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Antibiotic resistance 1

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Antibiotic resistance 1

  1. 1. Dr. RAGHU PRASADA M S MBBS,MD ASSISTANT PROFESSOR DEPT. OF PHARMACOLOGY SSIMS & RC.
  2. 2. Antibiotic resistance develops when bacteria adapt and grow in the presence of antibiotics. The development of resistance is linked to how often antibiotics are used Declared a crisis by the World Health Organization Centers for Disease Control and Prevention (CDC) Institute of Medicine Infectious Diseases Society of America, and virtually all other relevant organizations
  3. 3. Antibiotics are non-renewable resources Once resistance evolves, it can spread very rapidly across borders and around the world Drug resistance threatens to erase gains made in disease treatment and control in developing countries Infections with resistant organisms are associated with increased morbidity and mortality Extended stays in hospitals Reduced treatment options Untreatable infections Increased healthcare costs
  4. 4. S. pneumonia: Up to 55% resistance to penicillin in some regions HIV: Report of resistance to all marketed agents S. dyentariae: 90% resistance to cotrimoxazole S.Typhi: Outbreaks of multi-resistant strains in 11 countries M. tuberculosis: Multi-drug resistant tuberculosis P. falciparum: Chloroquine resistance in 81/92 countries
  5. 5. Diseases Agent Resistances Pneumonia S pneumoniae Penicillin Dysentery S dysenteriae Multiple resistances Typhoid S typhi Multiple resistances Gonorrhea N gonorrhoeae Penicillin and tetracycline Tuberculosis M tuberculosis Rifampicine and INH Nosocomial infections S aureus Methicillin, vancomycin E species Vancomycin Klebsiella, Pseudomonas Multiple resistances
  6. 6. Resistance to new drugs arises rapidly as they are introduced Mostly hospital acquired infections Community-acquired resistance is becoming more common Resistant bacteria become dominant
  7. 7. Overall use of antibiotics is increasing rapidly Irrational drug combinations Increasing drug pressure increases the rate of evolution of resistance, but removing drug pressure does not always lead to a decrease in resistance Transmissible resistance (on plasmids) is especially problematic
  8. 8. Prevent antibiotic from reaching its target Impaired cell membrane permeability Efflux phenomenon Prevent the antibiotic from binding to its target Supplementary targets Decreased affinity by target modification Inactivation before reaching the target
  9. 9. Enterobacteriaceae Enterococci StaphylococciPseudomonas Campylobacter Vibrio cholerae Pneumococci Streptococci
  10. 10. The concentration range tested for a drug and the interpretative criteria for various categories are based on extensive studies that correlate with Serum achievable levels for each antimicrobial agent Particular resistance mechanisms Successful therapeutic outcome In practice situations the entire range may not be used for decision making and therefore the concept of breakpoint concentration
  11. 11. Increase prescription auditing Doctors, Pharmacist and Patients Setting up national prescription surveillance networks to track the evolution and spread of resistant pathogens Hospitals with extensive insurances will definitely help in auditing
  12. 12. Data on antibiotic use and drug resistance data by microbe Strong testimony supporting resistance Identify areas of great need for corrective intervention.
  13. 13. Regions where antibiotics are unavailable Regions with high levels of resistance coexist in the same country Little or no regulation of antibiotics, at pharmacies Susceptibility testing and drug regulation are difficult in rural settings Costs money, lives and undermines effectiveness of health delivery programs Threat to global stability and national security
  14. 14. Do’s Understanding emergence and spread of antimicrobial resistance and the factors influencing it Establish a nationwide well coordinated antimicrobial program with well defined and interlinked responsibilities and functions of different arms of the program Rationalizing the usage of available antimicrobials
  15. 15. Do’s Reducing antibiotic selection pressures by appropriate control measures Promotion of discovery of newer and effective antimicrobials based on current knowledge of resistance mechanisms Rapid and accurate diagnosis of infections and infectious diseases
  16. 16. Do’s For monitoring use and misuse of antibiotics: Schedule H of the drug and cosmetics act contains a list of 536 drugs which are required to be dispensed on the prescriptions of a registered medical practitioner. A separate schedule - Schedule H1 under the Drugs and Cosmetics Rules to regulate sale of antibiotics exclusively. Tigecycline, Daptomycin - restricting their access to only tertiary hospitals.
  17. 17. Do’s For monitoring use and misuse of antibiotics: Appropriate steps should be taken to curtail the availability of fixed dose combination of antibiotics in the market Hospital based sentinel Surveillance System for monitoring antibiotic resistance to be set up with the identification of one of more Central institutions under the ministry of health as coordinating centres at the National Level.
  18. 18. For promoting rational use of drugs various strategies: Educational strategy: Training Printing materials Media-based Approach Managerial strategy: Monitoring & supervision Generic substitution Patient cost sharing
  19. 19. Enforcement, sanction, drug withdrawal, market control Formulation & implementation of an antibiotic policy With quality assured laboratory data in real time develop antibiotic policies that are standard national / local treatment guidelines. Advocating evidence based immunotherapy or combination therapy. This must include consideration of spectrum of antibiotics , pharmacokinetics / pharmacodynamics, adverse effects monitoring, Cost and special needs of individual patient groups
  20. 20. Antimicrobial resistance (AMR) monitoring and Strengthening diagnostic strategies are appropriate diagnostic tools rapid identification of pathogens for AMR surveillance. Robust quality assurance system  “Neutral” central institute. Reduce Inappropriate Antibiotic Use in Outpatients Switch antibiotics from intravenous (IV) to oral formulations to hasten discharge and reduce risks associated with IV catheters. This switch is easily done with many antibiotics (linezolid, metronidazole, fluoroquinolones, some cephalosporins, fluconazole, etc).
  21. 21. 1. Improve awareness and understanding of antimicrobial resistance through effective communication, education and training 2. Strengthen the knowledge and evidence base through surveillance and research 3. Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures 4. Optimize the use of antimicrobial medicines in human and animal health 5. Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions
  22. 22. Molecular methods polymerase chain reaction test for the detection of MRSA, vancomycin resistant Enterococcus, Neisseria gonorrhoeae, Chlamydia trachomatis, group B Streptococcus, tuberculosis, Candida albicans, and many others. Coming soon are tests that will detect practically every bacterium as well as other pathogens, making an etiologic diagnosis to facilitate antibiotic decision making within 12 hours of collecting the culture.
  23. 23. We need a novel method to deal with antibiotic development and its related costs. Possibilities include: A public private partnership such as the combined resources of the Bill & Melinda Gates Foundation, Janssen Pharmaceuticals, and the TB Alliance, which has now produced bedaquiline(2016), the first new FDA approved drug for tuberculosis in the past 40 years, DELAMANID- bactericidal drug Synriam as a fixed-dose combination of arterolane maleate and piperaquine phosphate by Sun Pharma.
  24. 24. 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. The principal goals of the software are: 1 to enhance local use of laboratory data; and 2 to promote national and international collaboration through the exchange of data. The understanding of the local epidemiology of microbial populations; the selection of antimicrobial agents; the identification of hospital and community outbreaks; and the recognition of quality assurance problems in laboratory testing
  25. 25. Antibiotic resistance is a major problem world-wide. Evolution and spread of antibiotic resistance is a consequence of how antibiotics are used and miss-used in humans, animals and the environment. Resistance is inevitable with use No new class of antibiotic introduced over the last two decades Appropriate use is the only way of prolonging the useful life of an antibiotic A world without effective antibiotics is a terrifying but real prospect. Overuse of antibiotics has led to dangerous outbreaks of drug resistant disease, and puts us in very real danger of a global pandemic

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