read the transcript - Antibiotic Awareness

Antibiotic Awareness Week, November 2011Rita Finley, Lynora Saxinger, Daniel ThirionTranscription: Marjolaine Hébertexposure to antibiotics, and we can see this with Strep pneumo. Andactually, I would like to relate this issue to our, one of the firstspeakers who was showing the amount of antibiotics used in theprovince. And, as you didn’t notice, in Quebec, there was the lowestuse of antibiotics per capita sold in the community. And this, I couldsay, is probably the result of Clostridium difficile, as a lot ofphysicians became aware of the problem with C. diff and the cause ofdeath that was associated with it, and stopped prescribing antibioticsfor indications where it was not really necessary. And the populationwas also aware of this and stopped requesting for antibiotics. And Ithink that shows how much potential we can go and get in the otherprovinces to decrease antibiotic use.Now, that’s one of the aspects, is trying to address the indication ofantibiotics and decrease that aspect. The other impact that we didn’thave was publishing provincial guidelines on how to diagnose, andwhich infections require what kind of antibiotic, for what type ofduration. And that pertains to the second aspect of it, is the durationof therapy.Okay, so, interventions to overcome antimicrobial resistance...this isfor specific patients who get a resistant infection, and we do adjusttherapy for different aspects. For example, in certain situations, inempiric situations, if we suspect resistance, we’ll either add on anantibiotic or choose an antibiotic that has broader spectrum. Thismostly occurs for severe infections for patients admitted into the ER,or going into the ICU. What we might also want to do is increase doseof certain agents, and we have seen this with Amoxicillin where we’reusing higher doses in the community empiric therapy to treat for aStreptococcus pneumoniae.Now, all these adjustments cannot be done vaguely. You do needgood data to make appropriate decisions. And it really depends onwhat kind of resistance we’re seeing, and what is the bug, and whatkind of antibiotic you’re using. So if we’re looking at the Amoxicillin,we have data that supports increased dosing does have some efficacyfor increasing resistance for Streptococcus pneumoniae. However,with MRSA, it’s an alteration of the target site with Penicillins. Evenincreasing doses will have no efficacy, and in those cases, you have toPUBLIC HEALTH AGENCY of CANADA//AGENCE DE LA SANTÉ PUBLIQUE du CANADA 24