Standing up to Emerging Antibiotic Resistance: How Can rational use of antibiotics help?

Ahmed F. El-YazbiBPSc, PhD, BCPS,RP (ACP)

Dalia A. HamdyBPSc, MSc, PhD, RP (ACP), MRSC

Nahla H. KandilBPSc, MSc, BCPS

I. Pharmacist Attitude and Role in the Prevention of

Antibiotic AbuseDalia A. Hamdy

BPSc, MSc, PhD, RP (ACP), MRSCAssistant professor, Faculty of PharmacyAlexandria University, Alexandria, Egypt

dr.daliahamdy@gmail.com

Outline

• Introduction to antibiotic misuse and resistance

• Identifying the knowledge and attitude (Cards game)

• Comparing our results to latest statistics in a recent study in Alexandria

• Introduction to some important terms and myths

• Employing counselling skills to educate the patientsStanding up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015) 3

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Antibiotic misuse

• AB Self-medication:• defined as obtaining an antibiotic from any source

other than a prescription from a healthcare provider

• Patient non-compliance to therapy:• Do not finish drug therapy• Change antibiotic during treatment

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)

Can antibiotics be used to cure infection caused by viruses?

YesNoI don't know

Recent Stats, Alexandria 2014. (n=400 participants)

42%

38%

20%

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)

Do you think the use of antibiotics will speed up the recovery of cold, cough & other diseases?

YesNoI don't know

Recent Stats, Alexandria 2014. (n=400 participants)

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)

65%

28%

7%

Have you ever heard of bacterial resistance?

YesNo

Recent Stats, Alexandria 2014. (n=400 participants)

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)

44%56%

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Antibiotic Resistance

“is the resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it “

WHO Fact Sheets, April 2014

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)

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Antibiotic Resistance

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In the past 12 months, have you ever used antibiotics without a prescription?

YesNo

Recent Stats, Alexandria 2014. (n=400 participants)

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)

64%

36%

What is MRSA? methicillin resistant staphylococcus aurousmyocardial reversal stenotic atrium describes a hepatic microsomal E deficiencymedullary rays stones assessment I don't know

Recent Stats, Alexandria 2014. (n=400 participants)

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)

51%

6%

40%

3%

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MRSA

https://youtu.be/gU7hrtxBWmA

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)

Aspocid infantile® can be used for children from 14-16 years?

Yes, for relieving mild fever &cold cases NO, because it may cause Reye's Syndrome for children under 18 years old Yes, it increases the immunity for children under 18 years old No, it may cause hemorrhageI don't know

Recent Stats, Alexandria 2014. (n=400 participants)

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)

30%

15%42%

3%10%

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Aspirin and Reye’s Syndrome

• Reye syndrome is an acute, non-inflammatory encephalopathy and hepatotoxicity that follows an acute viral illness. It is associated with salicylates treatment

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Aspirin and Reye’s Syndrome

• The National Reye's Syndrome Foundation, the U.S. Surgeon General, the FDA, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics recommend that aspirin and combination products containing aspirin not be taken by anyone younger than 19 years during fever-causing illnesses.

• The British Medicines and Health-care products Regulatory Agency recommends that aspirin labels state that aspirin is not for use in children younger than 16 years unless recommended by a physician.

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Pharmaceutical Care Practitioner

• Pharmaceutical Care Practitioner:Job is to assure that

a. Appropriate use of patient’s drug therapy for each medical condition

b. Drug therapy used is effective and safe

c. The patient is able and willing to take the medication intended

Assessment

Care Plan

Follow-up evaluation

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Structured patient communication skills

• Establishing Rapport

• Listening• Posing questions

• Providing feedback

-History taking-Probing for further details regarding the problem

-Checking information and using resources-Providing a recommendation, instructions, or information to the patient- Final Recap

-Introduction

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Structured patient communication skills

Data Collection

A lady is showing up at your pharmacy/ admitted to the hospital, she is looking for/ prescribed an antibiotic and is seeking your advice?

1. Collect the data from this patient using the rubrics given2. What do you think is the reason behind such symptoms?3. Do you have any other comments?

1

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Structured patient communication skills

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Structured patient communication skills

Looking up information using resources

1. Can AB be administered to pregnant ladies, children, ..etc?2. Do we need dose modification for patients with CrCl < 30 mL/min?3. I am allergic to eggs, soy bean …etc . Would AB be safe?4. I am on digoxin, is it OK to take AB with my therapy?5. Do I need to change the dose of my oral contraceptive upon taking AB?

2

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Structured patient communication skills

Conveying Data

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You are educating your patient about proper antibiotic use

• Hand washingKeep you away from getting cold and flu or spreading it to other people.

• General notesDrink a lot of fluidsUse a vaporizer or humidifierSouth your internal nose with saline (otrivin and rebound congestion)

• AB instructionsWhen would the AB kick inWhen should you stop antibioticWhat are the most common side effects and how to deal with them

3 Patient Education

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You are educating your patient about proper antibiotic use• Allergy

Warn from penicillin allergy for first time users

• FeverHow to alleviate symptoms and deal with fever

Aspirin and Reye’s syndrome

Paracetamol max. dose per day for children

• Concomitant medication and possible Drug interactionVitamins

Thyroid hormone replacement therapy

Oral contraceptives

4 Patient Education

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Structured patient communication skills

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Thank You

Standing up to Emerging Antibiotic Resistance (DH/AY/NK/ April, 2015)