“What I did with my Biological Sciences Degree”

Working as an Infectious Diseases Clinical Pharmacy SpecialistMinimizing the Impact through Antimicrobial Stewardship

Antibiotic Resistance is a Public Health Crisis

At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy.

I will consider the welfare of humanity and relief of human suffering my primary concerns.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve.

I will keep abreast of developments and maintain professional competency in my profession of pharmacy.

I will maintain the highest principles of moral, ethical, and legal conduct.

I will embrace and advocate change in the profession of pharmacy that improves patient care.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

Oath of a Pharmacist

Mission: Protect, promote and advance the health and safety of our nation.◦ Rapid and effective response to public health needs◦ Leadership and excellence in public health practices◦ Advancement of public health science

Corps officers are involved in ◦ disease control and prevention◦ biomedical research◦ regulation of food and drugs◦ mental health and drug abuse◦ health care delivery

The origins of the Public Health Service are to be found with sailors and medical care. July 16, 1798 – 5th Congress passed an Act, signed by President John Adams

◦ “to provide for the accommodation of sick and disabled seamen.” Today: more than 6,500 active-duty officers working to create a global world free of preventable

disease, sickness, and suffering.◦ CDC◦ NIH◦ IHS◦ NOAA◦ FDA◦ CMS◦ BOP

USPHS

General Biology Botany Cell Biology Invertebrates Parasitology Virology Microbiology Immunology Anatomy & Physiology Pathophysiology Genetics

Leading up to a career in ID PharmacyIBM Austin TexasSport’s AuthorityBiology & Chemistry TutorDispute resolution & mediationImmunology Lab Technician

American Association of Colleges of Pharmacy (AACP.org)◦ Calculus, Statistics, Physics with lab◦ General biology with lab◦ Human anatomy & physiology◦ Microbiology with lab◦ Upper division bioliogy (ex Molecular)◦ General Chem with lab, organic chem with lab◦ Biochemistry◦ Reading & writing for college or equivalen◦ Public speaking◦ Liberal arts / Humanities◦ Economics◦ Human Behavior (social,behavioral, psych)

Getting Into Pharmacy School

Sante Fe – Policy & advocacy

DC – AAIP VA – ambulatory care ID Homeless Shelter Clinics & volunteering

with health fairs Reservation PIMC

Walgreen’s IHS Cardiovascular risk

reduction

Retail Outpatient Consultant MTM Inpatient Midlevel Pharmaceutical Industry Research Radiopharmacy Toxicology Academia

Clinical Pharmacy◦ HIV◦ ID◦ Diabetes◦ Cardiovascular◦ Oncology◦ Pediatrics◦ Psych◦ Home Health◦ Critical Care◦ Emergency

Travel Medicine

Career Options with a PharmD

Broad-spectrum Once daily Oral and IV

Works by inhibiting topoisomerase II, IV◦ Enzyme needed to

separate replicating DNA

◦ Blocks cell division

Resistance◦ Efflux pumps◦ Plasmid-mediated

resistance genes for proteins that block binding

◦ Mutations in DNA gyrase

Levofloxacin

More than 2 million people are infected by drug-resistant germs each year

23,000 die of their infections The biggest killer is C. difficile Up to half the antibiotic Rx written are

unnecessary. These unneeded antibiotics are

making the superbug problem worse. There are not any new antibiotics

immediately in development that will kill these.

Older antibiotics with toxic side effects are the last line defense.

Public Health Crisis

NBC NEWS Sept 16, 2013

MDR Acinetobacter Drug-resistant

Campylobacter Fluconazole-resistant

Candida ESBLs VRE MDR Pseudomonas Drug-resistant Non-

typhoidal Salmonella Drug-resistant Shigella

CRE MRSA VRSA Drug-resistant Strep

pneumoniae Erythromycin-resistant

Group A Strep Clindamycin-resistant

Group B Strep Drug-resistant TB

Public Health Crisis

Abx resistant TB Mycobacterial efflux pump promotes intracellular

survival and may mediate tolerance to antimicrobials Verapamil – drug for heart disease C3HeB/FeJ mice model of TB – lung lesions like

humans◦ Infected with aerosol M. tuberculosis◦ Given standard anti-TB treatment (RIPE) + Verapamil◦ Lung colony-forming units progressively decreased and lower

than standard treatment at 2, 4, 8, & 12 weeks◦ All mice culture negative at 4 months with verapamil◦ Lower 3-month relapse

Murine model-Efflux-Pump

J Respir Crit Care Med 2013 Sep 1

Treat infection not colonization

Use the most effective drug, dose with the shortest duration

Minimize unnecessary broad-spectrum antibiotic exposure

Minimize the spread of resistant bugs

Education Guidelines Daily monitoring Restriction Microbiology

interpretation Rapid diagnostics

Antimicrobial Stewardship – Clinical Model

Thaddus D. Wilkerson, Pharm.D., BCPStdwilkerson@anthc.org(907) 729-2155

Contact Info: