Antibiotics

• Antibiotics use and overuse

• Emergence of resistant microorganism
• Decline in pharmaceutical company interest
in anti-infective research
• Emergence of multi-drug resistant micro-
organisms
 Judicious use of antibiotics
• Using an antibiotic only when indicated , choosing
a cost-effective agent which provides appropriate
antimicrobial coverage for the diagnosis that is
suspected and prescribing the optimal dose and
duration of the antimicrobial

• Gaur AH, English BK. The judicious use of antibiotics - An

investment towards optimized health care. Indian J Pediatr
2006;73:343-350
Appropriate use of antimicrobials

• The cost-effective use which maximizes

clinical therapeutic effect while minimizing
both drug-related toxicity and the
development of antimicrobial resistance

• WHO Global Strategy for Containment of Antimicrobial Resistance

 Scopes

humans and animals

• An understanding that the roots of this
problem are entrenched in societal and
cultural beliefs and expectations is the first
step in attaining a solution.
 Importance
• There is clear evidence that antibiotic resistance
develops under antibiotic pressure.
• Injudicious use of antibiotics comes with a cost.
• Injudicious use of antibiotics clearly influences the
ecosystem.
• Ongoing antibiotic misuse perpetuates a culture of
injudicious use where every contributor to this
undesirable practice makes it more difficult to change
the habit.
 Interventions layman-1
• Education
• Education regarding common diseases and the role of
antibiotics
• Efforts to increase awareness of antibiotic resistance and
its impact on individuals and the society
• Education to discourage self-initiation of treatment and
encourage appropriate and informed health care seeking
behavior
• Education to promote adherence to the prescribed
treatment
 Interventions layman-2
• Incentives and reassurance
• The use of delayed prescribing techniques （緩兵
之計）
• Promise a free return visit （不讓你吃虧）
• Suitable alternatives to antimicrobials for relief of
symptoms should be provided where applicable
（做點事吧）
• From acute care to comprehensive care （做功德
）
 Interventions professional-1
• Education

• Clinical provider training programs

• Continuing medical education
• Engaging local opinion leaders
 Interventions professional-2

• Affordable, reliable microbiology

laboratory services （巧婦難為無米炊）
• Clinical care guidelines （教戰守則）
• Education for “other” clinical care
providers （沒魚蝦也好）
• Hospital therapeutic committees and
antibiotic audits （以夷制夷）
 Interventions policy makers-1
• 1. Governments and physician organizations should provide
funding and resources to educate patients, prescribers and
dispensers as delineated in the previous paragraphs.
2. Governments should develop and enforce regulations limiting
over-the-counter purchase of antimicrobials.
3. Governments should develop and enforce regulations to
ensure the quality of antibiotics that are available in the market.
4. Governments and physician organizations should link
professional registration requirements for prescribers and
dispensers to requirements for training and continuing
education.
 Interventions policy makers-2
• 5. Government schemes should subsidize the creation of
affordable microbiology laboratory services.
6. Governments and physician organizations should provide
funding and collaboration to optimize antimicrobial resistance
surveillance.
7. Government schemes should subsidize the cost of certain
preferred antimicrobials and/or provide free access to them
through specific centers. This is especially important for
medications used for chronic illnesses such as tuberculosis and
HIV.
8. Governments should control and monitor pharmaceutical
company promotional activities and direct-to-consumer
advertising and limit these to only those that have educational
benefit.