Download presentation
Presentation is loading. Please wait.
1
New Antibiotic guidelines April 2013
Dr Fiona Donald Consultant Microbiologist Nottingham
2
Outline of talk New antibiotic guidelines, summary of changes
Update on antimicrobial resistance A bit about Microbiology
3
Antimicrobial guidelines – Why?
Simple, informed decision approach to prescribing Evidence based and using knowledge of local resistance rates and target organisms Saves money? Rational use of antibiotics leads to less antibiotic resistance and fewer side effects Educational tool Fewer phone calls to Microbiology
4
Changes to guidelines - overview
Updates to national guidance eg from HPA, CKS, SIGN and NICE Aim to reduce use of agents which will induce C difficile disease ie cephalosporins and quinolones Shorter courses are now recommended for some conditions Trying to stay ahead of resistant organisms
5
Changes to guidelines 2013 New sections on: Dental abscess
Diverticulitis Additional antibiotics for multi-resistant UTIs Linezolid added as amber 2 agent Mastitis and breast abscess Gonorrhoea
6
Changes to guidelines 2013 Updates on:
Community acquired pneumonia – add clarithromycin to amoxicillin Whooping cough Pelvic inflammatory disease/gonorrhoea – IM ceftriaxone, not cefixime MRSA treatment and decolonisation Meningococcal prophylaxis, ciprofloxacin now recommended Shingles age to consider treatment now 50 yrs
7
Use of antibiotics Antibiotics are essential to modern medicine but their abuse leads to resistance. A single course of antibiotics in primary care leads to bacterial resistance to that antibiotic (BMJ 18th May 2010). All staff who prescribe have a responsibility to their patients and for public health to prescribe optimally
8
Antibiotic side effects
Many Skin, GI, CNS, drug interactions Clostridium difficile infection Cephalosporins, penicillins, quinolones, macrolides Colonisation/infection with resistant bugs MRSA ESBL coliforms (NDM) Candida (thrush)
9
Antibiotic Resistance
Has been called one of the worlds most pressing public health problems In the US the annual cost of treating infections caused by just 6 types of multi-resistant bacteria exceeded the yearly cost of treating influenza November 2009 EU/USA summit announced a task force to deal with the problem (BMJ 22nd May 2010) Goal of developing 10 new antibiotics by 2020 (10 x 20 initiative, IDSA)
10
Local resistance patterns
But remember sampling bias
11
Local resistance patterns
Bur remember sampling bias
12
Local resistance patterns
But remember sampling bias
13
Local resistance patterns
14
Local resistance patterns
15
What can be done? Rationalisation of prescribing of antibiotics in hospital and the community, use of guidelines Good infection control practices Education of the public Rationalisation of the veterinary usage of antimicrobials, banning of antimicrobial growth promoters Prevention of disease e.g. vaccination Development of new antimicrobials or other drugs to beat bacteria
16
Antibiotic Resistant Superbugs
ESBL producing coliforms Most often seen in community urine samples Cause of UTI and sepsis Only one reliable antibiotic available to treat infections, IV meropenem Hardly any oral options New strain NDM-1even more resistant
17
ESBL E.coli laboratory data
2008/09: 551 urines positive with ESBL E coli 257 NUH 294 GP/community 49 blood cultures (vs 469 non- ESBL E coli) Currently around 9% of community acquired E coli bacteraemias are multi-resistant
18
New UTI antibiotics Fosfomycin and
Pivmecillinam (a type of penicillin) Classified as Amber 2 agents May be prescribed on the advice of a Medical Microbiologist Used for oral treatment of multi-resistant UTI when no other oral option available
19
Diagnosis of UTI Uncomplicated UTI in community – no need to send sample. Send sample if no response to short course of first line treatment If complicated UTI (eg pregnancy, loin pain, fever, catheter) send sample before treatment
20
Culture – chromogenic agar
21
Urine culture in men and women >65 years
Asymptomatic bacteriuria is common – one third of >65 yrs Do not send for culture on the basis of a positive urine dip unless symptomatic Do not treat asymptomatic bacteriuria, it does not reduce symptomatic episodes or mortality but does increase side effects and resistance rates
22
Urine culture in people with long-term catheters
Urine dipsticks are NOT useful, as catheters will normally become colonised with bacteria Do not send urine for culture unless there are symptoms of infection Do not treat asymptomatic bacteriuria in the presence of a catheter Do not routinely give antibiotic prophylaxis for catheter changes
23
Clinical microbiology service
Based at QMC A floor West Block All samples come here approx 800,000 per year One third from GPs, two thirds from acute trusts Sample processing and reporting carried out by biomedical scientists Medical microbiologists provide the clinical leadership and interaction with clinicians
26
Gram-stain Gram-positive cocci Gram-negative cocci
Gram-positive bacilli Gram-negative bacilli
27
Role of Clinical Microbiology
Diagnose infections From samples sent to us By clinical discussion and seeing patients Provide results on specimens Electronically reported Selected results are telephoned Generate a discussion about a patient
28
Role of Clinical Microbiology
Surveillance Data provided to local infection prevention and control teams Locally to HPU and CCDC - particularly notifiable diseases Nationally to HPA, CDSC, DH Advice on diagnosis and treatment of infections
29
Further information Full guideline available at www.nottsapc.nhs.uk
Microbiology website at NUH NUH antibiotic guidelines Health Protection Agency/ (now Public Health England) website
Similar presentations
© 2024 SlidePlayer.com. Inc.
All rights reserved.