1、Appropriate Antibiotic Use and Antibiotic Resistance in the Community,Kate Grant, MS Project Director Get Smart Virginia Virginia Department of Health,Importance of Pneumococcal Infections in the U.S.,2000 CDC Active Bacterial Core Surveillance (ABCs),Penicillin Resistance in S. pneumoniae, United S
2、tates 1979-2000,1979-1994: CDC Sentinel Surveillance Network,1995-2000: CDC Active Bacterial Core Surveillance (ABCS) SystemEmerging Infections Program,Drug Resistant Streptococcus pneumoniae,Emerged in Spain and South Africa Emerged in the U.S. in the last decade Use of antibiotics for viral infect
3、ions Threatening use of antibiotics for common infections,Resistance and Antibiotic Prescribing,Risk factors for resistant S. pneumoniae are: young age ( 1 year) higher socioeconomic status day-care attendance recent receipt of antibiotics (2-5 times greater risk),Pediatrics 1993;92:761-7.,Reasons f
4、or Antibiotic Overuse Conclusions from 8 Focus Groups,Patient Concerns want clear explanation green nasal discharge need to return to work/child care,Physician Concerns patient expects antibiotic diagnostic uncertainty time pressure,Barden, Clin Pediatric 1998;37:665-672,Antibiotic Prescription,Pati
5、ent Satisfaction and Antibiotics,Hamm, J Fam Pract 1996;43:56 Mangione-Smith, Pediatrics 1999;103:711-8,Satisfaction predicted by: time spent by MD explaining illness patient understanding of treatment choice Satisfaction not predicted by receipt of antibiotics,Can Resistance Trends Be Reversed?,Pub
6、lic health campaign in Iceland following dramatic increase in the rates of penicillin-resistant pneumococci from 2.3% to 20% in 4 years Rates fell from peak of 20% in 1993 to 16.9% in 1994 Carriage rates of resistant strains among day care attendees dropped from 20% to 15% in same periodJAMA 1996;27
7、5;175,Community and Clinician Education Can Effectively Reduce Antibiotic Use,Intervention: Distribution of materials and presentations to clinic staff, parents, day care providers, community groups Small group presentations for clinicians,A controlled intervention trial was conducted in several nor
8、thern Wisconsin communities during 1997-98.,Outcome: 11% reduction in liquid antibiotic prescriptions following intervention; 12% increase in control region.,Belongia Pediatrics 2001;108:575-583,UPDATE!,NAMCS data (2000): Children 15Population-based antibiotic prescriptions decreased 40% Visit-based
9、 antibiotic prescriptions decreased 29%Declines coincide with increased media attentionAntibiotic resistance has continued to increase through the 1990s,(JAMA 2002;287:3096-3102),CDC Treatment Guidelines,www.cdc.gov/drugresistance/community/technical.htm,Principles of Judicious Antimicrobial Use: Ot
10、itis Media - Key Messages,Episodes of otitis media should be classified as acute otitis media (AOM) or otitis media with effusion (OME)Antibiotics are not indicated for initial treatment of OME,Principles of Judicious Antimicrobial Use: Rhinitis and Sinusitis - Key Messages,Rhinitis: antibiotics sho
11、uld not be given for viral rhinosinusitis Sinusitis: prolonged URI symptoms more severe URI symptoms (i.e. facial pain or swelling, high fever) antibiotic treatment with the most narrow-spectrum agent,Principles of Judicious Antimicrobial Use: Pharyngitis - Key Messages,Diagnose as group A strepPeni
12、cillin is the drug of choice in treating group A strep use erthromycin if penicillin allergic,Principles of Judicious Antimicrobial Use: Cough and Bronchitis - Key Messages,Cough/bronchitis rarely needs antibioticsAntibiotic treatment for prolonged cough (10 days) may be needed Mycoplasma pneumonia-
13、 use macrolide agent for children 5,Appropriate Antibiotic Use Summary,Only prescribe antibiotic therapy when clearly beneficial Use an appropriate (targeted) agent Use the appropriate dose and duration,Prevention Pneumococcal Vaccination,23-valent polysaccharide vaccine (PPV) 60% effective in preve
14、nting bacteremic pneumococcal infection in immunocompetent adults 7-valent conjugate vaccine (PCV-7) for children age 3 -59 months 95% effective in preventing invasive disease in young children,Bartlett, Clin Infect Dis 2000;31:347-382 CDC, MMWR 2000;49(RR-9):1-34,HEDIS Performance Measures,National
15、 Committee for Quality Assurance Two measures for children URI diagnosis: rate of antibiotic prescribing, 3 mos 18 yrs Pharyngitis diagnosis: rate of group A strep tests given to 2-16 y/o who are prescribed antibiotics Pilot testing completed; public comment period for draft measures closed March 21
16、, 2003,CDC Lessons Learned,Prescribers and patients are all part of the problemInterventions must target both groupsNot everyone learns the same wayInterventions should be multifaceted,Virginias Appropriate Antibiotic Use Campaign,Mission To promote the judicious use of antibiotics and to reduce the
17、 problem of antibiotic resistance in Virginia.,General Strategy for a Campaign to Promote Judicious Use of Antibiotics in Virginia,Ongoing, comprehensive education Clinicians Consensus guidelines Printed materials to give patients Educational programGeneral public Mass media Materials from health pl
18、ans/insurers Other agencies/institutions providing services to parents, ie, daycare,Consumer Education,Conduct public awareness/education campaign Utilize mass media for information dissemination Distribute consumer education materials through many channels, pharmacies etc. Develop and implement chi
19、ldcare provider training curriculum,VDH and MSVF Partnership,Goals To provide clinically relevant information to physicians regarding appropriate antibiotic use.To provide information and resources to assist clinicians in educating patients regarding appropriate antibiotic use.,Letter to Daycare Pro
20、viders,Viral Prescription Pads,What We Know,Increasing antibiotic resistance threatens success of antibiotic treatment for common infectionsDecreased antibiotic use has been shown to reverse antibiotic resistant trends Many consumers use antibiotics inappropriately; education will target childcare,
21、schools and parentsEffective measures include; physician and public education on principles of appropriate use, distribution of educational materials & mass media,For More Information Contact:,Kate Grant Project Director Virginia Department of Health 804-225-2309,Beth Bortz Executive Director Medical Society of Virginia Foundation 804-353-2721, ext. 149,