Course

Unit 1

UNIT I Basics of antimicrobial use (5 hours)

1. Clinical Microbiology – 1 hour
   • Pathogens: bacteria, viruses, fungi
   • Structural differences and replication
2. Antimicrobials – 1 hour
   • Commonly used antimicrobials and mechanisms of action
   • Common adverse events, allergies, and interaction management of antimicrobials

3. Pharmacokinetics and Pharmacodynamics – 3 hour

• Impact of renal and hepatic impairment, PK/PD parameters
• Bioavailability of antimicrobial: Oral and Parenteral
• Special Populations – Pediatrics, pregnancy, breastfeeding, liver and renal impairment, elderly patients

Unit 2

UNIT II Basics of Antimicrobial Resistance and Antimicrobial Stewardship (7 hours)

1. Introduction to Antimicrobial Resistance (AMR)– 2 hours
   • Definition, mechanisms, and causes of AMR
   • Surveillance systems and software for antimicrobial surveillance

2. Strategies to Combat AMR – 1 hour
   • Global and national strategies, microbiology practices, and surveillance

3. Introduction to Antimicrobial Stewardship (AMS) – 1 hour

• Definition, principles (5 R’s) and roles
• Contribution to the reduction of AMR
• Government agencies and policy roles
• Organisational structure of

4. AMS interventions in hospital setting-2 hours

• Prospective audit and feedback
• Formulary restriction and preauthorisation
• Low hanging fruits of AMS

5. Role of Clinical Pharmacist in AMR containment and AMS– 1 hour

Unit 3

UNIT III System-Specific Infection Management (13 hours)

1. Gastrointestinal System – 1 hour
   • Intra-abdominal infections, infective diarrhea, travelers’ diarrhea, Pylori
   • Management options for bacterial GI infections
   • Management of Candida fungal infections affecting the GI tract
   • Risk factors for Clostridium difficile infection (CDI) and its management
2. Cardiovascular System – 1 hour
   • Risk factors, diagnosis, and management of infective endocarditis (IE)
   • Common causative organisms and antimicrobial therapy
   • Prophylaxis for IE and surgical site infections
3. Respiratory System – 1 hour
   • Upper and lower respiratory tract infections (URTI/LRTI)
   • Community-acquired, hospital-acquired, and ventilator-associated pneumonias
   • Antimicrobial therapy for complicated respiratory infections
4. Central Nervous System – 1 hour
   • Diagnosis and management of meningitis and viral CNS infections
   • Antimicrobial prophylaxis in contacts and surgical settings
5. Obstetrics and Gynaecology – 1 hour
   • Infections during pregnancy, delivery, and postpartum
   • Safety of antimicrobials during pregnancy and breastfeeding
   • Infections of the female genital tract and surgical prophylaxis
6. Urinary Tract – 1 hour
   • Diagnosis and management of upper and lower urinary tract infections (UTI)
   • Antimicrobial therapy and prophylaxis for UTI
   • Prevention of catheter-associated UTI

7. Malignant Disease and Immunosuppression – 1 hour

• Neutropenic sepsis management and prophylactic antimicrobial regimens
• Treatment options for bacterial, fungal, and viral infections in immunosuppressed patients

8. Blood – 1 hour
   • Common types of bacteremia and infections due to vascular disease
   • Antimicrobial prophylaxis for vascular surgery
9. Bones and Joints – 1 hour
   • Risk factors and treatment options for bone and joint infections
   • Use of antimicrobials in orthopedic trauma and surgery
10. Eye – 1 hour

• Infections affecting the eye and treatment options
• Antimicrobial prophylaxis for ophthalmic surgery

11. Ear, Nose, and Throat – 1 hour
    • Infections of the ears, nose, throat, and dental infections
    • Antimicrobial prophylaxis for ENT surgery
12. Skin and Soft Tissue – 1 hour
    • Signs, symptoms, and management of skin and soft tissue infections (SSTIs)
    • Causative organisms and potential complications

13. Genito-urinary and Sexually Transmitted Infections – 1 hour

• Management of genito-urinary infections and sexually transmitted infections (STIs)
• Antimicrobial treatment options and follow-up protocols

Unit 4

UNIT IV Advanced Antimicrobial Stewardship (5 hours)

1. AMS program metrics – 2 hours
   1. Measuring antimicrobial use
   2. cost savings
   3. process measures
   4. outcome measures

2. Introduction to antifungal and anti-tubercular stewardship- 1 hour

3. AMS in special settings-2 hours
   1. emergency department
   2. outpatient dialysis units
   3. Dental clinics
   4. Outpatient Parenteral Antimicrobial Therapy

This course is designed to equip students with a deep understanding of the prevalence of infections and their management, focusing on the principles and practices of antimicrobial stewardship (AS). The aim is to reduce antimicrobial resistance (AMR) through the rational use of antimicrobials, shaping students into experts capable of implementing and maintaining effective AS programs.

The course covers both outpatient and inpatient settings, providing students with the knowledge and skills necessary to deliver a high-quality clinical pharmacy service to patients with infections. Students will explore the global and national impact of AMR, understand the pharmacist’s role in AS, and develop strategies to influence appropriate antimicrobial use in various healthcare settings.Additionally, the course includes detailed instruction on the management of individual infections, equipping students with the ability to address specific infectious diseases effectively. Emphasis is placed on the importance of interdisciplinary collaboration and effective communication within healthcare teams, aiming to foster a holistic approach to combating AMR.

After successful completion of the course, the student shall be able to;

KNOWLEDGE

K1: Describe the basic concepts of antimicrobial resistance, its societal impact, and current global and national strategies to combat AMR.

K2: Identify existing gaps in systems designed to prevent AMR.

K3: Explain the necessity of implementing AS strategies in hospital settings.

K4: Assess the pharmacist’s role in AS programs and other areas to improve AMR.

K5: Develop expertise in antibiotic decision-making and utilize professional expertise to influence healthcare professionals and the community on appropriate antimicrobial use.

K6: Recognize the various guidelines for antimicrobial use in special populations and settings.

SKILLS

S1: Demonstrate the ability to trace reasons for microbial resistance.

S2: Illustrate solutions in hospital settings to overcome AMR.

S3: Apply the principles of antimicrobial stewardship (AMS) to clinical settings by implementing AMS strategies.

S4: Identify resistant pathogens at patient bedsides, nursing stations, outpatient settings, and operation theatres.

S5: Develop effective communication systems and strategies to minimize antibiotic resistance. S6: Perform therapeutic drug monitoring for antimicrobials with narrow therapeutic indices. ATTITUDES

A1: Embrace the One Health approach.

A2: Strengthen interpersonal relationships among healthcare professionals.

A3: Cultivate proper sample handling techniques.

A4: Practice ethics in the profession.

A5:Follow antibiotic policy guidelines consistently. A6: Counsel patients on the proper usage of antibiotics.

RECOMMENDED TEXTBOOKS:

• Sanford Guide to Antimicrobial 2024.
• Kucers A, Crowe SM, Kucers’ The use of antibiotics: a clinical review of antibacterial, antifungal and antiviral drugs. 7th ed. Taylor & Francis; 2016.
• Dunleavy L, Renal drug handbook. 5th ed. Wiley-Blackwell; 2020.

USEFUL WEBSITES:

• European Centre for Disease Prevention and Control (ECDC)
• Infectious Diseases Society of America (IDSA)
• Centre for Disease Control and Prevention (CDC)
• Public Health England (PHE)
• British Society for Antimicrobial Chemotherapy (BSAC)
• British Infection Association (BIA)
• Prudent Antibiotic User website (Pause)
• National Institute for Health and Care Excellence (NICE)
• British National Formulary (BNF)
• Electronic Medicines Compendium (medicines.org)

JOURNALS:

• Journal of Antimicrobial Chemotherapy – Oxford University Press on behalf of the British Society
• Journal of Infection – Wiley
• Antimicrobial Agents and Chemotherapy – American Society for Microbiology
• Clinical Infectious Diseases – Oxford University Press
• Lancet: Infectious Diseases
• International Journal of Antimicrobial Agents – International Society of Chemotherapy
• New England Journal of Medicine – Massachusetts Medical Society
• American Journal of Health-System Pharmacy – American Society of Health- System Pharmacists