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Antibiotherapy

F-Xavier Lescure
Infectious dieases specialist
Bichat hospital, Paris
Antibiotics

Prescription right

100% doctors 100% antibiotics


All ATB are different according to:
Spectrum activity
Pharmacodynamic characteristics
Pharmacokinetic features
PKPD parameters
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Antibiotics users and prescriptions distribution

Extensive knowledge about antibiotherapy:


Infectious diseases specialists
< 5%
Intensivists

Proportion of ATB prescription in Bichat


hospital: Non IDU + non ICU > 2x IDU + ICU

Overall proportion of ATB prescription:


Community > 90%

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Antibiotics, main principles for efficacy

No mistake for Microbiological


severe infections documentation

Optimal Reconsider
dosing allergy notion
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Antibiotics, main principles for control damage

Not to start each time it is


possible

Shorten the Spare ATB having a


duration large ecological impact
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Antibiotics, improvement by abstention

100% viral infections


Acute bronchitis without comorbidities
Tonsillitis with negative strep-test
Pharyngitis or rhinosinusitis

Asymptomatic bacteriuria

Fever alone
Biological inflammation alone
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Antibiotics, improvement by duration

≤ 1 week of treatment

Pneumonia
Urinary tract infection in women
Non-necrotizing skin and soft tissue infections
Diarrhea (except C. difficile colitis)
Bacteremia (except due to S. aureus)
The majority of operated infections

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Antibiotics, improvement by ecological vision

Broad or
Gut elimination anaerobes including
spectrum of activity

Carbapenems

3GC Fluoroquinolones

Metronidazole Clindamycin

BL + inhibitors

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Antibiotics, some examples of overuse

Community
ATB treatment in pharyngitis or rhinosinusitis
25-30 % Glinz D et al . JAC 2017

Hospital
ATB treatment of asymptomatic bacteriuria
45 % Flokas ME et al . OFID 2017

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Antibiotics, human consumption 2005-2014, OECD

UnitedDefined
KingdomDaily
ATB planDose
sinceper
2013
Dedicated funding
1000
Franceinhabitants
ATB planper day2002
since
No dedicated funding
OECD 2016
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Antibiotics, carbapenems consumption, 2005-2010

Pakistan

Egypt

India

Laxminarayan et al . LID 2014

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Antibiotics, new drug application approvals…

ATB R&D ?
ATB alternatives ?

12 Lescure - Antibiotherapy FDA Center for Drug Evaluation and Research


Take home message
1. Antibiotherapy has become complicated
Lots of different drugs
Systematic collateral damage under ATB

2. Simple actions can lead to improvements


Abstention
Shorten duration
3. Can ATB be prescribed by all doctors ?
Yes for ATB having safe ecological impact
Maybe not for polluters (broad/anaerobes spectrum) ATB or new ATB
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