that the susceptibility of the organism isolated or

switchin to a narrower s ectrum is recommended



Role of Infection Control in Prophylaxis

Antibiotics are also important to protect patients in situations that mar e y increase t eir vu nera i ity to in ection

ey s ou e app e e ore surg ca opera ons or w en

subsequent infection could have very serious consequences such as

valve replacement

Surgeons in any grade (specialists, senior specialist, or consultants) should follow the locally approved or internationally

known policy in selecting proper antibiotics

A point that should be considered always is that prophylactic

thera should not be continued for more than 24 hours



So

what

is

re uired

from

us

as

IC?

Application of simple restriction policy

Minimize the use of some wide spectrum antibiotics and other final hope

treatment

Do not allow for prophylaxis misuse

Suc a group o anti iotics s ou e su scri e on y y consu tants an wit

the support

and

agreement

of

the

medical

microbiologist

P armacy s ou mon tor suc app cat on an s ou not spense restr cte

antibiotics to junior doctors

E ucat ona sess on or c rcu at on o t e ea o suc an app cat on s use u an

mandatory



Antibiotic Control

Antibiotics that must be controlled in the hospital:

Vancomycin/teicoplanin

Third & fourth generation cephalosporins (ceftazidime, ceftriaxone &cefepeme)

Carbepenems (meropenem & imipenem)

Tazocin

Ciprofloxacin

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