A growing body of evidence demonstrates that hospital based programs dedicated to improving antibiotic use, commonly referred to as “Antibiotic S
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tewardship Programs (ASPs),” can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. This document summarizes core elements of successful hospital Antibiotic Stewardship Programs. It complements existing guidelines on ASPs from different American organizations.
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STGs are designed to assist health care professionals in making decisions about appropriate, effective patient care. However, health managers often have trouble setting and meeting the high standards required of modern, developed health care systems. With stakeholders expressing concern over issues
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such as strength of evidence, transparency, conflicts of interest, and effective implementation, it is clear that many health care professionals need further guidance in developing and making use of STGs.
This manual guides health professionals through the process of establishing and implementing STGs, placing special emphasis on the low- and middle-income country (LMIC) context. By including tools, templates, and success stories as well as hyperlinks to useful resources, the manual helps health practitioners understand not only important concepts of treatment guidelines, but also how they can best be used in practice.
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Objective: To review the effectiveness of antibiotic stewardship interventions in hospitals in low- and middle-income countries.
As a public good, antimicrobial medicines require rational use if their effectiveness is to be preserved. However, up to 50% of antibiotic use is i
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nappropriate, adding considerable costs to patient care, and increasing morbidity and mortality. In addition, there is compelling evidence that antimicrobial resistance is driven by the volume of antimicrobial agents used. High rates of antimicrobial resistance to common treatments are currently reported all over the world, both in health care settings and in the community. For over two decades, the Region of the Americas has been a pioneer in confronting antimicrobial resistance from a public health perspective. However, those efforts need to be stepped up if we are to have an impact on antimicrobial resistance and want to quantify said impact.
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Antibiotic resistant bacteria are spreading at an alarming rate and some bacterial infections may once again be untreatable. Antibiotic resistance (ABR), conservatively calculated, causes more than
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500 000 deaths every year. This number is projected to rise dramatically if radical actions are not taken. Lack of effective antibiotics, diagnostics and vaccines threatens the health of millions and hampers fulfilment of several of the Sustainable Devel- opment Goals. Access to effective antibiotics should be part of every adult and child’s right to health.
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Technical Note on Antimicrobial Resistance
This document reflects UNICEF’s response to the growing global threat of AMR to child survival, growth and development. It identifies UNICEF’s AMR-specific and AMR-sensitive actions in reducing infections, promoting access to and optimal
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use of antimicrobials, and increasing AMR awareness and understanding. Of particular relevance to this group, UNICEF country offices are directed to provide technical support for development and implementation of national AMR action plans, linking them as appropriate to maternal, newborn and child health programmes and ensuring these are prioritized in both surveillance and policy changes. The guidance note on AMR is intended to inform UNICEF’s AMR-related internal initiatives, programming and activities, as well as external engagements with governments and other stakeholders.
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Antibiotic resistance is a natural occurrence caused by mutations in bacteria’s genes. However, inappropriate use of antibiotics accelerates the emergence and spread of
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antibiotic-resistant bacteria. When exposed to antibiotics, susceptible bacteria are killed; while excessive antibiotic use or their use for the wrong reasons can cause bacteria to become resistant and continue to grow and multiply. These resistant bacteria may spread and cause infections in other people.
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One health Response to AMR Containment.
In a significant move for the public health sector, Kerala has become the first state in India to launch an action plan to combat the growing cases of antimicrobial immunity, arising primarily from irrational use
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of medicines and excessive antibiotics used in livestock and poultry.
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Historically, the discovery of the sulfa drugs in the 1930s and the subsequent development of penicillin during World War II ushered in a new era in the treatment of infectious diseases. Infections that were common causes of death and disease in the pre-
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antibiotic era - rheumatic fever, syphilis, cellulitis and bacterial pneumonia - became treatable, and over the next 20 years most of the classes of antibiotics that find clinical use today were discovered and changed medicine in a profound way. The availability of antibiotics enabled revolutionary medical interventions such as cancer chemotherapy, organ transplants and essentially all major invasive surgeries from joint replacements to coronary bypass. Antibiotics, though, are unique among drugs in that their use precipitates their obsolescence. Paradoxically, these cures select for organisms that can evade them, fueling an arms race between microbes, clinicians and drug discoverers.
Wright BMC Biology 2010, 8:123 http://www.biomedcentral.com/1741-7007/8/12
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BMJ Global Health Vol.4 (2019 no.4
The Drug Resistance Index (DRI) is proposed as measure of antibiotic effectiveness in a given country, by combining, in a single metric the use of various
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antibiotic groups and the resistance proportions of several pathogens.It is a complicated measure that gives results that cannot be understood by common knowledge and logic. The DRI conveys a wrong message.
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This document was prepared in response to a need to review and potentially update the current recommendations for the antibiotic treatment of both inpatient and outpatient management of severe acute malnutrition (SAM). The current recommendations (T
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able 1) are based on guidelines published in 2013 in the WHO Pocketbook for Hospital Care for Children, and the 2013 update on SAM (outpatient management). The global threat of increasing antimicrobial resistance and new data on efficacy and safety profiles requires a re-review of the current evidence to ensure recommendations are the most appropriate. The evidence base for the use of antibiotics in children presenting with uncomplicated SAM has been recently enlarged.
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User GuideThe toolkit is composed of three sections: Hospital and Health System Resources - includes a readiness assessment tool, the starting point in developing or enhancing a successful Antimicrobial Stewardship Program (ASP). The tool, a checklist developed by the CDC, should be shared with se
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nior management, a senior leader for quality, purchasing directors, clinic managers, nurse managers, key physician leaders, risk managers, pharmacy leaders, infection preventionists and hospital epidemiologists, laboratory staff and information technology staff. For ease of use, it is divided into two sections, one for those just beginning a program, the other for those who wish to enhance an existing program. Clinician Resources - includes webinars, clinical evidence supporting appropriate use of antibiotics, implementation guides and related articles.Patient Resources - includes frequently asked questions, pamphlets and handouts on how patients can best engage in their care and resources on appropriate use of antibiotics.
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This is the first edition of Empiric Antibiotic Guidelines, as a guidance to all medical practitioners at North Okklapa General & Teaching Hospital.
Antibiotics are critical in the management of infection and can have a significant impact in redu
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cing morbidity and mortality. Emerging antimicrobial resistance has been identified as global challenge by the World Health Organization. Careful use of antibiotics targeted to likely pathogens is an important strategy in combating development of antimicrobial resistance.
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The WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) was launched in 2015 to foster AMR surveillance and inform strategies to contain AMR. The system started with surveillance of AMR in bacteria causing common human infections
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and has expanded its scope to include surveillance of antimicrobial consumption (AMC), invasive fungal infections, and a One Health surveillance model relevant to human health. To meet future challenges, it is in continuous evolution to enhance the quality and representativeness of data to inform the AMR burden accurately. As of the end of 2022, 127 countries, territories and areas participate in GLASS.
The fifth GLASS report, produced in collaboration with Member States, summarizes 2020 data on AMR rates in common bacteria from countries, territories, and areas. The report brings new features, including analyses of population testing coverage or AMR trends. For the first time, the report presents 2020 data on AMC at the national level. A new interactive dashboard allow users to explore AMR and AMC global data, country profiles and download the data.
This report marks the end of the early implementation phase of GLASS. In addition to presenting data collected through the latest data call, this report provides a summary of five years of national AMR surveillance data contributed to GLASS from its initiation, presents AMR findings in the context of progress of country participation in GLASS and in global AMR surveillance coverage and laboratory quality assurance systems at (sub)national level.
Patterns of antimicrobial consumption are presented by country with a particular focus on antibacterials. The report also presents the antimicrobial consumption according to the WHO AWaRe antibiotic classification, for penicillins and cephalosporines. From a One Health perspective, the report presents antimicrobial consumption data in the human sector expressed in tons to allow a comparison with antimicrobial consumption from other sectors (not included in this report).
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Treatment Recommendations for Adult Inpatients
Sunsari Technical College Journal Oktober 2012
The Global Antibiotic Resistance Partnership (GARP) aims to address the challenge of antibiotic resistance by developing actionable Policy Proposals in Vietnam and four other low- and middle-income
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countries: China, India, Kenya and South Africa. GARP will develop the evidence base for Policy action on antibiotic resistance and identify policy opportunities where research, advocacy and information have the best chance of slowing the development and spread of resistance.
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This course will offer a practical approach to prescribing antibiotic therapy and development of antimicrobial stewardship across all specialties and settings. Antibiotics are among the most frequently prescribed classes of drugs and it is estimate
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d that approximately 50% of antibiotic use, in both the outpatient and inpatient settings, is inappropriate. At the same time, in contrast to any other class of drugs, every antibiotic use has a potential public health consequence – inappropriate use may not harm only the individual patient, but contributes to societal harm by exerting an unnecessary selective pressure that may lead to antibiotic resistance among bacteria. This video based course will introduce learners to the basic principles of appropriate antibiotic use, demonstrate how to apply these principles to the management of common infections, and outline how to develop and maintain an antimicrobial stewardship program.
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