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Mike Jones Vice President, Royal College of Physicians of Edinburgh

Responses to Changes in Antibiotic Policies and Current Challenges in Managing Infection within Acute Medicine. Mike Jones Vice President, Royal College of Physicians of Edinburgh. Where’s the problem?. So where’s the problem?. Oh Dear Lord is he really that stupid?.

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Mike Jones Vice President, Royal College of Physicians of Edinburgh

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  1. Responses to Changes in Antibiotic Policies and Current Challenges in Managing Infection within Acute Medicine. Mike Jones Vice President, Royal College of Physicians of Edinburgh

  2. Where’s the problem?

  3. So where’s the problem? • Oh Dear Lord is he really that stupid?

  4. Acute Medicine and infection • “Medicine at the front door” • Pneumonia/Infective exacerbation of COPD • UTI/pyelonephritis • Soft tissue infection • “PUO” • Sepsis syndromes • Therapy guided by ?

  5. Response

  6. Response

  7. Response

  8. Changes in Policy • Inevitable • Resistance of bacteria • New therapies • Based on evidence • Difficult • Communication • Pre-conceived ideas • Resistance

  9. Antimicrobial practice Failure to implement hospital antimicrobial prescribing guidelines: a comparison of two UK academic centres M. H. Ali1, P. Kalima2 and S. R. J. Maxwell1,* 1 Clinical Pharmacology Unit, University of Edinburgh, Queen's Medical Research Institute, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4TJ, UK; 2 Department of Medical Microbiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK

  10. Results • More patients were admitted (CAP: 78.9%versus 48.4%, P < 0.05) • Given antimicrobials intravenously(CAP: 53.4% versus 21.2%, P < 0.05). • CAP adherence was significantly higher (83.3% versus 38.0%; P < 0.05). • Fewer than half of the doctorssurveyed used the local hospital guideline

  11. Poor guidelineadherence results from inadequate dissemination of the recommendedinformation • Local and national guidelinesvary • Medical school teaching and senior doctors as majorinfluences

  12. Education and Training is the answer?

  13. Restriction of Use • Alert antibiotics • E.g. Ertapenem IV • Ganciclovir IV (Ophthalmologist, Renal Specialist) • Linezolid IV/Oral • Meropenem IV (Haematologist, Oncologist, Cystic Fibrosis Specialist) • Specific indication antibiotics • E.g.Ceftazidime: PD peritonitis, Pseudomonas infection • Clindamycin: lung abscess, brain abscess

  14. Challenges for Acute Medicine • Role model • Consistency of prescribing • Evidence based practice • Need to balance: • Sensitivity of most common causative organisms • Risk of antibiotic related illness • Consequences of an ineffective antibiotic • Association of C.difficile (et al) infection with antibiotic use • Accuracy of diagnosis • UTI in the elderly

  15. Acute Medical Management • Balance use of IP management/ambulatory care/ care in the community • Development of OHPAT (out patient and home anti-infective therapy) services where they don’t exist

  16. St Mary's treats hundreds of patients in the community - 21 September 2009 • Hundreds of patients needing intravenous antibiotics are being treated at home - assisting their recovery and freeing up hospital beds at St Mary's.  • Recently published figures have shown that a massive 7,394 in-patient bed days were saved between September 2004 and April 2008 thanks to the pioneering OHPAT (outpatient and home parenteral antimicrobial therapy) service, which allows patients to be managed at home. 

  17. Acute Medical Management • Balance use of IP management/ambulatory care/ care in the community • Development of OHPAT (out patient and home anti-infective therapy) services where they don’t exist • Co-operation with services that will benefit: • ID, orthopaedics, cardiology, vascular etc • Use of evidence base

  18. Summary • Need for Acute Medicine to be: • Consistent • Proactive • Collaborative • Need for growth in evidence base to assess all aspects of care • Acute Medicine can and must help

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