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Rational Use of Antibiotics

Dr.Hossein Khalili , BCPS, Department of Clinical Pharmacy, TUMS. Rational Use of Antibiotics. What is Rational Use of Drugs?.

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Rational Use of Antibiotics

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  1. Dr.HosseinKhalili, BCPS, Department of Clinical Pharmacy, TUMS Rational Use of Antibiotics

  2. What is Rational Use of Drugs? The rational use of drugs requires that patients receive medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and the community. (WHO 1988) • Appropriate indication • Appropriate drug • Appropriate administration, dosage, and duration • Appropriate patient • Appropriate patient information • Appropriate evaluation Problems of Irrational Drug Use

  3. Irrational Use of Drugs = Pathology of Prescribing • The use of drugs when no drug therapy is indicated • The use of wrong drugs for a specific condition requiring drug therapy • The use of drugs with doubtful or unproven efficacy • The use of drugs of uncertain safety status • Failure to prescribe available, safe, & effective drugs • Incorrect administration, dosages, or duration Problems of Irrational Drug Use

  4. Examples of Common Inappropriate Prescribing Practices • The overuse of antibiotics and antidiarrheals for nonspecific childhood diarrhea • Multiple or over-prescription • Use of antibiotics for mild, non-bacterial infection, e.g., URI • Tonics and multivitamins for malnutrition • Unnecessary use of expensive antihypertensives Problems of Irrational Drug Use

  5. Components of the Drug Use System Local Drug Imports Manufacture The DrugSupply Process Provider and + Consumer Behavior Private Physician or Hospital or Pharmacist or Other Practitioner HealthCenter Drug Trader Illness Patterns Public Problems of Irrational Drug Use

  6. Patients Prescribers Industry Drug Regulation • lack of education and training • lack of drug information • heavy patient load • pressure to prescribe • generalization of limited beliefs • misleading beliefs about efficacy • drug misinformation • misleading beliefs • inability to communicate problems • promotion • misleading claims • availability of unsafe drugs • informal prescribers • etc. Drug Supply • inefficient management • non-availability of required drugs Factors Underlying Irrational Use of Drugs Problems of Irrational Drug Use

  7. Impact of InappropriateUse of Drugs Reduced quality of therapy Waste of resources Risk of unwanted effects Psycho-social impacts • Reduced availability • increased cost • patients rely on unnecessary drugs • morbidity • mortality • adverse reactions • bacterial resistance Problems of Irrational Drug Use

  8. Problems of Irrational Drug Use

  9. Problems of Irrational Drug Use

  10. Problems of Irrational Drug Use

  11. Problems of Irrational Drug Use

  12. Problems of Irrational Drug Use

  13. Problems of Irrational Drug Use

  14. Problems of Irrational Drug Use

  15. Outlines • نحوه توزیع دارو در دنیا و ایران • مصرف آنتی بیوتیک در کشور • مصرف آنتی بیوتیک در اروپا • نکات قابل توجه

  16. Ireland

  17. Antibiotics Sale in Iran

  18. Antibiotics Sale in Iran

  19. Oral Antibiotics

  20. Oral Antibiotics

  21. Oral Cephalosporins

  22. Oral Cephalosporins

  23. Oral Macrolides

  24. Oral Penicillins

  25. Oral Quinolones

  26. Antimicrobial Consumption in Iran

  27. Definitions • The Defined Daily Dose (DDD)is the assumed average maintenance dose per day for a drug used for its main indication in adults. Eg: • For Amoxicillin DDD = 1.5g • For ClindamycinDDD = 1.2g oral and 1.8g parenteral

  28. Definitions • Usage data (quantities of antibiotic products dispensed or sold) were converted to rates of DDD per 1000 Inhabitants per Day (DID)

  29. Antimicrobial Consumption in European Countries

  30. Main Points • DDD/1000 در ایران تقریبا 5 برابر متوسط کشورهای اروپایی است • متوسط مصرف آنتی بیوتیک غیر تزریقی در یک روز در سال 1388 معادل 940 میلیون تومان بوده است • اگر مصرف آنتی بیوتیک در کشور به استانداردهای کشورهای اروپایی نزدیک شود روزانه 752 میلیون تومان فقط در هزینه مصرف دارو در کشور صرفه جویی خواهد شد یعنی 268 میلیارد تومان در یک سال

  31. Main Points • متوسط هزینه ساخت یک بیمارستان 100 تختخوابی 10 میلیارد تومان است. یعنی هر سال 26 بیمارستان 100 تختخوابی • بیشترین آنتی بیوتیک در بیماران سرپایی برای عفونتهای تنفسی تجویز می گردد این در حالی است که بیشتر این عفونتها خودبخود محدود شونده هستند

  32. Main Points • تجویز آنتی بیوتیک برای موارد غیر ضروری منجر به مشکلات زیر می گردد • اتلاف سرمایه • بروز عوارض جانبی ناشی از داروها • توصیه به مصرف آنتی بیوتیک به آشنایان در موارد مشابه • مقاومت میکروبی

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