Antibiotic control

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Antibiotic control

• Thursday 1/17/07

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(No Transcript)
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Suggested Ab use strategies for controlling
resistance

• Ab restriction / Infectious Disease consultants
• Combination therapies
• Cycling
• Hit hard and early abbreviated Ab treatments
• PK/PD mutant prevention concentration
• Judicious Ab educational interventions

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Antibiotic restrictionMacrolide restriction in
Finland / Seppala et al. NEJM 1997
Total consumption of macrolides by outpatients in
Finland
Frequency of Ery-R GAS isolates from throat pus
in Finland
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Macrolide restriction in Finland / Bergman et
al. CID2004

• Azithromycin and other macrolide consumption in
  Finland
• Ery-R in GAS isolates in Finland

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Combination therapies

• What are the conditions under which this will
  work?
• It is effective in preventing antibiotic
  resistance for TB, HIV, but for any of the
  bacteria we discussed?
• Not shown effective for other bacteria.

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Antibiotic cycling

• Two or more antibiotic classes are alternated on
  a time scale of months years.

Squeezing the balloon
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Kollef M. CID 2006
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Abbreviated antibiotic treatments

• For many infections still as effective as
  standard treatments (UTI/ OM/pneumoniae?/ rt.
  Endocarditis)
• But less Ab pressure.

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Using PK/PD to reduce resistance emergence

• Time dependent killing (TgtMIC)
• Concentration dependent killing (AUC/MIC or
  Cmax/MIC)
• MPC (mutant prevention concentration) -
  flouroquinolones

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Educational interventions to implement judicious
Ab use

• To decrease misuse and abuse of antibiotics
  (estimated as gt50 prescriptions to outpatients).

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But can Ab control reduce Ab resistance?