WORLD HEALTH DAY          7TH April  Antimicrobial Resistance         Dr.T.V.Rao MD            Dr.T.V.Rao MD    1
WHO – World Health Day• World Health Day is  celebrated every  year on 7 April,  under the  sponsorship of the  World Heal...
Beginning of World Health Day• In 1948, the World Health Organization held the First World  Health Assembly. The Assembly ...
World Health Day 2011• For World Health Day 2011, WHO will launch a  worldwide campaign to safeguard these medicines for  ...
Antibiotic Resistance    Threat to Humans and Animals• Antibiotic resistance has become a serious  problem in both develop...
Themes of previous World Health                  Days•   # 2011: anti-microbial resistance•   # 2010: Urbanization and hea...
Themes of previous World Health Days•   # 2002: Move for Health•   # 2001: Mental Health: Stop Exclusion, Dare to Care•   ...
The magic bullets - Antibiotics    • Antibiotics revolutionised medicine    • The first antibiotic, penicillin, was discov...
Resistance• It took less than 20 years for, bacteria to  show signs of resistance• Staphylococcus aureus, which causes blo...
Multiple resistance• It seems that some resistance was already  naturally present in bacterial populations• The presence o...
Resistance gets around• When antibiotics are used  on a person, the numbers of  antibiotic resistant bacteria  increase in...
Our Vision to save Antibiotics we live in an era of medical breakthroughswith new wonder drugs available to treatcondition...
Are we loosing advantage of our            Achievements• Antimicrobial resistance - the theme of  World Health Day 2011 - ...
Dr.T.V.Rao MD   14
Too many drugs – contribute to          Misuse of Drugs• Currently, about 20 000 medicines are sold on the  global market....
Factors contributing Misuse of               Antibiotics• # More than 50% of all medicines are prescribed,  dispensed or s...
Factors contributing Misuse of                 Antibiotics• * In developing countries, less than 40% of patients in  the p...
Incorrect use of medicines• WHO estimates that more  than half of all medicines are  prescribed, dispensed or sold  inappr...
Drugs Have Become Part of Our Life?               Dr.T.V.Rao MD      19
Incorrect prescriptions have great impact           on Drug Resistance• Medical doctors, including veterinarians and denti...
Broad Spectrum Antibiotics are major  contributors to Antibiotic Resistance• Many doctors also prescribe broad-spectrum  a...
Patents too contribute to Antibiotic               Resistance• Patients themselves also contribute to the  problem when th...
Antimicrobial resistance with Overuse of               Antibiotics• Antimicrobial resistance. Overuse of antibiotics  incr...
Scientific Basis of Antibiotic Resistance• Generally, antibiotic resistance is spread through a  process called horizontal...
What can be done to improve      Rational use of Medicines?• # a national body to coordinate policies on medicine  use and...
What can be done to improve rational            use of medicines?• # problem-based training in pharmacotherapy and prescri...
Is an antibiotic necessary ?Useful only for the treatment of bacterialinfectionsNot all fevers are due to infectionNot all...
Think before -        Prescribing an antibioticIs an antibiotic necessary ?What is the most appropriateantibiotic ?What do...
Choice of regimenOral vs parenteralTraditional view  “serious = parenteral”  previous lack of broad spectrum oral antibiot...
We can alter RESISTANCE1. Maintain sufficiently high levels of the drug   in the tissues   inhibit original population   a...
What Is Antimicrobial Stewardship?• A commination of infection control and antimicrobial management• Mandatory infection c...
IDSA Guidelines – Definition of             Antimicrobial Stewardship• Antimicrobial   stewardship is an activity thatprom...
The Primary Goal of            Antimicrobial Stewardship• The primary goal of antimicrobial stewardship is to– Optimize cl...
Between 1962 and 2000, no major classes of antibiotics                 were introduced                               Fisch...
Physicians Can Impact                               Other cliniciansPatientsOptimize patient evaluation          Optimize ...
Campaign to Prevent Antimicrobial Resistance in Healthcare Settings         12 Steps to Prevent Antimicrobial             ...
Microbes are evolving to save               themselves• Unfortunately, because we  ignored evolution for so long,  we are ...
Teach Hand Washing a Habit to         Everyone            Dr.T.V.Rao MD       38
Antibiotics save LivesSave Antibiotics from Misuse            Dr.T.V.Rao MD      39
Document your Antibiotic Resistance and   Sensitivity Patterns with WHONET• WHONET is a free  software developed by  the W...
Medical Teaching Needs Change on      Rationalism of Antibiotic Use• The society needs  educated on the Role of  Antibioti...
Global United Efforts Can Reduce        Antibiotic Misuse              Dr.T.V.Rao MD        42
Created by Dr.T.V.Rao MD      for“e” learning resources for Developing                World                   Email       ...
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World health day

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World health day

  1. 1. WORLD HEALTH DAY 7TH April Antimicrobial Resistance Dr.T.V.Rao MD Dr.T.V.Rao MD 1
  2. 2. WHO – World Health Day• World Health Day is celebrated every year on 7 April, under the sponsorship of the World Health Organization (WHO). Dr.T.V.Rao MD 2
  3. 3. Beginning of World Health Day• In 1948, the World Health Organization held the First World Health Assembly. The Assembly decided to celebrate 7 April of each year, with effect from 1950, as the World Health Day. The World Health Day is celebrated to create “awareness of a specific health theme to highlight a priority area of concern for the World Health Organization (WHO)”. Activities – related to that particular theme and the resources provided – continue beyond 7 April, that is, the designated day for celebrating the World Health Day. Dr.T.V.Rao MD 3
  4. 4. World Health Day 2011• For World Health Day 2011, WHO will launch a worldwide campaign to safeguard these medicines for future generations. Antimicrobial resistance - the theme of World Health Day 2011 - and its global spread, threatens the continued effectiveness of many medicines used today to treat the sick, while at the same time it risks jeopardizing important advances being made against major infectious killers. Dr.T.V.Rao MD 4
  5. 5. Antibiotic Resistance Threat to Humans and Animals• Antibiotic resistance has become a serious problem in both developed and underdeveloped nations. By 1984 half of those with active tuberculosis in the United States had a strain that resisted at least one antibiotic.In certain settings, such as hospitals and some childcare location Dr.T.V.Rao MD 5
  6. 6. Themes of previous World Health Days• # 2011: anti-microbial resistance• # 2010: Urbanization and health• # 2009: Save lives, Make Hospitals Safe in Emergencies• # 2008: Protecting health from the adverse effects of climate change• # 2007: International health security• # 2006: Working together for health• # 2005: Make every mother and child count• # 2004: Road safety• # 2003: Shape the Future of Life: Healthy Environments for Children Dr.T.V.Rao MD 6
  7. 7. Themes of previous World Health Days• # 2002: Move for Health• # 2001: Mental Health: Stop Exclusion, Dare to Care• # 2000: Safe Blood Start with Me• # 1999: Active Aging Makes the Difference• # 1998: Safe Motherhood• # 1997: Emerging Infectious Diseases• # 1996: Healthy Cities for Better Life• # 1995: Global Polio Eradication Dr.T.V.Rao MD 7
  8. 8. The magic bullets - Antibiotics • Antibiotics revolutionised medicine • The first antibiotic, penicillin, was discovered by Alexander Fleming in 1929 • It was later isolated by Florey and Chain • It was not extensively used until the 2nd World War when it was used to treat war wounds • After 2nd World War many more antibiotics were developed • Today about 150 types are used • Most are inhibitors of the protein synthesis, blocking the 70S ribosome, which is characteristic of prokaryotes© Dr.T.V.Rao MD 8
  9. 9. Resistance• It took less than 20 years for, bacteria to show signs of resistance• Staphylococcus aureus, which causes blood poisoning and pneumonia, started to show resistance in the 1950s• Today there are different strains of S. aureus resistant to every form of antibiotic in use Dr.T.V.Rao MD 9
  10. 10. Multiple resistance• It seems that some resistance was already naturally present in bacterial populations• The presence of antibiotics in their environment in higher concentrations increased the pressure by natural selection• Resistant bacteria that survived, rapidly multiplied• They passed their resistant genes on to other bacteria (both disease causing pathogens and non-pathogens) Dr.T.V.Rao MD 10
  11. 11. Resistance gets around• When antibiotics are used on a person, the numbers of antibiotic resistant bacteria increase in other members of the family• In places where antibiotics are used extensively e.g. hospitals and farms antibiotic resistant strains increase in numbers Dr.T.V.Rao MD 11
  12. 12. Our Vision to save Antibiotics we live in an era of medical breakthroughswith new wonder drugs available to treatconditions that a few decades ago, or even afew years ago in the case of HIV/AIDS, wouldhave proved fatal. For World Health Day2011, WHO will launch a worldwide campaignto safeguard these medicines for futuregenerations Dr.T.V.Rao MD 12
  13. 13. Are we loosing advantage of our Achievements• Antimicrobial resistance - the theme of World Health Day 2011 - and its global spread, threatens the continued effectiveness of many medicines used today to treat the sick, while at the same time it risks jeopardizing important advances being made against major infectious killers. Dr.T.V.Rao MD 13
  14. 14. Dr.T.V.Rao MD 14
  15. 15. Too many drugs – contribute to Misuse of Drugs• Currently, about 20 000 medicines are sold on the global market. WHOs List of Essential Medicines, which includes examples of medicines addressing all the major diseases of public health importance, contains 316 products. The wide range of very similar medicines that exist for the same condition can lead to irrational use and all the negative consequences this brings with it. Dr.T.V.Rao MD 15
  16. 16. Factors contributing Misuse of Antibiotics• # More than 50% of all medicines are prescribed, dispensed or sold inappropriately, and half of all patients fail to take medicines correctly.• # The overuse, underuse or misuse of medicines harms people and wastes resources.• # More than 50% of all countries do not implement basic policies to promote rational use of medicines. Dr.T.V.Rao MD 16
  17. 17. Factors contributing Misuse of Antibiotics• * In developing countries, less than 40% of patients in the public sector and 30% in the private sector are treated according to clinical guidelines.• * A combination of health-care provider education and supervision, consumer education, and an adequate medicines supply is effective in improving the use of medicines, while any of these interventions alone has limited impact. Dr.T.V.Rao MD 17
  18. 18. Incorrect use of medicines• WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. This incorrect use may take the form of overuse, underuse and misuse of prescription or non- prescription medicines. Dr.T.V.Rao MD 18
  19. 19. Drugs Have Become Part of Our Life? Dr.T.V.Rao MD 19
  20. 20. Incorrect prescriptions have great impact on Drug Resistance• Medical doctors, including veterinarians and dentists, often incorrectly prescribe antibiotics: they prescribe the wrong antibiotics or the incorrect dosage of an antibiotic for a particular infection; they prescribe antibiotics for non-bacterial infections (e.g. colds, coughs, or influenza); they prescribe antibiotics prophylactically (in a low dosage for months at a time to prevent future infections; for example, for young children with a history of multiple ear infections). Dr.T.V.Rao MD 20
  21. 21. Broad Spectrum Antibiotics are major contributors to Antibiotic Resistance• Many doctors also prescribe broad-spectrum antibiotics, which kill many different types of bacteria, rather than run a diagnostic lab test so they can prescribe a narrow-spectrum antibiotic that would specifically target the bacteria causing the infection.• • In many other countries, antibiotics are freely available over the counter, without a doctor’s prescription, leading to widespread misuse. Dr.T.V.Rao MD 21
  22. 22. Patents too contribute to Antibiotic Resistance• Patients themselves also contribute to the problem when they feel better after a few days, and then stop taking the antibiotics, instead of continuing with the full cycle prescribed to them. In a 1995 Gallup poll, it was estimated that more than half of American adults taking antibiotics failed to complete their prescribed dosage. Dr.T.V.Rao MD 22
  23. 23. Antimicrobial resistance with Overuse of Antibiotics• Antimicrobial resistance. Overuse of antibiotics increases antimicrobial resistance and the number of medicines that are no longer effective against infectious disease. Many surgical procedures and cancer therapies are not possible without antibiotics to fight infection. Resistance prolongs illnesses and hospital stays, and can even cause death, leading to costs of US$ 4–5 billion per year in the United States of America1 and €9 billion per year in Europe. Dr.T.V.Rao MD 23
  24. 24. Scientific Basis of Antibiotic Resistance• Generally, antibiotic resistance is spread through a process called horizontal gene transfer, the simple passing of genes from one individual to another. Bacteria are very adept at this, thus the interest among scientists in identifying biological pathways that limit horizontal gene transfer, particularly the process called conjugation, which is most commonly associated with the spread of antibiotic resistance. Dr.T.V.Rao MD 24
  25. 25. What can be done to improve Rational use of Medicines?• # a national body to coordinate policies on medicine use and monitor their impact;• # evidence-based clinical guidelines for training, supervision and supporting decision-making about medicines;• # lists of essential medicines used for medicine procurement and insurance reimbursement;• # drug (medicines) and therapeutics committees in districts and hospital Dr.T.V.Rao MD 25
  26. 26. What can be done to improve rational use of medicines?• # problem-based training in pharmacotherapy and prescribing in undergraduate curricula;• # continuing medical education as a requirement of licensure;• # publicly available independent and unbiased information about medicines for health personnel and consumers;• # public education about medicines;• # elimination of financial incentives that lead to improper prescribing, such as prescribers selling medicines for profit to supplement their income;• # regulations to ensure that promotional activities meet ethical criteria; and• # adequate funding to ensure availability of medicines and health personnel. Dr.T.V.Rao MD 26
  27. 27. Is an antibiotic necessary ?Useful only for the treatment of bacterialinfectionsNot all fevers are due to infectionNot all infections are due to bacteria There is no evidence that antibiotics will prevent secondary bacterial infection in patients with viral infection Dr.T.V.Rao MD 27
  28. 28. Think before - Prescribing an antibioticIs an antibiotic necessary ?What is the most appropriateantibiotic ?What dose, frequency, route andduration ?Is the treatment effective ? Dr.T.V.Rao MD 28
  29. 29. Choice of regimenOral vs parenteralTraditional view “serious = parenteral” previous lack of broad spectrum oral antibiotics with reliable bioavailabilityImproved oral agents higher and more persistent serum and tissue levels for certain infections as good as parenteral Dr.T.V.Rao MD 29
  30. 30. We can alter RESISTANCE1. Maintain sufficiently high levels of the drug in the tissues inhibit original population and first-step mutants.2. Simultaneous administration of two drugs that do not give cross-resistance delay emergence of mutants resistant to the drug (e.g. INH + Rifampicin)3. Limit the use of a valuable drug avoid exposure of the organism to the drug Dr.T.V.Rao MD 30
  31. 31. What Is Antimicrobial Stewardship?• A commination of infection control and antimicrobial management• Mandatory infection control compliance• Selection of antimicrobials from each class of drugs that doesthe least collateral damage• Collateral damage issues include– MRSA– ESBLs– C difficile– Stable derepression– MBLs and other carbapenemases– VRE• Appropriate de-escalation when culture results are availableDellit TH, et al. Clin Infect Dis. 2007;44:159-177. Dr.T.V.Rao MD 31
  32. 32. IDSA Guidelines – Definition of Antimicrobial Stewardship• Antimicrobial stewardship is an activity thatpromotes– The appropriate selection of antimicrobials– The appropriate dosing of antimicrobials– The appropriate route and duration ofantimicrobial therapy Dr.T.V.Rao MD 32
  33. 33. The Primary Goal of Antimicrobial Stewardship• The primary goal of antimicrobial stewardship is to– Optimize clinical outcomes while minimizing unintendedconsequences of antimicrobial use• Unintended consequences include the following– Toxicity– The selection of pathogenic organisms, such as C difficile– The emergence of resistant pathogens Dr.T.V.Rao MD 33
  34. 34. Between 1962 and 2000, no major classes of antibiotics were introduced Fischbach MA and Walsh CT Science 2009 Dr.T.V.Rao MD 34
  35. 35. Physicians Can Impact Other cliniciansPatientsOptimize patient evaluation Optimize consultations with otherAdopt judicious antibiotic cliniciansprescribing practices Use infection control measuresImmunize patients Educate others about judicious use of antibiotics Dr.T.V.Rao MD 35
  36. 36. Campaign to Prevent Antimicrobial Resistance in Healthcare Settings 12 Steps to Prevent Antimicrobial Resistance Prevent Transmission 12 Break the chain 11 Isolate the pathogen Use Antimicrobials Wisely 10 Stop treatment when cured 9 Know when to say “no” to vanco 8 Treat infection, not colonization 7 Treat infection, not contamination 6 Use local data Diagnose & Treat Effectively 5 Practice antimicrobial control 4 Access the experts 3 Target the pathogen Prevent Infections 2 Get the catheters out1 Vaccinate Dr.T.V.Rao MD 36
  37. 37. Microbes are evolving to save themselves• Unfortunately, because we ignored evolution for so long, we are in a crisis of antibiotic resistance.• Granted, even if antibiotics had been used wisely from the very beginning, bacterial populations would still have evolved resistance eventually; however, it would have taken much longer, we would have known it would happen, Dr.T.V.Rao MD 37
  38. 38. Teach Hand Washing a Habit to Everyone Dr.T.V.Rao MD 38
  39. 39. Antibiotics save LivesSave Antibiotics from Misuse Dr.T.V.Rao MD 39
  40. 40. Document your Antibiotic Resistance and Sensitivity Patterns with WHONET• WHONET is a free software developed by the WHO Collaborating Centre for Surveillance of Antimicrobial Resistance for laboratory-based surveillance of infectious diseases and antimicrobial resistance. Dr.T.V.Rao MD 40
  41. 41. Medical Teaching Needs Change on Rationalism of Antibiotic Use• The society needs educated on the Role of Antibiotics in Health and Science.• In the Developing world there should be a change in perceptions on Antibiotics through more dedicated Teaching, better national policies. Dr.T.V.Rao MD 41
  42. 42. Global United Efforts Can Reduce Antibiotic Misuse Dr.T.V.Rao MD 42
  43. 43. Created by Dr.T.V.Rao MD for“e” learning resources for Developing World Email • doctortvrao@gmail.com Dr.T.V.Rao MD 43
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