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How To Treat Infections Without Using Antibiotics dr shabeel pn
Disclosures ,[object Object],[object Object],[object Object],[object Object],[object Object]
My Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Your Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bottom of the R&D Barrel ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nosocomial Menace ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Community Menace ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Darwin and the Microbes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Playing for Stalemate
Ecological Burden of Resistance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
More use of fewer effective Abx Self amplifying cycle “ Treatment Stenosis” New Infection Abx Therapy Clinical Cure Abx Stopped
Basic Tenants of Stewardship ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antibiotic Balance - Patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antibiotic “Co-lateral Damage” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antibiotic Balance - Population ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antibiotic “Co-lateral Damage”
Antibiotic Stewardship ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Strategies for Outpatients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infectious Syndromes to Target ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Viral or  self limited bacteria Excessive Abx use
AVOID ANTIBIOTIC PRESCRIBING
Avoid Prescribing When Safe ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sinusitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sinusitis – Primary Care RCT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sinusitis – Meta-analysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Asymptomatic Bacteriuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Asymptomatic Bacteriuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Otitis Media ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Otitis Media ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Otitis Media ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FIX THE UNDERLYING PROBLEM
Infection as a “Symptom” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Example - Cellulitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Example - Cellulitis Courtesy of Center for Disease Control and Prevention Image Library
Case Controlled Studies Bjornsdottir  et al.  Clin Infect Dis 2005; 41:1416-22 Dupuy  et al.  BMJ 1999; 318:1591-4 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prophylaxis Pitfalls ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DO NOT OVER VALUE NON STERILE SITE CULTURES
Non Sterile Site Cultures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colonization Contamination Disease Invasion Non Sterile Site Sample Sterile Site Sample Skin Flora – Low Virulence (e.g. CoNS,  Corynebacterium sp ., Viridans Group Strep) Skin Flora – Moderate Virulence (e.g.  Staphylococcus aureus ,  E. coli ,  Pseudomonas ) Professional Pathogen - High Virulence (e.g. M.tuberculosis ,  Brucella ,  Franciella ) More Less Clinical Correlation to Culture Results
A Typical Case ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DM Foot Discordance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MAKE THE DIAGNOSIS
Death to Empiric Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Community Acquired Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Bronchitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TAPER TO (OR USE) NARROW SPECTRUM THERAPY
Less is More ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Community Acquired Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COPD Exacerbations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SHORTER DURATIONS
Longer Is Not Better ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shorter Duration - Cellulitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shorter Duration - Cystitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shorter Duration - CAP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeel’s face eye trauma lidocaine anodontia management medical medi