mike jones vice president, royal college of physicians of edinburgh
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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?. - PowerPoint PPT PresentationTRANSCRIPT
Mike JonesVice President, Royal College of
Physicians of Edinburgh
Where’s the problem?
So where’s the problem?
Oh Dear Lord is he really that stupid?
Acute Medicine and infection“Medicine at the front door”
Pneumonia/Infective exacerbation of COPDUTI/pyelonephritisSoft tissue infection“PUO”Sepsis syndromes
Therapy guided by ?
Response
Response
Response
Changes in PolicyInevitable
Resistance of bacteriaNew therapiesBased on evidence
DifficultCommunicationPre-conceived ideasResistance
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
ResultsMore 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 doctors surveyed used
the local hospital guideline
Poor guideline adherence results from inadequate dissemination of the recommended information
Local and national guidelines varyMedical school teaching and senior doctors
as major influences
Education and Training is the answer?
Restriction of UseAlert 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
Challenges for Acute MedicineRole modelConsistency of prescribingEvidence 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 useAccuracy of diagnosis
UTI in the elderly
Acute Medical ManagementBalance 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
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.
Acute Medical ManagementBalance 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 existCo-operation with services that will benefit:
ID, orthopaedics, cardiology, vascular etc Use of evidence base
SummaryNeed for Acute Medicine to be:
ConsistentProactiveCollaborative
Need for growth in evidence base to assess all aspects of care
Acute Medicine can and must help