Antimicrobial Stewardship

Antibiotic resistance is a phenomenon in which germs evolve to be able to resist the action of drugs. This causes illnesses that were once easily curable with antibiotics to become dangerous infections, requiring alternative medications or higher doses. With millions of deaths increasing every year, antibiotic resistance has become one of the world's most pressing public health problems. This essay will explain the key causes of the emergence of resistant bacteria, including antibiotic misuse, inappropriate prescribing and availability of few new antibiotics, and outline relevant effects of antibiotic resistance.

Antibiotics are powerful very frequently used potential drugs in fighting bacterial infections worldwide, [1]. These agents saved millions of lives in the past fifty years in both hospital-based and outpatient settings. Inadequate measures to control the spreading of infections, overprescribing as well as inappropriate selection and dosing of antibiotics by healthcare providers, unfettered access to antimicrobials by public, failure to adhere to clinically desired treatment regimens are some of the driving force to spread of antibiotics resistance, [2]. In addition, lack of regulations to promote the rational use of antibiotics in humans, infection prevention and control are some of the other factors that lead to emergence of resistance to antibiotics, [3].

Antibiotics are inarguably one of the greatest advances in medical science of the past century. Although the first natural antibiotic Penicillin was not discovered until 1928 by Scottish biologist Alexander Flemming, evidence exists that certain plant and mold growths were used to treat infections in ancient Egypt, ancient India, and classical Greece (Forrest, 1982). In our modern world with the advent of synthetic chemistry synthetic antibiotics like Erithromycin and its derivative Azithromycin have been developed. Antibiotics have many uses including the treatment of bacterial and protozoan infection, in surgical operations and prophylactically to prevent the development of an infection. Through these applications, antibiotics have saved countless lives across the world and radically altered the field of medicine. Though a wonderful and potentially lifesaving tool, antibiotic use is not without its disadvantages. Mankind has perhaps been too lax in regulation and too liberal in application of antibiotics and growing antibiotic resistance is the price we must now pay. A recent study showed that perhaps 70% of bacterial infections acquired during hospital visits in the United States are resistant to at least one class of antibiotic (Leeb, 2004). Bacteria are not helpless and their genetic capabilities have allowed them to take advantage of society’s overuse of antibiotics, allowing them to develop

Although declining, inappropriate antibiotic prescribing continues to be a problem, especially the use of broad-spectrum antibiotics for infections of predominantly viral etiology, increasing risk for developing drug-resistant infection complications (Aspinall, Good, Metlay, Mor, & Fine, 2008; Garau & Dagan, 2003). Few interventions have been effective in moderating antibiotic overuse for acute URTIs (Legare et al., 2012). Emphasis on infection control alone is inadequate to address the rise of resistant infections. Judicious prescribing is the

Antibiotic resistance is becoming a more prevalent issue. This is a growing dilemma because, not only do patients have the potential to develop resistance, but they also can transmit the resistant bacteria to others (McKellar, 2014). Additionally, it is estimated that over one-third of all antibiotics prescribed to patients are unnecessary (Centers for Disease Control and Prevention, 2016). Overutilization of antibiotics is a growing problem due to some patients’ inappropriate demands for antibiotics or misdiagnoses by prescribers, however, underutilization of antibiotics can be just as problematic. Physicians are trained to use good antimicrobial stewardship when prescribing antibiotics; only giving them to patients who truly do have a bacterial infection. This becomes an issue when providers are too cautious and do not prescribe antibiotics in an attempt not to contribute to antibiotic resistance. Unfortunately, this caution could have a detrimental effect on the health of patients who actually need the antibiotics. To combat this issue, we must find a balance between good antimicrobial stewardship to minimize resistance while also taking underutilization into consideration. We, as pharmacists, are at a unique position between the physician and

Antibiotics-resistant organisms have become one of the most serious threats to public health, infecting over two million people and killing approximately 23,000 people annually.1 According to the CDC, “total inappropriate antibiotic use,” such as prescribing unnecessary antibiotics or giving the wrong dose or duration, makes up to 50% of all outpatient antibiotic use,2,3 and in 2009, the United States spent $10.7 billion on antibiotics, indicating that there is a lot of potential money to save.4

Adherence to antibiotic prophylaxis guidelines at University Medical Center is poor within the study period. Supporting implementation of antibiotic stewardship program and making sure that all of prophylactic antibiotics are covered by Health Insurance are importance and necessary in order to improve effectiveness and appropriateness of antibiotic prophylaxis usage

Antibiotic stewardship program for this study is the independent variable, which is operationally defined as a program that provides education to clinician on the diagnosis, treatment plan and strategy for the prevention of CDI. In this program, a checklist with high, medium and low risk antibiotics is provided to prescribers with guidelines and microbiological diagnostic to help prevent the inappropriate diagnosis of high risk antibiotics. In this list, Tetracycline, Linezolid, Fosfomycin, Vancomycin, Daptomycin, Metronidazole, and Trimethoprim/sulfamethoxazole were identified as the low

The development and advancement of antibiotic resistance is dependent on a number of factors, and cannot be resolved with one single solution. Research suggests the best strategy to manage the misuse of antibiotics leading to antibiotic resistance, is mandating all hospitals to implement an antimicrobial stewardship program. This solution meets all of the required criteria and is a sensible approach in resolving the growing rate of resistant. Making antimicrobial stewardships a part of the patient safety effort will help bring new support and spark the conversation that must take place in order to make advancement in resolving antibiotic resistance. Multiple studies have been conducted to evaluate the before and after introduction of ASPs and

Consequently within a decade, bacteria can get the upper hand and the only way to cure an infection will be radical surgery to eradicate the source of infection similar to the pre-antibiotics era. Frequent antibiotic use contributes to fastening the spread of antibiotic resistance gene due to selective pressure. To prevent increase of superbugs, controlling the antibiotic use by implying mandatory antimicrobial stewardship programs which allows restrict monitoring of the prescribed antibiotics has been suggested. In this report, the potential of mandatory antimicrobial stewardship programs on controlling antibiotic use which can lead to decrease in the rate of emerging superbugs will be

Widespread use of antibiotics has been very controversial in the media as well in the general population. Due to these controversies, it is very misunderstood to how antibiotics work leading to many patients in the hospital setting wanting to take them when it is not necessary or refusing to take when it is necessary for their survival. Some of this controversy is due to antibiotic resistance, which has spread an alarming rate in the 21st century (Walsh, 2000). Antibiotic resistance is the result of very strong bacteria or microbes that are resistant to the antibiotic prescribed and those microbes accumulate overtime by their survival, reproduction and transfer, leading to increased levels of antibiotic resistance.

The most pervasive anti-toxin safe disease that must be considered and comprehend in the current world is the "Methicillin-safe Staphylococcus aureus (MRSA) contamination". It is caused by a strain of Staphylococcus microbes that have created impervious to the basic anti-microbial for treating ordinary staphylococcic aureus disease. This anti-microbial safe contamination happened in patients living in doctor's facilities. The MRSA disease in the healing centers is caused by utilizing obtrusive gadgets or strategies, for example, intravenous tubing and surgeries.

Low doses, increased dose intervals and reduced treatment duration can lead to recrudescence of the infection and may increase the risk of selecting resistant organisms. On the other hand, the treatment period should never be prolonged unnecessarily as this will affect withdrawal times and amplify the adverse effects on the commensal flora. The variables affecting length of treatment have not been defined. Responses of different types of infections to antimicrobial drugs vary, and clinical experience with many infections is important in assessing response to treatment. For acute infections, it will be clear within 2days whether or not therapy is clinically effective. If no response is seen by that time, both the diagnosis and treatment should be reconsidered. Treatment of acute infection should be continued for at least 2 days after clinical and microbiological resolution of infections. For serious infections, treatment should last at least 7-10 days. For chronic infections, particularly intracellular infections, treatment will be considerably longer and may involve months. Some uncomplicated infections, such as cystitis in human females, have been treated successfully with single doses of antibiotics, and some antimicrobial agents are now being marketed for single administration in

Continue what I have learned about implementing the use of antimicrobial stewardship (AMS), through selecting the right antimicrobial, dose, frequency and duration; to reduce the development of antimicrobial resistance, toxicity and cost. This objective will be measured through reviewing the optimal choice of the antimicrobial regiment during clinical rounds, everyday discussion with my preceptor and developing care plans during the one month rotation.

The overuse of antibiotics has been a problem for well over a decade. This misuse leads to many nonvisible problems arising within the human population. As the use of antibiotics increases, the number of antibiotic resistant bacteria also increases. When bacteria become resistant to an antibiotic, another antibiotic must be used to try and kill it and the cycle becomes vicious. Michael Martin, Sapna Thottathil, and Thomas Newman stated that antimicrobial resistance is, “an increasingly serious threat to global public health that requires action across all government sectors and society” (2409).