Friday General Session Maximizing Treatment Outcomes in an Era of Antibiotic Resistance Edward Dominguez, MD Medical Director, Organ Transplant and Infectious Diseases Methodist Dallas Medical Center Dallas, Texas Educational Objectives By the end of this educational activity, participants should be better able to: 1. Discuss the role of antibiotic therapy in modern medical care and feel comfortable in presenting alternative treatments to patients when the need for antibiotics has not been clearly established. 2. Recognize the most likely organisms developing resistance and adjust therapeutic plans accordingly. 3. Discuss the rationale for altering empiric selection of antibiotics on a periodic basis to help preclude the emergence of resistance. Speaker Disclosure Dr. Dominguez has disclosed that he is a consultant for Amgen. 5
Dr. Dominguez has disclosed that he is a consultant for Amgen. Edward A. Dominguez, MD, FACP FIDSA Medical Director, Organ Transplant Infectious Disease Methodist Dallas Medical Center Antibiotics are life-saving medicines Antimicrobial resistance is both a global and local problem There is a link between antibiotic use and resistance Antimicrobial stewardship is a proven strategy to help stem resistance spread. https://www.cdc.gov/wcms/video/low-res/antibioticuse/2017/841841cdc_au_30tv_cut17_released_youtube.mp4 Antimicrobial resistance occurs when bacteria, parasites, viruses or fungi change to protect themselves from the effects of antimicrobial drugs designed to destroy them. This means previously effective antimicrobial drugs (e.g. antibiotics) used to treat or prevent infections may no longer work. The World Health Organization (WHO) has identified AMR as one of the biggest threats to global health. 1
Antimicrobial resistance is a natural phenomenon, BUT Overuse and inappropriate use of antibiotics increases risk Higher acuity patients often receive longer duration Prolonged hospitalisation The implications of medical tourism Source: Centers for Disease Control and Prevention Relationship between total antibiotic consumption and Streptococcus pneumoniae resistance to penicillin in 20 industrialised countries. May 2015, the World Health Assembly adopted a Global Action Plan on Antimicrobial Resistance: 1. Improve awareness and understanding of antimicrobial resistance 2. Strengthen the knowledge and evidence base 3. Reduce the incidence of infection 4. Optimise the use of antimicrobial medicines 5. Develop the economic case for sustainable investment. May increase risk of adverse effects, including: Resistance in current and future patients Treatment failure C. difficile disease Increased cost Top reasons for inappropriate use Spectrum too broad Antimicrobial not indicated Incorrect dose or frequency Incorrect duration Spectrum too narrow Incorrect route 2
A systematic approach to optimising the use of antimicrobials Goals: Improve patient outcomes/patient safety Reduce antimicrobial resistance Reduce cost The BEST D Best Drug(s), at the Best Dose(es), for the Best Duration, against The right Disease AMS works hand-in-hand with infection prevention and control strategies Requires teamwork at all levels: Everybody's business Executive and clinical leadership Clinical team (doctors, nurses, pharmacists, allied health) Consumers Structure, governance and people Executive and clinical leadership AMS committee and Multidisciplinary AMS team Expert advice from Infectious diseases experts Microbiologists Pharmacists Education and training Prescribers, pharmacists, nurses Consumers Information technology resources Essential Strategies for AMS Programs Multidisciplinary efforts Implementing clinical guidelines consistent with Therapeutic Guidelines: Antibiotic Establishing formulary restrictions and an approval system Reviewing/auditing antimicrobial prescribing with intervention and direct feedback to prescribers Selective reporting of susceptibility testing results Monitoring antimicrobial use and outcomes, and reporting to clinicians and management. 3
Utilize societies guidelines for relevant disorders Common adult and pediatric infections are covered on CDC websites: www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/adult-treatmentrec.html www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/pediatrictreatment-rec.html On-line tools for the Antibiotic Tango MOOC PCN-allergy: 10% of population reports PCN-allergy but <1% of the whole population is truly allergic www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/adult-treatment-rec.html www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/adult-treatment-rec.html www.conversationsforhealth.com/antibiotics/ 4
Share social media messages, images, and animated graphics on your social media channels. Use #USAAW18 and #BeAntibioticsAware in every post! Include information about Be Antibiotics Aware and U.S. Antibiotic Awareness Week in your print and e-newsletters. Print and share handouts and posters with patients, Available in Spanish, French, Portuguese, Vietnamese, Chinese and Korean Play videos (available in English and Spanish) on ipads and TV screens in your medical office, pharmacy, waiting room, or lobby. Sign up for our email listserv: antibioticuse@cdc.gov. Last 3 years Ceftazidime-avibactam (Avycaz) Ceftolozane-tazobactam (Zerbaxa) Meropenem-vaborbactam (Vabomere) Delafloxazin (Baxdela) Eravacycline (Xerava) Plazomicin (Zemdri) Next 1-5 years Imepenem-relebactam Fosfomycin IV (currently available PO in USA) Cefiderocol Lefamulin Antimicrobial resistance occurs when an organism evolves and develops resistance to an antimicrobial that should inhibit or destroy it Antimicrobial resistance reduces efficacy of antimicrobials Overuse and inappropriate use of antimicrobials contributes to antimicrobial resistance Antimicrobial stewardship works hand in hand with prevention and control strategies to help address antimicrobial resistance On-line resources available to assist in the outpatient setting 5
Medication Index Maximizing Treatment Outcomes in an Era of Antibiotic Resistance The following medications were discussed in this presentation. The table below lists the generic and trade name(s) of these medications. Generic Name Ceftazidime/Avibactam Ceftolozane/Tazobactam Delafloxacin Eravacycline Fosfomycin IV Meropenem/Vaborbactam Plazomicin Trade Name Avycaz Zerbaxa Baxdela Xerava Monurol Vabomere Zemdri
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