Antibiotic Policies: Theory and Practice

757 Pages·2005·3.451 MB·English

by  Ian Phillips (auth.), Ian M. Gould, Jos W. M. van der Meer (eds.)

Antibiotic Policies:
Theory and Practice
Antibiotic
Policies: Theory
and Practice
Edited by
Ian M. Gould
Aberdeen Royal Infirmary
Foresterhill, UK
and
Jos W. M. van der Meer
University Hospital Nijmegen
Nijmegen, The Netherlands
KLUWER ACADEMIC PUBLISHERS
NEW YORK,BOSTON, DORDRECHT, LONDON, MOSCOW
eBookISBN: 0-387-22852-7
Print ISBN: 0-306-48500-1
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Foreword
Bacterial resistance to antibiotics and the critical need to curtail this global
public health problem have reached wide awareness among healthcare
providers, hospital administrators, public health officials, and even the public.
The professional and lay literature continues to report the consequence of
antibiotic misuse and the rise in strains resistant to antibiotics. When trying to
understand drug resistance and develop ways to control the mounting public
health problem, there are many factors to consider, which have both health and
ecologic considerations. This book addresses that challenge.
The major thrust of the authors is to define the problem and offer global
and multidisciplinary approaches to resolve it as drug resistance confronts
individuals, hospitals and communities. What do we need to know to help
clinicians and public health officials correct the situation? What theories
should be entertained and what policies and practice can be engaged to pro-
duce a change? These are some of the questions asked and discussed from a
variety of viewpoints. Using theory, an understanding of practice, and the fac-
tors involved in creating and perpetuating the problem, the authors suggest
policies and guidelines which target reversing drug resistance.
Antibiotic use, both in terms of quantity and length of application, is the
major contributor to the selection and propagation of resistant strains. While
some antibiotic resistance may emerge with each treatment, the steady rise in
resistance frequency in an environment generally implies prolonged use and/or
use at a concentration which is too low to effect cure, but high enough to
encourage growth of resistant strains. Besides antibiotic use, other factors,
including epidemiology, gene transfer, and even other drugs, influence the resis-
tance phenomenon. Understanding and quantifying the relationship between
v
vi Foreword
drug use and resistance represent an on-going quest and are critical, not only
for finding ways to reduce resistance, but also for improving quality of care in
the treatment of infectious diseases.
The composition and breadth of information provided make this volume
different from other books which deal more with the phenomenon of this
infectious disease issue and less with its resolution. In a single volume, one
learns about the extent of the problem in different geographic settings, the
factors involved, and how this information can help develop guidelines and
policies which, when put into practice, can lead to change.
One prevalent theme is the need to address drug resistance locally, nation-
ally, and internationally. The importance of international cooperation and com-
pliance is stressed. Such a public health endeavor would benefit the resident
peoples as well as the whole world, since bacteria and other microorganisms
travel so easily from country to country. The problem certainly necessitates
altering physician and patient behaviors as well as establishing guidelines
which can be accepted by the providers. Such changes will only succeed if the
healthcare provider and/or system sees the need for change and seeks to imple-
ment it. Emphasis is placed on local monitoring and surveillance of drug use
and susceptibility data, which help to pinpoint conditions geographically and
define what means can effectively improve the situation. There is a potential
role for pharmacists in overseeing appropriate drug prescription and usage, but
this role is not generally appreciated. The inclusion of the pharmacist in efforts
to improve antibiotic use and curtail resistance is just one of many suggestions
in the authors’multidisciplinary approach.
Infection prevention and its impact on the resistance problem is examined
in both the hospital and community environments. The appropriate use of dis-
infection and antisepsis needs to be appreciated better in both environments.
Misuse of surface antibacterials, such as overuse in healthy homes, could
affect the efficacy of the products needed to protect vulnerable patients and
potentially increase the risk of antibiotic resistance. If used appropriately,
antibacterials should control spread of infections, leading to fewer antibiotic
prescriptions and consequently, decreased resistance.
Costs of resistance have been estimated in billions of US dollars, but
financial resources to effect change and save money are limited. So, despite
concerted interest, the means to obtain necessary data and to develop policy for
change are lacking. Inroads into providing these sources of revenue are criti-
cally needed.
This book is a comprehensive, fact-filled, and welcomed addition to the
library of public health officials, healthcare providers and research scientists.
While it focuses chiefly on bacterial pathogens, it also addresses the resistance
problem as it relates to viruses and fungi. The chapters are written by noted
experts in the field who bring forth both their own medical and scientific
Foreword vii
experience as well as wide knowledge of the field. Together, the contributors
produce a well-described composite of the resistance problem and the poten-
tial for its resolution.
Stuart B. Levy, M.D.
Director
Professor of Molecular Biology and Microbiology
Professor of Medicine
Tufts University School of Medicine
President, Alliance for Prudent Use of Antibiotics
Preface
Antibiotics have been a tremendous success story for over 50 years but this
very success has led to major problems with antibiotic resistance. There is
increasing interest in policies and guidelines to reduce antibiotic use and
improve quality of prescribing and consequently, patient outcome. Much of
this activity is concentrated in hospitals where antibiotic resistance problems
are greatest due to the intensity of antibiotic use complicated by cross infec-
tion. Greater volumes of antibiotics are consumed in the community in patients
and animals and key issues there, are also addressed.
Issues regarding the interaction between resistance and consumption are
explored in detail such as control of resistance by modifying and/or reducing
consumption, analysis of associations between resistance and consumption,
developments in surveillance of resistance and consumption and statistical
models.
Modern concepts of evidence medicine are explored as they apply to inter-
ventions to reduce antibiotic resistance and improve antibiotic use. The latest
evidence about how to design, implement, and evaluate policies and guidelines
is described. As well as dealing with the theory, several chapters will give prac-
tical advice as to how to implement the latest ideas in antibiotic stewardship.
Issues critical and unique to developing countries are explored as well.
ix
Contents
Foreword v
Preface ix
1. Antibiotic Policies—A Historical Perspective 1
IANPHILLIPS
2. Guideline Implementation: It is Not Impossible 15
PETERA. GROSS
3. UK Guidelines: Methodology and Standards of Care 23
DILIPNATHWANI
4. Pneumonia Guidelines in Practice 37
GAVINBARLOW
5. Collecting, Converting, and Making Sense of Hospital
Antimicrobial Consumption Data 67
STEPHANIENATSCH
6. How Do Measurements of Antibiotic Consumption 75
Relate to Antibiotic Resistance?
ROGERL. WHITE
7. Quantitative Measurement of Antibiotic Use 105
FIONAM. MACKENZIEand IANM. GOULD
8. Benchmarking 119
HENRIKWESTH
xi
xii Contents
9. Experiences with Antimicrobial Utilisation
Surveillance and Benchmarking 133
CATHERINEM. DOLLMAN
10. Interventions to Optimise Antibiotic Prescribing in
Hospitals: The UK Approach 159
ERWINM. BROWN
11. Improving Prescribing in Surgical Prophylaxis 185
JOSW. M. VANDERMEERand MARJOVANKASTEREN
12. Audits for Monitoring the Quality of Antimicrobial Prescriptions 197
INGEC. GYSSENS
13. Multidisciplinary Antimicrobial Management Teams and the
Role of the Pharmacist in Management of Infection 227
KARENKNOX, W. LAWSON, and A. HOLMES
14. Antibiotic Policy—Slovenian Experiences 251
MILANCˇIZˇMANand BOJANABEOVIC´
15. Intensive Care Unit 261
HAKANHANBERGER, DOMINIQUEL. MONNET, and
LENNARTE. NILSSON
16. The Real Cost of MRSA 281
STEPHANIEJ. DANCER
17. Antifungal Agents: Resistance and Rational Use 311
FRANKC. ODDS
18. Strategies for the Rational Use of Antivirals 331
SHEILAM. L. WAUGHand WILLIAMF. CARMAN
19. Disinfection Policies in Hospitals and the Community 351
EMINEALPand ANDREASVOSS
20. The Evolution of Antibiotic Resistance within Patients 367
IANR. BOOTH
21. Impact of Pharmacodynamics on Dosing Schedules:
Optimizing Efficacy, Reducing Resistance, and
Detection of Emergence of Resistance 387
JOHANW. MOUTON
22. Types of Surveillance Data and Meaningful Indicators
for Reporting Antimicrobial Resistance 409
HERVÉM. RICHET
Contents xiii
23. Data Mining to Discover Emerging Patterns of
Antimicrobic Resistance 421
J. A. POUPARD, R. C. GAGNON, and M. J. STANHOPE
24. Applications of Time-series Analysis to Antibiotic
Resistance and Consumption Data 447
JOSÉ-MARÍALÓPEZ-LOZANO, DOMINIQUEL. MONNET,
PILARCAMPILLOSALONSO, ALBERTOCABRERAQUINTERO,
NIEVESGONZALOJIMÉNEZ, ALBERTOYAGÜEMUÑOZ,
CLAUDIATHOMAS, ARIELLEBEYAERT, MARKSTEVENSON, and
THOMASV. RILEY
25. Biocide Use and Antibiotic Resistance 465
JEAN-YVESMAILLARD
26. Interventions to Improve Antibiotic Prescribing in the Community 491
SANDRAL. ARNOLD
27. Education of Patients and Professionals 531
CHRISTINEBOND
28. The Influence of National Policies on Antibiotic Prescribing 545
MOYSSISLELEKISANDPANOSGARGALIANOS
29. Antibiotic Use in the Community 567
SIGVARDMÖLSTADand OTTOCARS
30. Antibiotic Use in the Community: The French Experience 583
AGNÈSSOMMETand DIDIERGUILLEMOT
31. Antibiotic Policies in Developing Countries 593
ANÍBALSOSA
32. Antimicrobial Resistance and its Containment in
Developing Countries 617
DENISK. BYARUGABA
33. Antibiotic Use in Animals—Policies and Control
Measures Around Europe 649
PASCALSANDERS
34. The Pharmaceutical Company Approach to Antibiotic Policies 673
ANTHONYR. WHITE
35. Antibiotic Use—Ecological Issues and Required Actions 701
IANM. GOULD
Author Index 717
Subject Index 733