Moustapha Mounib
Senior Consultant of Chest Diseases
Military Medical Academy
Since the discovery of penicillin, the first
antibiotic known, in 1929 the antibiotics
became the magic drug for infectious
diseases. Their remarkable healing power
observed at that period led to the wide
spread uses and often the inappropriate
prescriptions and consequently the
emergence of the antibiotic abuse and
resistance.
The majority of hospitalized patients
receive antibiotics for therapy or
prophylaxis during their inpatient stay
and after discharge. It has been
estimated that about fifty percent of
patients receive antibiotics needlessly
and that the antibiotic prescriptions in
hospital are often irrational.
In an analysis of prescribing
practices in teaching hospitals
worldwide, more than 40 percent
of all antimicrobials prescribed
were considered inappropriate
Reasons include inappropriate
prescribing an antibiotic for
prophylaxis, continuation of
empiric therapy despite negative
culture in a stable patient, and
lack of awareness of susceptibility
patterns of common pathogens.
Antibiotic
misuse- contributing factors
Habits and expectations hard to
change “ cultural factors “.
Lack of knowledge re risks.
Self medication and non
completion.
Lack of control over aggressive
marketing.
Rationale use
of antibiotics in respiratory
tract infections
But the snot is green.
But he is coughing really bad for a whole
week
But the school wont let him back until he
gets an antibiotic for his running nose.
But I need to return to work as early as
possible.
But if I didn’t prescribe an antibiotic I
may loose my patients.
“ Who needs a doctor !!! “
Some real situations
Case 1:
2 years old male, brought with history
of fever and cough with rhinorrhea of
two days.
Red eyes,
Diarrhea, cough ++.
History of similar case in family.
O/E : Throat congested.
Clinically diagnosed : Viral Upper
Respiratory Tract Infection – seasonal
( Pharyngotonsillitis ).
Management :
- General and symptomatic therapy.
- ANTIBIOTICS : Not Needed.
Case 2 :
40 years old otherwise healthy, non smoker male.
Present C/O :
-dry cough for 2 weeks.
-clear sputum production & fatigue
Denies : pharyngitis, fever, chills.
Vital signs : normal temperature , respiratory rate &
pulse.
Diagnosis : Acute Bronchitis.
* Over 90% are viral.
* Approximately 60% of patients seeking
medical care are given antibiotics !!!
* One of the most common causes of
antibiotic abuse.
Most common viruses causing acute bronchitis
# Coronavirus.
# Rhinovirus.
# Influenza A and B.
# Parainfluenza.
# respiratory syncitial virus.
# Human metapneumovirus.
Influenza
* Cough, purulent sputum, fever
and constitutional complaints
during the influenza season.
* Amantadine, rimantadine, or
neuraminidase inhibitors, must be
given within 48 hours of symptoms
onset for demonstrable benefit.
Pneumonitis vs Acute bronchitis.
Abnormal vital signs :
Temp. > 38 degree centigrade.
Pulse > 100/min.
Respiratory rate > 24/min.
Crackles on examination.
Think…….
* Post nasal drip syndrome
* Asthma
* Gastroesophageal reflux
Case 3 :
28 years old otherwise healthy female
who complains of :
nasal congestion, purulent nasal
discharge, maxillary tooth discomfort,
hyposmia, and facial pain or pressure that
is worse when bending forward, headache,
fever ( non acute ), halitosis, fatigue,
cough, ear pain, and ear fullness.
@ Almost all cases viral in etiology.
- Rhinovirus, Parainfluenza, and Influenza virus.
- Usually resolves in 7-10 days.
@ 2 % complicated by acute bacterial sinusitis
( Streptococcus pneumoniae and Haemophilus
influenzae ).
@ Self-limited, 75% resolve without ttt. In 1 month.
•Average adult has from 2-3 colds and influenzalike illnesses per year.
•Average child six to ten.
•Represents approximately one billion acute
respiratory illnesses annually.
•Approximately 0.5 to 2 percent of colds and
influenza-like illnesses are complicated by acute
bacterial sinusitis.
Take home messages
•Viruses cause most common
respiratory illnesses
•Viral illness needs time to
heal, antibiotic can not help
Taking antibiotics for viral illnesses
will not :
*cure the infection.
*keep others from getting the illness.
*makes the patient feel better.
But it will make it more likely to
bacterial resistance.
Clinical differentiation is possible between
bacterial and viral infection most of the times.
* Viral infection is disseminated
throughout the system (URT/LRT). Fever is
usually high at onset, settles by day 3-4.
* Bacterial infection is localized to one
part of the system ( acute tonsillitis does
not present with running nose or chest
signs ). Fever is generally moderate at the
onset and peaks by day 3-4.
So there is no need to hurry
through antibiotic prescription.
Mr: Don’t forget to take one
of our antibiotics free
sample before you leave the
hospital
Free
sample
Restrict antibiotic availability
without prescription
References
1-Angela Heithaus. Internal Medicine Seatle Arts
Center.Diagnosis and Treatment of Common
Infectious Diseases.2009 (ppt. presentation )
2-Nagwa Khamis, Than Lecompte. Antibiotic Usage in
Hospitals. First edition, 2011.
3-Pawla Renouf. Primary/Family Health Care, Aukland,
New Zealand. Judicious Use and Misuse of Antibiotics,
Cases from the frontline.2007 ( ppt. presentation )
4-Raju C. Shah. Ankur Institute of Child Health.
Prescribing antibiotics in pediatrics office
practice.2005. (ppt. presentation )
Thank you