抗生素超量使用与耐药（英文PPT）AntibioticOveruse and .pptVIP

Antibiotic Overuse Resistance Carolyn Bray April 11, 2006 Sponsored By: Dr. Craig Hoesley INTRODUCTION Antimicrobial resistance in the community. Penicillin-resistant Streptococcus pneumoniae Pediatrics: Physician Parent Antibiotic Perceptions Pharmacotherapy: Can we keep up with bacterial drug resistance? UAB Microbial Resistance 2005 Combative strategies FACTORS CONTRIBUTING TO ANTIBIOTIC RESISTANCE Inappropriate antibiotic use Animal husbandry and agriculture Prolonged Hospitalization ICU Hospitalization Immunocompromised patient population Use of invasive devices and catheters AMBULATORY ANTIBIOTIC UTILIZATION Approximately 50% of outpatient antibiotic prescriptions are inappropriate. JAMA 1999: In the US, acute respiratory tract infections are the indication for up to 75% of all antibiotics prescribed in an ambulatory setting. Approximately 50% of common colds URIs, and 80% of bronchitis visits treated with antibiotics each year. Between 1980-1992 prescribing rates for more expensive, broad spectrum antibiotics (e.g. cephalosporins) tripled. Cochrane Collaboration Review 2006: Delayed prescriptions for infections where antibiotics were not immediately indicated reduces antibiotic use without increasing patient morbidity. PENICILLIN-RESISTANT STREPTOCOCCUS PNEUMONIAE Leading cause of CAP, meningitis, otitis media in the US. Excessive antibiotic use for ARIs is fueling an epidemic of community antibiotic-resistant bacteria. Major risk factor for carriage spread of resistant S. pneumoniae is prior antibiotic use. JAMA 1998: Prior to 1980, 99% of all S. pneumoniae cases were susceptible to penicillin. In the past decade, 40% of isolates have intermediate to high penicillin resistance. Dagan 1998: 19 of 120 children had a new pneumococcal isolate colonizing their nasopharynx within 3-4 days of treatment. In 16 of the 19 children, the isolate was resistant to the antibiotic the child was taking. PENICILLIN-RESISTANT STREPTOCOCCUS