rational use of antimicrobials

[Guest guest]

Dear Anupama, You have pointed out most of the factors responsible for antimicrobial resistance. If we just concentrate on doctors,regarding their prescribing behaviour on antibiotics, reasons for over prescription of antibiotics may be Lack of confidence:While it is very easy to write a prescription, it takes a fair amount of courage to avoid unnecessary prescriptions. Inability to make a fairly accurate clinical diagnosis is one of the most common causes for over-drugging. Inability to convince the patient about the nature and simplicity of the illness and about the non-requirement of antibacterials is another reason. Defensive' practice: To avoid ‘loss of practice' they tend to prescribe these 'powerful' remedies. Company pressure: The companies mislead the doctors about the indications, suppress the facts on adverse effects and hide the facts on cost of therapy. Recently there is a dangerous trend of 'combining' antibacterials irrationally. Trupti anupama sukhlecha <anupama_acad@...> wrote: Dear Dr Trupti, Congrats for selecting an interesting topic for moderation. Antibiotics are the "wonder-drugs"of this century.However, there has been more of misuse rather than rational use of this class of drugs by the clinicians. The factors that contribute to resistance to antibiotics could be: - use of antibiotics for viral infections like cough, cold, dirrhoea (viral)... - use of broad spectrum antibiotics for minor infections - improper doses and duration - non-compliance by the patient - use of irrational combinations - use of antibiotics without culture and sensitivity More in coming posts Anupama.Trupti Swain <drtruptiswain > wrote: Friends, After a vibrant discussion on “Medicine price in India-”moderated by Dr Anita Kotwani, I welcome you all for yet another topic of

immense Community importance. Antibiotics have been called the single most important therapeutic discovery in the history of medicine. But to ensure their survival, organisms started developing resistance. Death due to infection is still the leading cause of death in developing countries. Significant global burden of resistant hospital -acquired infections adding to this problem. Resistance to first line drugs for most of the pathogens ranges from 0-100%.New antibiotics are expensive. Thus for common People it means that -People cannot be effectively treated -People are ill for longer -People are at great risk of dying -Epidemics are

prolonged -Increased cost of health care Can we halt antimicrobial resistance? Answer probably is - No It can only be contained. But best option would definitely be prevention of

infection. But how to contain this problem? Friends lets discuss this issue. highlights of this discussion may be: - Problem of Antimicrobial resistance - Factors contributing to this burden - Surgical Prophylaxis of Antimicrobials - Irrational Antibiotic combinations - Economic aspect of antimicrobial Use - Antibiotics use in special groups

like pregnancy & pediatric population - Antibiotic policy & Therapeutic guidelines Anything more to be added? I invite all our esteem members to put forth their views and suggestions on these important aspects of Antimicrobial use. Trupti Swain Orissa Be a better friend, newshound, and know-it-all with Mobile. Try it now. 5, 50, 500, 5000 - Store N number of mails in your inbox. Click here.

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[Guest guest]

dear friends,

this one is really a topic of public health importance and the topic that has

been constantly or deliberately paid no attention or we can say ignored since

long time in spite of the emergence of resistance for antimicrobials on large

scale.

(I am feeling that the NetRUMians are also paying no attention on this topic,

the number of reply depicts it.)

Nevertheless, who shall be blamed?

The physician who treats?

The patient who is non compliant?

The manufacturers who device irrational combinations?

The policy makers and implementars who never keep a vigilance on all these

ongoing processes?

Who?

And next important aspect is regarding the steps that shall be followed to

tackle or curb this problem on large scale.

What shall be done?

Any suggestions?

Dr Kiran Chaudhari

Lecturer, Pharmacology,

GMC, Nagpur.

-- original message --

Subject: Rational Use of Antimicrobials- Surgical Prophylaxis

From: Trupti Swain <drtruptiswain@...>

Date: 21st December 2007 11:18:30

Friends,

With relation to my previous posting, I want to point out that

Antimicrobial Prophylaxis is highly recommended in

- Gastro-intestinal and colorectal surgery,

- Contaminated and dirty wound surgery

- During prosthesis implantation.

- Biliary or genito-urinal surgeries,

- Cardiac, thoracic and breast surgeries

-Clean contaminated surgery

- Surgery in the old aged above 60 years.

But not recommended in

- clean head and neck surgery,

- nose and sinus surgery

- Clean uncontaminated surgeries,

however, this view remains controversial.

As the most common organism causing surgical site infection include staph

aureus,coagulase negative staph, enterococcus and e.coli, the first generation

cephalosporins are the drugs of first choice for most clean procedures due to

their safety, long half life and low cost. Metronidazole is indicated in all

abdominal surgeries. Vancomycin or linezolid are indicated for methicillin

resistant staph aureus associated with most nosocomial infections and prosthesis

or vascular graft surgeries. Other antibiotics usually used include penicillin G

and other beta-lactams for streptococcal and pnemococcal infections, 2nd gen

cephalosporins for e.coli, proteus, klebseilla or mixed infections, 3rd

generation cephalosporins for enterobacteriaceae, and the higher antibiotics

like clindamycin, imipenem, meropenem for the most commonly encountered anaerobe

B. fragilis

Trupti

---------------------------------

Never miss a thing. Make your homepage.

Send instant messages to your online friends http://in.messenger.

[Guest guest]

Respected all instead of discussing the problem of irrational use of anti microbials , let us focus what solutions exist . How to senstise the doctors, pharmacists and more importantly the Patients. I request vall members to share ur ideas. I thank Prof Vijay for raising the issue of antimicrobials resistance and cost to community. as a group can we think of something to reduce misuse of anti microbials cost to society by 1000 croers. let us understand the responsibility to guide Doctors ,pharmacists and patients rests with Pharmocologists community. Best regards bhava Narayana pharmed trade news 09849551183. Vijay <drvijaythawani@...> wrote: The community costs for irrational use of antimicrobials The irrational use of antimicrobials (AM) results in early demise of efficacious AM. The search for newer AM is not all that fruitful as fewer AM are coming up on the scene. The irrational use is responsible for micro organism resistance with the result that in future higher AM have to be used, which are more costly, thereby adding to the cost of therapy. Thus it is the patient who finally pays more for irrational us of AM. The pharma companies investing in research of newer AM finally recover the investment made in

research from the product. Thus the community pays higher price for newer molecules because the older ones become less effective. Some of the older AM are still effective eg. Penicillins. These are not used commonly due to the fear of anaphylaxis, thereby leading to disuse. Thus cheaper AM inspite of being available have been shelved and newer AM inspite of being costly are preferred. Thus the patient pays higher for getting the new AM. For all the blunders that the medics, pharmacists and nursing staff commit in AM prescription, supply and administration, it is the patient who is the recipient, sufferer and payee. Vijay Thawani V. BHAVA NARAYANA

EDITOR PUBLISHER

PHARMED TRADE NEWS

3-3-62A, NEW GOKHALE NAGAR

RAMNTHPUR, HYDERABAD 500 013

A.P INDIA

TEL 91-040-27030681

MO 9198495 51183

URL hhtp//www. pharmedtradenews.com

email editorptn@...,pharmedtradenews@...

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[Guest guest]

-Respected kaushik 7 members.

The pharma industry India is very powerful. our govt is yet to

declare Pharma policy from 2002.the matter is refered to a group of

ministers in early 07 , literally kicked up stairs by our hon min

Ram vilas .

Coming back to industry , they believe in 4 C s.-- convince,

confuse, criticize and confront.

after failing all first three through lot of meetings in Oct and

Nov, they have decided to approch Chennai high court on 28 nov.

They claim DCGI has no power to ask State drug controllers to cancel

licenses etc. The matter involves fedaral and state relations and

may involve Supreme court in six months. The current DCGI is on

Extension after retirement and industry will ensure he will not get

extension.

dear5 Kaushik

if people educated like u and me do not take up the 294 Fdc

combinations declared illegal will be available for next 10 yrs

along with other dangerous drugs .

we should ask Dr Vijay to lead us and seek the co-operation of

Dr.Sujan chakrobarty-Member Of Loksabha. By the way dr sujan after

M.Pharm did his doctorate.he is the lone member of pharmacy

community in parliament.

dr Sujan email address is sujanchak@...

website www.sujan.info

tel nos 011-23092899, 03218-260432

i can provide mobile number after taking his permission.

best regards to al

bhava narayana

editor , pharmed trade news

09849551183

-- In netrum , kaushik chakraborty

<kaushik_chakr@...> wrote:

>

> Dear Friends,

> This is definitely a great subject and a need of the hour to

discuss, formulate policies and above all strict gov supervision to

withdraw all harmful irrational drugs from the market. Surely this

is not going to be good news for the Indian and Multinational pharma

companies operating in INDIA if all the physicians stop prescribing

irrational fixed dose cominations which are abandant due to absence

of strict regulatory regulations in india unlike other developed

nations like US. We need regular sensitisation interms of CMEs that

keep reminding us - Usefulness of Rational drug prescribing. Good

news is that at last, there has been some actions from drug general

governor of India and they asked several companies ( including some

reputed ones like ranbaxy, cipla etc) to withdraw many of their

presently available irrational fixed drug combinations.

> Wishing all a brain storming session,

> Dr. Kaushik Chakraborty, RIMS.

>

> Trupti Swain <drtruptiswain@...> wrote:

> Dearv Kiran and Friends,

>

> I also feel that NetRUMians are not paying appropriate attention

to

> a subject which needs thorough discussion.

>

> Everybody, starting from physician, patient himself

> Pharma industry and policy makers contribute to this

> problem.

>

> But the treating physician should take maximum responsibility.

> Because he is in right position to decide either to prescribe

> or not prescribe antibiotics and he should also provide proper

> information, instruction and warning to the patient regarding

> regarding use of Antimicrobials

>

> Trupti

>

>

>

>

> kiranchaudhari7@... wrote:

>

> dear friends,

>

> this one is really a topic of public health importance and the

topic that has been constantly or deliberately paid no attention or

we can say ignored since long time in spite of the emergence of

resistance for antimicrobials on large scale.

>

> (I am feeling that the NetRUMians are also paying no attention on

this topic, the number of reply depicts it.)

>

> Nevertheless, who shall be blamed?

> The physician who treats?

> The patient who is non compliant?

> The manufacturers who device irrational combinations?

> The policy makers and implementars who never keep a vigilance on

all these ongoing processes?

> Who?

>

> And next important aspect is regarding the steps that shall be

followed to tackle or curb this problem on large scale.

>

> What shall be done?

> Any suggestions?

>

> Dr Kiran Chaudhari

> Lecturer, Pharmacology,

> GMC, Nagpur.

>

> -- original message --

> Subject: Rational Use of Antimicrobials- Surgical

Prophylaxis

> From: Trupti Swain <drtruptiswain@...>

> Date: 21st December 2007 11:18:30

>

> Friends,

> With relation to my previous posting, I want to point out that

>

> Antimicrobial Prophylaxis is highly recommended in

>

> - Gastro-intestinal and colorectal surgery,

> - Contaminated and dirty wound surgery

> - During prosthesis implantation.

> - Biliary or genito-urinal surgeries,

> - Cardiac, thoracic and breast surgeries

> -Clean contaminated surgery

> - Surgery in the old aged above 60 years.

>

> But not recommended in

>

> - clean head and neck surgery,

> - nose and sinus surgery

> - Clean uncontaminated surgeries,

>

> however, this view remains controversial.

> As the most common organism causing surgical site infection

include staph aureus,coagulase negative staph, enterococcus and

e.coli, the first generation cephalosporins are the drugs of first

choice for most clean procedures due to their safety, long half life

and low cost. Metronidazole is indicated in all abdominal surgeries.

Vancomycin or linezolid are indicated for methicillin resistant

staph aureus associated with most nosocomial infections and

prosthesis or vascular graft surgeries. Other antibiotics usually

used include penicillin G and other beta-lactams for streptococcal

and pnemococcal infections, 2nd gen cephalosporins for e.coli,

proteus, klebseilla or mixed infections, 3rd generation

cephalosporins for enterobacteriaceae, and the higher antibiotics

like clindamycin, imipenem, meropenem for the most commonly

encountered anaerobe B. fragilis

>

> Trupti

>

> ---------------------------------

> Never miss a thing. Make your homepage.

>

> Send instant messages to your online friends

http://in.messenger.

>

>

>

>

> ---------------------------------

> Never miss a thing. Make your homepage.

>

>

>

>

> ---------------------------------

> Meet people who discuss and share your passions. Join them now.

>

[Guest guest]

Dear Bhava,

Please send me Sujan's E-mail and website again. I will invite him to

NetRUM.

The E-mail ID provided by you is not complete and the website shows

some commercial conflict.

Vijay

> >

> > dear friends,

> >

> > this one is really a topic of public health importance and the

> topic that has been constantly or deliberately paid no attention or

> we can say ignored since long time in spite of the emergence of

> resistance for antimicrobials on large scale.

> >

> > (I am feeling that the NetRUMians are also paying no attention on

> this topic, the number of reply depicts it.)

> >

> > Nevertheless, who shall be blamed?

> > The physician who treats?

> > The patient who is non compliant?

> > The manufacturers who device irrational combinations?

> > The policy makers and implementars who never keep a vigilance on

> all these ongoing processes?

> > Who?

> >

> > And next important aspect is regarding the steps that shall be

> followed to tackle or curb this problem on large scale.

> >

> > What shall be done?

> > Any suggestions?

> >

> > Dr Kiran Chaudhari

> > Lecturer, Pharmacology,

> > GMC, Nagpur.

> >

> > -- original message --

> > Subject: Rational Use of Antimicrobials- Surgical

> Prophylaxis

> > From: Trupti Swain <drtruptiswain@>

> > Date: 21st December 2007 11:18:30

> >

> > Friends,

> > With relation to my previous posting, I want to point out that

> >

> > Antimicrobial Prophylaxis is highly recommended in

> >

> > - Gastro-intestinal and colorectal surgery,

> > - Contaminated and dirty wound surgery

> > - During prosthesis implantation.

> > - Biliary or genito-urinal surgeries,

> > - Cardiac, thoracic and breast surgeries

> > -Clean contaminated surgery

> > - Surgery in the old aged above 60 years.

> >

> > But not recommended in

> >

> > - clean head and neck surgery,

> > - nose and sinus surgery

> > - Clean uncontaminated surgeries,

> >

> > however, this view remains controversial.

> > As the most common organism causing surgical site infection

> include staph aureus,coagulase negative staph, enterococcus and

> e.coli, the first generation cephalosporins are the drugs of first

> choice for most clean procedures due to their safety, long half

life

> and low cost. Metronidazole is indicated in all abdominal

surgeries.

> Vancomycin or linezolid are indicated for methicillin resistant

> staph aureus associated with most nosocomial infections and

> prosthesis or vascular graft surgeries. Other antibiotics usually

> used include penicillin G and other beta-lactams for streptococcal

> and pnemococcal infections, 2nd gen cephalosporins for e.coli,

> proteus, klebseilla or mixed infections, 3rd generation

> cephalosporins for enterobacteriaceae, and the higher antibiotics

> like clindamycin, imipenem, meropenem for the most commonly

> encountered anaerobe B. fragilis

> >

> > Trupti

> >

> > ---------------------------------

> > Never miss a thing. Make your homepage.

> >

> > Send instant messages to your online friends

> http://in.messenger.

> >

> >

> >

> >

> > ---------------------------------

> > Never miss a thing. Make your homepage.

> >

> >

> >

> >

> > ---------------------------------

> > Meet people who discuss and share your passions. Join them now.

> >

>

[Guest guest]

How to reduce the misuse of antimicrobials ?

For Doctors:

- Introduce periodic re-exam (say every 5 years) for medical licence to practice

-Make 10 hour credits for RUM and essential medicines for every re-exam compulsory

- Bring in accountability through prescription audits

- Identify the irrationalists, sue them, if found guilty then ban them from practice.

For Hospitals:

- Run the hospital on EML, ban prescriptions for buying medicines from outside (if outside medicines have to be purchased then the prescription should be cleared by knowledgable rationalist).

- Make prescription audits compulsory

- Start medicine information bulletins for the prescribers and patients as well

- Initiate action against irrationalists and misusers of medicines.

For Government:

- Drastically prune the list of medicines being manufactured in the country.

- Weed out all irrational, bannable, dangerous medicines and unwanted combinations.

- Allow production of only essential medicines in the country. Till this is attained, have differential pricing structure by making irrational medicines costly. Make essential medicines affordable and allow higher mark ups for non essential medicines to enable industry to earn from these.

- Start medicine information service for IEC of the patients

For Pharmacists:

- Make all purchase and sell of medicines accountable.

- Catch sale of prescription medicines without prescription and introduce stringent punishment by cancelling the licence.

Vijay Thawani

> The community costs for irrational use of antimicrobials> The irrational use of antimicrobials (AM) results in early demise of efficacious AM. The search for newer AM is not all that fruitful as fewer AM are coming up on the scene. The irrational use is responsible for micro organism resistance with the result that in future higher AM have to be used, which are more costly, thereby adding to the cost of therapy. Thus it is the patient who finally pays more for irrational us of AM.> The pharma companies investing in research of newer AM finally recover the investment made in research from the product. Thus the community pays higher price for newer molecules because the older ones become less effective. > Some of the older AM are still effective eg. Penicillins. These are not used commonly due to the fear of anaphylaxis, thereby leading to disuse. Thus cheaper AM inspite of being available have been shelved and newer AM inspite of being costly are preferred. Thus the patient pays higher for getting the new AM.> For all the blunders that the medics, pharmacists and nursing staff commit in AM prescription, supply and administration, it is the patient who is the recipient, sufferer and payee.> Vijay Thawani> > > > > > > > V. BHAVA NARAYANAEDITOR & PUBLISHERPHARMED TRADE NEWS3-3-62A, NEW GOKHALE NAGARRAMNTHPUR, HYDERABAD 500 013A.P INDIATEL 91-040-27030681MO 9198495 51183URL hhtp//www. pharmedtradenews.comemail editorptn@...,pharmedtradenews@...> > ---------------------------------> Be a better friend, newshound, and know-it-all with Mobile. Try it now.>

[Guest guest]

Friends, We must thank Dr Vijay for providing us detail information regarding steps to reduce misuse of antimicrobials. Trupti Vijay <drvijaythawani@...> wrote: How to reduce the misuse of antimicrobials ? For Doctors: - Introduce periodic

re-exam (say every 5 years) for medical licence to practice -Make 10 hour credits for RUM and essential medicines for every re-exam compulsory - Bring in accountability through prescription audits - Identify the irrationalists, sue them, if found guilty then ban them from practice. For Hospitals: - Run the hospital on EML, ban prescriptions for buying medicines from outside (if outside medicines have to be purchased then the prescription should be cleared by knowledgable rationalist). - Make prescription audits compulsory - Start medicine information bulletins for the prescribers and patients as well - Initiate action against irrationalists and misusers of medicines. For

Government: - Drastically prune the list of medicines being manufactured in the country. - Weed out all irrational, bannable, dangerous medicines and unwanted combinations. - Allow production of only essential medicines in the country. Till this is attained, have differential pricing structure by making irrational medicines costly. Make essential medicines affordable and allow higher mark ups for non essential medicines to enable industry to earn from these. - Start medicine information service for IEC of the patients For Pharmacists: - Make all purchase and sell of medicines accountable. - Catch sale of prescription medicines without prescription and introduce stringent punishment by cancelling the

licence. Vijay Thawani > The community costs for irrational use of

antimicrobials> The irrational use of antimicrobials (AM) results in early demise of efficacious AM. The search for newer AM is not all that fruitful as fewer AM are coming up on the scene. The irrational use is responsible for micro organism resistance with the result that in future higher AM have to be used, which are more costly, thereby adding to the cost of therapy. Thus it is the patient who finally pays more for irrational us of AM.> The pharma companies investing in research of newer AM finally recover the investment made in research from the product. Thus the community pays higher price for newer molecules because the older ones become less effective. > Some of the older AM are still effective eg. Penicillins. These are not used commonly due to the fear of anaphylaxis, thereby leading to disuse. Thus cheaper AM inspite of being available have been shelved and newer AM inspite of being costly are preferred. Thus the patient pays higher for

getting the new AM.> For all the blunders that the medics, pharmacists and nursing staff commit in AM prescription, supply and administration, it is the patient who is the recipient, sufferer and payee.> Vijay Thawani> > > > > > > > V. BHAVA NARAYANAEDITOR & PUBLISHERPHARMED TRADE NEWS3-3-62A, NEW GOKHALE NAGARRAMNTHPUR, HYDERABAD 500 013A.P INDIATEL 91-040-27030681MO 9198495 51183URL hhtp//www. pharmedtradenews.comemail editorptn@...,pharmedtradenews@...> > ---------------------------------> Be a better friend, newshound, and know-it-all with Mobile. Try it now.>

Be a better friend, newshound, and know-it-all with Mobile. Try it now.

[Guest guest]

Thanks to the moderator for running the show on NetRUM.

Vijay

> > The community costs for irrational use of antimicrobials

> > The irrational use of antimicrobials (AM) results in early demise

of efficacious AM. The search for newer AM is not all that fruitful

as fewer AM are coming up on the scene. The irrational use is

responsible for micro organism resistance with the result that in

future higher AM have to be used, which are more costly, thereby

adding to the cost of therapy. Thus it is the patient who finally

pays more for irrational us of AM.

> > The pharma companies investing in research of newer AM finally

recover the investment made in research from the product. Thus the

community pays higher price for newer molecules because the older

ones become less effective.

> > Some of the older AM are still effective eg. Penicillins. These

are not used commonly due to the fear of anaphylaxis, thereby leading

to disuse. Thus cheaper AM inspite of being available have been

shelved and newer AM inspite of being costly are preferred. Thus the

patient pays higher for getting the new AM.

> > For all the blunders that the medics, pharmacists and nursing

staff commit in AM prescription, supply and administration, it is the

patient who is the recipient, sufferer and payee.

> > Vijay Thawani

> >

> >

> >

> >

> >

> >

> >

> > V. BHAVA NARAYANAEDITOR & PUBLISHERPHARMED TRADE NEWS3-3-62A, NEW

GOKHALE NAGARRAMNTHPUR, HYDERABAD 500 013A.P INDIATEL 91-040-

27030681MO 9198495 51183URL hhtp//www. pharmedtradenews.comemail

editorptn@,pharmedtradenews@

> >

> > ---------------------------------

> > Be a better friend, newshound, and know-it-all with

Mobile. Try it now.

> >

>

>

>

>

>

>

>

> ---------------------------------

> Be a better friend, newshound, and know-it-all with Mobile.

Try it now.

>

[Guest guest]

Friend, Regarding pharmaceutical industries, there are three c's described by editorial of BMJ 2004. these are; convince, confuse and corrupt. the last is the panacea of all .........Despite, the all facts, it is very difficult to change these policies of PI. Thanks, Dr.viral Shah pharmedtradenews <pharmedtradenews@...> wrote: -Respected kaushik 7 members.The pharma industry India is very powerful. our govt is yet to declare Pharma policy from 2002.the matter is refered

to a group of ministers in early 07 , literally kicked up stairs by our hon min Ram vilas .Coming back to industry , they believe in 4 C s.-- convince, confuse, criticize and confront.after failing all first three through lot of meetings in Oct and Nov, they have decided to approch Chennai high court on 28 nov.They claim DCGI has no power to ask State drug controllers to cancel licenses etc. The matter involves fedaral and state relations and may involve Supreme court in six months. The current DCGI is on Extension after retirement and industry will ensure he will not get extension.dear5 Kaushikif people educated like u and me do not take up the 294 Fdc combinations declared illegal will be available for next 10 yrs along with other dangerous drugs .we should ask Dr Vijay to lead us and seek the co-operation of Dr.Sujan chakrobarty-Member Of Loksabha. By the way dr sujan after M.Pharm did his

doctorate.he is the lone member of pharmacy community in parliament.dr Sujan email address is sujanchakgmailwebsite www.sujan.infotel nos 011-23092899, 03218-260432i can provide mobile number after taking his permission.best regards to al bhava narayanaeditor , pharmed trade news09849551183-- In netrum , kaushik chakraborty <kaushik_chakr@...> wrote:>> Dear Friends,> This is definitely a great subject and a need of the hour to discuss, formulate policies and above all strict gov supervision to withdraw all harmful irrational drugs from the market. Surely this is not going to be good news for the Indian and Multinational pharma companies operating in INDIA if all the physicians stop prescribing irrational fixed dose cominations which are abandant due to

absence of strict regulatory regulations in india unlike other developed nations like US. We need regular sensitisation interms of CMEs that keep reminding us - Usefulness of Rational drug prescribing. Good news is that at last, there has been some actions from drug general governor of India and they asked several companies ( including some reputed ones like ranbaxy, cipla etc) to withdraw many of their presently available irrational fixed drug combinations.> Wishing all a brain storming session,> Dr. Kaushik Chakraborty, RIMS.> > Trupti Swain <drtruptiswain@...> wrote:> Dearv Kiran and Friends,> > I also feel that NetRUMians are not paying appropriate attention to> a subject which needs thorough discussion.> > Everybody, starting from physician, patient himself> Pharma industry and policy makers contribute to this > problem.> > But

the treating physician should take maximum responsibility.> Because he is in right position to decide either to prescribe > or not prescribe antibiotics and he should also provide proper > information, instruction and warning to the patient regarding> regarding use of Antimicrobials> > Trupti > > > > > kiranchaudhari7@... wrote:> > dear friends,> > this one is really a topic of public health importance and the topic that has been constantly or deliberately paid no attention or we can say ignored since long time in spite of the emergence of resistance for antimicrobials on large scale.> > (I am feeling that the NetRUMians are also paying no attention on this topic, the number of reply depicts it.)> > Nevertheless, who shall be blamed?> The physician who treats?> The patient who is non compliant?> The

manufacturers who device irrational combinations?> The policy makers and implementars who never keep a vigilance on all these ongoing processes?> Who?> > And next important aspect is regarding the steps that shall be followed to tackle or curb this problem on large scale.> > What shall be done?> Any suggestions?> > Dr Kiran Chaudhari> Lecturer, Pharmacology,> GMC, Nagpur.> > -- original message --> Subject: Rational Use of Antimicrobials- Surgical Prophylaxis> From: Trupti Swain <drtruptiswain@...>> Date: 21st December 2007 11:18:30 > > Friends, > With relation to my previous posting, I want to point out that> > Antimicrobial Prophylaxis is highly recommended in > > - Gastro-intestinal and colorectal surgery, > - Contaminated and dirty wound surgery > - During

prosthesis implantation. > - Biliary or genito-urinal surgeries, > - Cardiac, thoracic and breast surgeries> -Clean contaminated surgery > - Surgery in the old aged above 60 years. > > But not recommended in> > - clean head and neck surgery,> - nose and sinus surgery > - Clean uncontaminated surgeries, > > however, this view remains controversial.> As the most common organism causing surgical site infection include staph aureus,coagulase negative staph, enterococcus and e.coli, the first generation cephalosporins are the drugs of first choice for most clean procedures due to their safety, long half life and low cost. Metronidazole is indicated in all abdominal surgeries. Vancomycin or linezolid are indicated for methicillin resistant staph aureus associated with most nosocomial infections and prosthesis or vascular graft surgeries. Other antibiotics

usually used include penicillin G and other beta-lactams for streptococcal and pnemococcal infections, 2nd gen cephalosporins for e.coli, proteus, klebseilla or mixed infections, 3rd generation cephalosporins for enterobacteriaceae, and the higher antibiotics like clindamycin, imipenem, meropenem for the most commonly encountered anaerobe B. fragilis > > Trupti> > ---------------------------------> Never miss a thing. Make your homepage.> > Send instant messages to your online friends http://in.messenger. > > > > > ---------------------------------> Never miss a thing. Make your homepage. > > > > > ---------------------------------> Meet people who discuss and share your passions. Join them

now.>Dr. Viral Shah MBBS, MD,FCCP Consultant Physician, 33, New People Society, Subhashanagar, Bhavnagar-364001. Mail: viralshah_rational@... drshahviral@...

Forgot the famous last words? Access your message archive online. Click here.

[Guest guest]

-Dr.vijay thawani

the postal address

Dr.sujan chakraborty

108 north avenue

new delhi-100001

Mobile number09868180108

offf tel 011-23092899

you may ring up on mobile

Regards

bhava narayana

-- In netrum , " Vijay " <drvijaythawani@...> wrote:

>

> Dear Bhava,

> Please send me Sujan's E-mail and website again. I will invite him

to

> NetRUM.

> The E-mail ID provided by you is not complete and the website

shows

> some commercial conflict.

> Vijay

>

> > >

> > > dear friends,

> > >

> > > this one is really a topic of public health importance and the

> > topic that has been constantly or deliberately paid no attention

or

> > we can say ignored since long time in spite of the emergence of

> > resistance for antimicrobials on large scale.

> > >

> > > (I am feeling that the NetRUMians are also paying no attention

on

> > this topic, the number of reply depicts it.)

> > >

> > > Nevertheless, who shall be blamed?

> > > The physician who treats?

> > > The patient who is non compliant?

> > > The manufacturers who device irrational combinations?

> > > The policy makers and implementars who never keep a vigilance

on

> > all these ongoing processes?

> > > Who?

> > >

> > > And next important aspect is regarding the steps that shall be

> > followed to tackle or curb this problem on large scale.

> > >

> > > What shall be done?

> > > Any suggestions?

> > >

> > > Dr Kiran Chaudhari

> > > Lecturer, Pharmacology,

> > > GMC, Nagpur.

> > >

> > > -- original message --

> > > Subject: Rational Use of Antimicrobials- Surgical

> > Prophylaxis

> > > From: Trupti Swain <drtruptiswain@>

> > > Date: 21st December 2007 11:18:30

> > >

> > > Friends,

> > > With relation to my previous posting, I want to point out that

> > >

> > > Antimicrobial Prophylaxis is highly recommended in

> > >

> > > - Gastro-intestinal and colorectal surgery,

> > > - Contaminated and dirty wound surgery

> > > - During prosthesis implantation.

> > > - Biliary or genito-urinal surgeries,

> > > - Cardiac, thoracic and breast surgeries

> > > -Clean contaminated surgery

> > > - Surgery in the old aged above 60 years.

> > >

> > > But not recommended in

> > >

> > > - clean head and neck surgery,

> > > - nose and sinus surgery

> > > - Clean uncontaminated surgeries,

> > >

> > > however, this view remains controversial.

> > > As the most common organism causing surgical site infection

> > include staph aureus,coagulase negative staph, enterococcus and

> > e.coli, the first generation cephalosporins are the drugs of

first

> > choice for most clean procedures due to their safety, long half

> life

> > and low cost. Metronidazole is indicated in all abdominal

> surgeries.

> > Vancomycin or linezolid are indicated for methicillin resistant

> > staph aureus associated with most nosocomial infections and

> > prosthesis or vascular graft surgeries. Other antibiotics

usually

> > used include penicillin G and other beta-lactams for

streptococcal

> > and pnemococcal infections, 2nd gen cephalosporins for e.coli,

> > proteus, klebseilla or mixed infections, 3rd generation

> > cephalosporins for enterobacteriaceae, and the higher

antibiotics

> > like clindamycin, imipenem, meropenem for the most commonly

> > encountered anaerobe B. fragilis

> > >

> > > Trupti

> > >

> > > ---------------------------------

> > > Never miss a thing. Make your homepage.

> > >

> > > Send instant messages to your online friends

> > http://in.messenger.

> > >

> > >

> > >

> > >

> > > ---------------------------------

> > > Never miss a thing. Make your homepage.

> > >

> > >

> > >

> > >

> > > ---------------------------------

> > > Meet people who discuss and share your passions. Join them

now.

> > >

> >

>

[Guest guest]

-

hi Dr deepali

excellent points.

i admitted my BIl couple of years back at cAre hospital with suspicion

of myasthania gravis. he died after 15 days not because of myasthenia

gravis but ventilator induced infection.

i look fwd that you should take intiatives in helping all doctors

understand and prevent nosocomial and ventilator induced infections.

as long as clinical pharmocologists are sleeping instead of leading ,

the med profession will be purely dependent on pharma reps talk and

peer pressure.

the responsibility of educating doctors and retail chemists depends on

people like you.

Regars

bhava

09849551183

pharmedtradenews@...

-- In netrum , " Deepali " <deepali_tehre@...> wrote:

>

>

> Hello madam,

>

>

>

>

>

> Antibiotics resistance is everybody's problem and we need a

> concerted and long term strategy to avoid health hazards.

>

> Prudent use of antibiotics has 3 components, rational use, adherence to

> local guidelines and policies, and avoidance or reversal of upward

> demographic trends in antibiotic resistance. Although rational use is

> mandatory, it must be recognized that adherence to policies will reduce

> clinical freedom, for good or ill.

>

> In more recent years the concept of prudent use has been extended. There

> have been additional demands that the use of antibiotics for a

> particular infection

>

> should be shown by clinical trial to be effective; that the financial

> costs should be properly estimated, minimized and balanced against

> effectiveness; and that the

>

> Community-wide effects of increasing resistance among pathogens and

> normal flora should be taken into account.

>

> The use of antimicrobial agents has been identified as an important

> factor in the emergence of antibiotic resistant bacterial infections in

> the ICU.Recent experience shows that, At least 7 days of mechanical

> ventilation, previous antibiotic use, and previous use of broad-spectrum

> antibiotics

>

> (third-generation cephalosporin, fluoroquinolone, carbapenem, or a

> combination) were the most important risk factors associated with the

> development of ventilator-associated pneumonia caused by antibiotic

> resistant pathogens. Other risk factors, such as prolonged length of

> hospital

>

> stay,chronic co-morbid conditions may obscure the clinical signs and

> symptoms of infection.

>

>

>

> STRATEGIES FOR PREVENTING ANTIMICROBIALRESISTANCE IN ICU

>

>

>

> strategies aimed at limiting the unnecessary use of antibiotics or at

> optimizing their effectiveness in hospitalized patients. In addition to

> these, clinicians must ensure that antibiotic administration follows

> certain minimal requirements, such as proper dosing, interval

>

> administration, optimal duration of treatment, monitoring of drug levels

> when appropriate, and avoidance of unwanted drug interactions.

>

>

>

> Recommendation à

>

> * Limit unnecessary antibiotic administration.

> * Develop hospital-based guidelines for antibiotic use

> * Create an antibiotic use quality improvement team

> * Provide education and professional detailing on antibiotic use for

> physicians

> * Create a national intervention policy restricting

antimicrobial use

> * Develop guidelines with a multidisciplinary approach, involving

> local and national peer leaders

> * Restrict the hospital formulary

> * Use narrow-spectrum or older antibiotics

> * Use quantitative cultures and quantitative assessments for

> nosocomial pneumonia

> * Optimize antimicrobial effectiveness

> * Consult with an infectious disease specialist

> * Use antibiotic cycling and scheduled antibiotic changes

> * Use area-specific empirical antimicrobial therapy

> * Avoid routine antimicrobial decontamination of the aero digestive

> tract in the intensive care unit.

>

>

>

> In addition to implementing currently recognized strategies for the

> prevention of antimicrobial resistance, continued research is needed to

> identify and develop innovative approaches. Finally, interventions aimed

> at limiting antibiotic resistance should be carefully evaluated to

> determine their effectiveness and cost-benefit, allowing scarce

> resources to be deployed in the most efficient manner.

>

>

>

> FINALY, Steps in the Development and Implementation of a Program To

> Control Antibiotic Resistance

>

>

>

> 1. Identify the prevention of antibiotic-resistant bacterial

> colonization and infection as a high-priority task To decrease

> horizontal transmission of antibiotic resistance, provide

>

> professional and academic detailing for hospital staff on infection

> control practices and reducing antibiotic misuse and overuse Educate

> hospital administration on program benefits Employ local and outside

> experts and opinion leaders for program development and acceptance

>

> 2. Establish microbiological definitions of antimicrobial resistance and

> clinical

>

> definitions of tracking and defining treatment failures

>

> 3. Establish systems for tracking and reporting antibiotic-resistant

> infections

>

> Publish and disseminate antimicrobial resistance trends (unit- or

> wardspecific)

>

> Identify administration of inadequate antimicrobial treatment (such as

> inappropriate antibiotic selection based on culture results)

>

> Rapidly report antimicrobial-resistant infection, inadequate

> antimicrobial

>

> treatment, or both to clinicians

>

> Develop a mechanism for detecting unit-specific outbreaks of antibiotic-

>

> resistant infections

>

> 4. Optimize compliance with institutional infection control policies and

> practices (handwashing, use of barrier precautions, environmental

> decontamination)

>

> Use surveillance to detect antibiotic resistance Use isolation for

> patients colonized or infected with antibiotic resistant pathogens

>

> Identify optimal patient-to-staff ratios Hold regular educational

> in-services

>

> Give feedback regarding individual or unit-specific infection control

> performance

>

> Establish local or unit-specific ownership and accountability of

> infection control practices in addition to hospital-based programs.

>

> Develop interventions to interrupt horizontal transmission of antibiotic

> resistance

>

> 5. Develop or obtain appropriate information systems support Maintain

> unit or physician profiling of antimicrobial resistance and inadequate

> or inappropriate antibiotic prescription.

>

> Develop a decision support system to optimize administration of

> antimicrobial

>

> agents

>

> Unburden patient care staffs from administrative duties, data

> collection,

>

> and generation of reports

>

> 6. Review and update the program on a regular basis Incorporate new

> technology

>

> Review changing disease patterns Incorporate new information on

> antibiotic resistance.

>

> Exchange experiences and data with other institutions

>

> Evaluate changes in practices according to their effect on antibiotic

> resistance.

>

>

>

> Thank you,

>

> Regards,

>

> Dr Deepali

>

> GMC

>

> Nagpur

>

[Guest guest]

Dear Smita , Narendra and Deepali, Thanks a lot for your valuable input. We really missed you all, in the first part of this discussion. TruptiSmita <smt_mali@...> wrote: Hello all, Almost all issues about RU of AM are either raised by participants or majoritily explained by Trupti madam. I will like to add, proper counselling of patient while managing his/her illness as one of the tool to use AM rationally. Explain them about viral origin of illness when present (fever/URTI/dirrhoea) which need no AM but just supportive treatment. (handle patient pressure) Where necessary

prescribe appropriate AM, but ask them to complete the protocol to ensure no relapse will occur and hence minimise emergence of resistent microbial flora. (patient compliance) Treatment of tuberculosis like infections needs special attention as though national programmes are formulated and it is known fact that disease is curable, preconception/misconception about "TB"makes the situation complecated. Though tuberculosis is corelated with immunocompramised status non-pulmonary tuberculosis is also prevalent in well to do families and in such circumstances delay in diagnosis (as TB is rarely considered D/D in these cases) and then irresponsible behavior on patients' side (shy to take anti-TB medicines initialy or fail to complete the protocol) might add to irrationality in treatment. So to have few minutes reserved for counselling apart from prescribing rationaly is must for RU of AM and in that

case for any treatment. Regards, Dr. Smita Mali, JR II, GMC, Nagpur.

Never miss a thing. Make your homepage.

[Guest guest]

Dear all, This irrational combination is very popular also.It is even taken as OTC. Others in this category include: Paracetamol+ Ibuprofen. Even my pharmacologist collegue says: Dard ke liye to ye hi sabse acchi hei Amoxycillin+ Cloxicillin...and so on. It is really difficult to explain even the elite community. -Anupama.Narendra <naren_bachewar@...> wrote: Hello all,It had been very disappointing to me that somehow I

could not access NetRUM in last few days, and missed this important discussion.I am not aware, if the use of antimicrobials in loose motions has been discussed or not. A combination of Fluroquonolones with Metronidazole/Tinidazole is very frequently used...Is this justified?If isn't why this combination is available in market then, just like other FDCs?RegardsDr. Narendra BachewarGMC, Nagpur

Get the freedom to save as many mails as you wish. Click here to know how.

[Guest guest]

Today we had visit to Sanganer CHC for Patients exit survey.It was

really dishearting that no medicines were available at this CHC.Every

Patient is asked to purchase the medicines from private Pharmacy.most

of the Patients did not have enough money to purchase the medicines

[Guest guest]

>

> Today we had visit to Sanganer CHC for Patients exit survey.It was

> really dishearting that no medicines were available at this CHC.Every

> Patient is asked to purchase the medicines from private Pharmacy.most

> of the Patients did not have enough money to purchase the medicines

>

[Guest guest]

Dear Sir/ Madam,

Thank you very much for raising such a hot discussion!!

 

I regrate to inform you That the same scenario is in Bikaner, S.P. Medical College & A.G. of Hospital, were patients have to share bed with other patient having any other indication, which leads to cross contamination as well as spread of disease. I gone there three times & intimate the same matter to there ethical committee as well board of director, but unfortunately not get any response. As patient of that region is not able to go any private clinic so they have to suffer. If any member of netrum group has visited that site they have better experience. Along with bed they have to mug drug related problem as no any life saving drug is available at the Gov. Pharmacy.

 

This is not only for your kind information but also to know wat`s the actual condition of our gov. hospitals as we are also the part of same community so we need to do some thing along with discussion.

 

looking for yor valuable suggession in this regards!

 

 

Thanks & Regards,

Pushpraj

 

 

Every one know wat`s the problem but the man who take any valuable initiative is man of the century..

 

On Mon, Mar 2, 2009 at 9:15 PM, Rajendra D.Diwe <rajendradiwe@...> wrote:

>> Today we had visit to Sanganer CHC for Patients exit survey.It was

> really dishearting that no medicines were available at this CHC.Every> Patient is asked to purchase the medicines from private Pharmacy.most> of the Patients did not have enough money to purchase the medicines

>

--       Regard Pushpraj K. Singh(M.Pharm, Pharmacology)WEENERS are not those who never FAIL, they are those who never QUIT...