Download Thanks to penicillin the chicken is cheap

Thanks to penicillin the chicken is cheap
Dag Berild 2014
Dag Berild 2014
Evolution of resistance in tuberculosis
Resitance
Year
Number of cases
Monoresistant TB
1950-60
?
Multi drug resistant TB
1990?
9-32% new pts
>50% previously treated
Extensively resistant TB
2006, now in 84 countries
630 000, East-Europe, Asia
Totally resistant TB
2012 India, Iran, Poland
Dag Berild 2014
Intervention to reduce macrolides
Dag Berild 2014
But, good things are happening i
Norway too
Dag Berild 2014
Dag Berild 2014
Penetrerende abdominale skader 1. verdenskrig
• ”During World War I battlefield surgeons were reluctant to
operate on the abdominal cavity when active sepsis was
present. The accepted procedure for treating a penetrating
abdominal wound was to use morphine for pain, prayers for
the soul, and watchful waiting for the peritonitis to resolve.”
• Gorbach SL. Abdominal infections. Clin Infect Dis 1993; 17:
961–7.
Dag Berild 2014
Doses the impact of interventions sustain?
Dag Berild 2014
Until now, no visionary political leadership
Dag Berild 2014
Adjust therapy according to blood cultures
Berild D, Jensenius M, Ringertz SH, Mohseni A. JAC 2006;57:326-30
354 episodes
of positive
blood cultures
92 episodes with CNS
and other contaminants
Appropriate antibiotic therapy
continued in 60 episodes
226 episodes of true bacteraemia
Guidelines recommended
adjustment of antibiotics
in 166 episodes
Treatment adjusted in
146 (88%) episodes
In 36 episodes the patients died
or were discharged before
the results of blood cultures
Dag Berild 2014
Not adjusted in 20 episodes
Cost reduction
19800 EUR (21%)
Dag Berild 2014
Dag Berild 2014
Clinical successes
Dag Berild 2014
Pneumococcal infections
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Serumterapi (hesteserum)
Dag Berild 2014