8 September 2018

About 160 medical practitioners attended our 4th teaching seminar in 2018 entitled “ The Art & Science of Managing Infections”. The venue was at the Tower Ballroom, Shangri- La Hotel.

In his introduction to the seminar, Dr Wong Sin Yew showed data that global consumption of antibiotics had been increasing steadily. This seminar was to share with participants on the pattern and scale of antimicrobial resistance in Singapore and the region and how antibiotics may be used appropriately in family practice, the community and restructured hospitals. There were also lectures on how to differentiate between bacterial and viral infections and the use of systemic steroids in respiratory infections.

A/Prof Tan Tze Lee, President of the College of Family Physicians, started the seminar proper and spoke on the usage of antibiotics in family medicine. He discussed the following:

  •  Current antibiotic landscape in Singapore
  •  Barriers to reducing antibiotic use – Fear of unintended harm as a result of not prescribing an antibiotic
  •  Bacterial Resistance: how extensive is the problem in the community?
  •  Patients’ ideas, concerns & expectations and how to manage them

Antibiotic resistance in the Community was presented by another of our guest speakers, Professor Paul Ananth Tambyah, Senior Consultant Infectious Disease Physician, NUH and Professor of Medicine at NUS. Prof Tambyah spoke about the various bacteria causing infections in hospitals and communities, the emerging threat of multi drug resistant gram negative bacteria, inappropriate antimicrobial therapy and its impact on mortality. He also discussed the global dissemination of methicillin-resistant Staphylococcus aureus (MRSA) and included studies on community acquired MRSA in Singapore. Finally, he spoke about a study in Singapore on the patterns of antibiotic usage in febrile patients attending primary care clinics.

A/Prof David Lye, Senior Consultant at TTSH went through the last 9 years of antimicrobial stewardship in restructured Hospitals and discussed the various interventions to improve antimicrobial prescribing practices for inpatients. He also discussed the usage of various antimicrobials including Ceftriaxone, Amoxycillin, Piperacillin/tazobactam, Amoxicillin-clavulanic acid, Levofloxacin, Ciprofloxacin, Moxifloxacin and Carbapenems and the resistance patterns of the common Gram negative bacteria. He also elaborated on the safety and clinical outcomes of carbapenem de-escalation strategies as part of an antimicrobial stewardship, clinical outcomes of antimicrobial de-escalation in the ICU, and finally results from global point prevalence studies on antimicrobial use in hospitals including one done in Singapore.

Dr Lam Mun San started her session by focusing on the theme that “ Misuse of antibiotics puts us all at risk” and elaborated on effects of antibiotic overuse and also consequences of delayed antibiotic use. She then went on to the need to distinguish between bacterial and viral infection, a list of useful pointers on how to differentiate between bacterial and viral infections and patient factors driving antibiotic use. Dr Lam then spoke briefly on Rapid Viral Tests and bacterial tests that are available and elaborated on the use of Procalcitonin and CRP. Finally she gave a list of the types of infections which are usually bacterial, viral or possibly either and the general guidelines on when antibiotics should be used. In conclusion, she added that all doctors should be ‘antibiotic aware’.

Our final speaker, Dr Wong Sin Yew, presented on ‘Systemic Steroid Use in Respiratory Tract Infections’. He focused on systemic steroid use in acute pharyngitis, acute sinusitis, nonasthmatic Lower Respiratory Tract Infections and Community acquired pneumonia. He discussed the results of several meta analyses. Lastly, he discussed data from an observational study on the possible harmful effects of short term steroid use.

We wish to thank our speakers for presenting interesting talks to the participants. We are grateful to our co-organizer and sponsor, MSD for making all the logistic arrangements for all the participants.