社区抗生素耐药（英文ppt）down with superbugs! antibiotic resistance and our community课件

AntibioticResistanceandourCommunity DownWithSuperbugs WhatWe llCover Whatisantibioticresistance WhyshouldIbeconcerned Howcanwekeepourfamiliessafe GreenmucusandotherexcitingtopicsYourquestions Digression 1 UpperRespiratoryInfection Aviralorbacterialinvasionofthe Nose sinusitis Throat pharyngitis Chest bronchialtubes bronchitis Ear otitismedia Digression 2 itis itis meansinflammation 2 Inflammationoftheupperrespiratorytractcanhavemanycauses Viruses allergies environmentalexposures bacteria 3 itis doesnotimplybacteriaorbacterialinfection Strep throat scarlet rheumaticfever ChronicsinusinfectionsPneumoniaBladderinfectionsChlamydia syphilis gonorrhea Theytreatmanybacterialillnesses including TheGoodNews AntibioticsKillBacteria AdaptedfromLevinBR ClinInfectDis2001 AntibioticsKillBacteria Viruses Bacteria Antibiotics AdaptedfromLevinBR ClinInfectDis2001 AntibioticsNeedTimetoWork Day5 Day1 Day10 Mostupperrespiratoryinfectionsarecausedbyviruses Antibioticshavenoeffectagainstcoldsandtheflu AntibioticsDon tHelpColdsortheFlu Whenwetakeantibioticstotreatcoldsandtheflu theylosetheireffectivenessagainstbacteria Thisphenomenonisknownasantibioticresistance OverusingAntibioticsMakesthemIneffectiveAgainstBacteria AntibioticResistance Overtime bacteriadeveloptheabilitytosurvivetreatmentwithdrugsthatusedtokillthem Causesofresistance UnnecessaryuseforviralinfectionsQuittingtreatmenttoosoonUnnecessaryuseofbroad spectrummedications Scenario 1 Janehasasorethroat Withouttesting herhealthcareproviderprescribespenicillin justincase it sstrep UnnecessaryAntibioticsCauseResistance ResistantBacteriaCanMultiplyandSpread Janeisnowacarrierofpenicillin resistantbacteria Scenario 2 Ashleycomeshomefromschoolwithasorethroatandfever Afterapositivestreptest herpediatricianprescribespenicillin Herparentsdecideit sOKtostop Ashleytakeshermedicineforthreedays Ashleyfeelsfine Scenario 2 AdaptedfromLevinBR ClinInfectDis2001 IncompleteTreatmentCausesResistance ResistantInfectionsRequireSpecialTreatment ResistantInfectionsareDangerous Medicationtoxicity sideeffects ContagiousCanpassresistancetootherorganisms WorstCaseScenario Theinfectionmaybecomeresistanttoallmedications untreatable PenicillinResistanceinS pneumoniaeUnitedStates1979 2003 1979 1994 CDCSentinelSurveillanceNetwork 1995 2003 CDCActiveBacterialCoreSurveillance ABCs EmergingInfectionsProgram vaccine PercentofinvasiveS pneumoniaeisolatesnon susceptibletopenicillin Portland 1996 2004 ABCsSurveillance OregonEmergingInfectionsProgram0 12 2 WhyWeOveruseAntibiotics Patients Thinkgreennasaldischarge bacterialinfectionNeedtoreturntowork schoolExpectantibioticsifthey vebeengiventhembefore PhysiciansThinkpatientsexpectantibioticsConcernedaboutpatientsatisfactionDiagnosisisdifficultTimepressure ClinPediatr 1998 37 665 672 WhatCanParentsDo Askyourhealthcareprovidertoexplainthediagnosis Don tinsistonantibiotics Remember MostrespiratorysymptomsarecausedbyvirusesAntibioticsprobablywon tmakeyoubetteranyfasterGreenoryellowmucusdoesn tmeanbacterialinfection Washyourhands TheGreenMucusMyth StottBMJ1976 2 556 0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 20 40 60 80 100 Daysofillness Patientsrecordingyellowsputum Antibiotics SugarPill Don taskforaparticularbrand WhenYourChildTakesAntibiotics Takeeverydose unlessyou respecificallydirectedotherwise NEVERsaveantibioticsforlaterillnesses NEVERshareantibioticsbetweenfamilymembers BeRealistic ItTakesTimetoGetOveraVirus GwaltneyJAMA1967 202 158 fever sorethroat cough Runnynose WhatCanHealthCareProvidersDo Taketimetoexplainthediagnosisandsuggestwaystofeelbetter Askpatientsabouttheirexpectations Sticktoestablishedtreatmentguidelines Treatconservativelyifpossible SoreThroat RapidStrepTestifmorethanoneofthefollowingarepresent DischargefromtonsilsSwollen sorelymphnodesFeverNocough Antibioticofchoiceforconfirmedstrep Penicillin 90 ofsorethroatsarecausedbyviruses EarInfections Buildupoffluidinthemiddleearisverycommonininfantsandtoddlers Treatment Ifmild uncomplicated noperforatedeardrumand 24mosold consider wait and see for72hours Antibioticofchoice amoxicillin Notreatmentisrequiredunlessthefollowingarepresent Earpain fever irritability bulgingyellow redeardrum Sinusitis Ifnasaldischarge 10daysORseveresymptoms High persistentfever apparentillnessFacialpainononesidePostnasaldripSwellingaroundtheeyearea Antibioticofchoice amoxicillin Yellow greenmucusdoesnotmeanbacterialinfection CoughIllness Treatonlyconfirmedpertussis whoopingcough orpneumoniawithantibiotics Mostcoughsinchildrenarecausedbyviruses andmaylastfor2 3weeks Antibiotictreatmentwillnotpreventpneumonia Yellow greenmucusdoesnotmeanbacterialinfection ACommunityApproachtoAppropriateAntibioticUse Improvediagnosis trainprovidersandstudents Collectinformationonresistancepatterns Workwithhea