Antibiotic control

Thursday 1/17/07

Antibiotic use

Antibiotic resistance

How can we change / reduce

Ab use???

Will it reduce Ab resistance???

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

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

Macrolide restriction in Finland / Bergman et al. CID2004

• Azithromycin and other macrolide consumption in Finland

• Ery-R in GAS isolates in Finland

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.

Antibiotic cycling

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

Squeezing the balloon…

Kollef M. CID 2006

Abbreviated antibiotic treatments

• For many infections still as effective as ‘standard treatments’ (UTI/ OM/pneumoniae?/ rt. Endocarditis)

• But less Ab pressure.

Using PK/PD to reduce resistance emergence

• Time dependent killing (T>MIC)

• Concentration dependent killing (AUC/MIC or Cmax/MIC)

• MPC (mutant prevention concentration) - flouroquinolones

Educational interventions to implement judicious Ab use

• To decrease misuse and abuse of antibiotics (estimated as >50% prescriptions to outpatients).

But can Ab control reduce Ab resistance?