AntibioticSelectionandResistance:APharmacist’sperspectiveTheuseofantibioticsisthesinglemostimportantfactorleadingtoantibioticresistanceUpto50%ofallantibioticsprescribedarenotneededorarenotoptimallyeffectiveasprescribedN.gonorrhoeaeResistanceintheUnitedStates1987-2011TheGonococcalIsolateSurveillanceProjectIndividualsprescribedanantibioticinprimarycareforarespiratoryorurinaryinfectiondevelopresistancetothatantibioticGreatesteffectinthemonthimmediatelyfollowingtreatmentbutmaypersistforupto12monthsCostelloe,C.etal.BMJ2010:340:c2096.EffectofAntibioticPrescribinginPrimaryCareonAntimicrobialResistanceCostelloeCetal.BMJ.2010;340:c2096.NursingHomePatientsExample1CentersforMedicareandMedicaidServices,LongTermCareMinimumDataSet,Residentprofiletableasof05/02/2005.Baltimore.MD.2Loeb,Met.al.AntibioticuseinOntariofacilitiesthatprovidechroniccare.JGenInternMed2001;16:376-383.3CentersforDiseaseControlandPrevention,NationalCenterforHealthstatistics,1999NationalNursingHomeSurvey.NursingHomeResidents,number,percentdistribution,andrateper10,000,byageatinterview,accordingtosex,race,andregion:UnitedStates,1999.AcinetobacterResistancetoImipenemInappropriateDosingMayLeadtoResistanceDatapooledfrom4studiesGram-negativepneumoniaCiprofloxacinresistanceassociatedwithAUC/MIC<100ThomasJK,etal.AntimicrobAgentsChemother.1998;42:521-527.DosingMatters–PenicillinExamplePenicillinhalf-lifeisonly30-45minutesRetrospectivereviewofStreptococcalinfectiveendocarditisPenicillingivenevery4hourswasassociatedwithsuccessfultreatmentvsevery6hours(OR2.79;95%CI1.43-5.62)SandoeJAT,etal.JAntimicrobChemother.2013;June13[Epubaheadofprint]PseudomonasaeruginosaMICDistributionDosingOptimizationExampleSheaKM,etal.AnnPharmacother2009;43:1747-1754OptimizingDosing–

CefepimeExampleCefepimeTertiaryreferencessuggestadoseof1-2gq8-12hSusceptibilitybreakpointsarebasedon1gq8h(=2gq12h)Meaning:using1gq12hforpneumoniadoesnotoptimizethedosingofcefepimeandrisksundertreatingthepatientCurrentAntibioticResistanceThreatintheUnitedStatesCDC.ThreatReport2013.BADBUGS,NODRUGSAsAntibioticDiscoveryStagnates…APublicHealthCrisisBrewsBoucherHW,etal.ClinInfectDis2009;48:1-12.TheAntibiotic

PipelineAccessedJan1,2013Anti-infectiveStewardshipPromotionofappropriateandresponsibleuseofanti-infectiveagentsOptimizeanti-infectivetherapyDrugDoseRouteDurationPatienttoleranceandsafetyLimitpreventableadverseeventsDrug-drugordrug-diseaseinteractionsQuestionsAreAntibioticsReallyBenign?CDC.ThreatReport2013.InfectionswithResistantOrganismsareontheRiseObjectivesAntibioticoverusepromotesresistanceGoal–usemostnarrowspectrumagentforappropriatedurationIncreasedresistantorganismsareontheriseInappropriateantibioticdosingmaypromoteresistanceAntibioticpipelineisdiminishingWhattodoPromoteappriopriateanti-infectiveuseUsemostnarrowspectrumanti-infectiveagentatoptimaldosesfortheappropriateduration9、人的價值，在招收誘惑的一瞬間被決定。2月-232月-23Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。16:51:2216:51:2216:512/3/20234:51:22PM11、人總是珍惜為得到。2月-2316:51:2216:51Feb-2303-Feb-2312、人亂于心，不寬余請。16:51:2216:51:2216:51Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。2月-232月-2316:51:2216:51:22February3,202314、抱最大的希望，作最大的努力。03二月20234:51:22下午16:51:222月-23