Antibiotic Resistance

1. Dr. Afroza Sultana Liza
FCPS Trainee
Department of Paediatrics
Institute of Child and Mother Health
Date: 28.12.2023
WELCOME

2. Emergence of
Antibiotic Resistance

3. Antibiotics are powerful drugs that kill or inhibit
the growth of bacteria.
Antibiotic Do
Work Aginst
Antibiotic Do
Not Work Aginst
VIRUS FUNGUS BACTERIA

4. The First Antibiotic
The first antibiotic was discovered by Alexander Fleming in
1928 when he noticed that the fungus penicillium killed
disease causing bacteria.
Penicillium
In his Novel Prize lecture,Fleming himself warned of the danger of resistance

5. Mechanism of Antibiotic Action
Inhibition of
cell wall
synthesis
Cell Wall
e.g. Penicillins,
Cephalosporin
Block pathways
and inhibit
metabolism
Folic Acid
e.g. Sulphonamides,
Trimethoprim
Disruption of
cell membrane
function
Cell
Membrane
e.g. Polymyxin
Ribosome
Inhibition of
protein
synthesis
e.g.Tetracyclines
DNA
Inhibition of
nucleic acid
synthesis
e.g. Quinolones.

7. Therefore antibiotic are called wonder drug. In
summary one can called antibiotic revolutionized
Medicine

8. Non-genetics

9. B-lactams
Macrolids
Vancomycin
Aminoglycosides

11. Antibiotic Resistance Facts
Antibiotic resistance happens when bacteria change and become
resistant to the antibiotics used to treat the infections they cause
Over
prescribing
of antibiotics
Patients not
finishing their
treatment
Over use of
antibiotics in
animals
Poor infection
control in
hospitals
Lack of
hygiene &
sanitation
Lack of new
antibiotics
being
developed

13. Why Resistance is a Concern?
 Resistant organism leads to treatment failure.
 Increased mortality
 Resistance bacteria may spread in community
 Added burden of health care costs.
 Threatens to return pre-antibiotic era.

14. Impact of Resistant in Bangladesh

15. Global Impact of Resistant
❑ It is estimated that bacterial AMR was directly
responsible for 1.27 million global deaths in 2019
and contributed to 4.95 million deaths
❑ The World Bank estimates that AMR could result in
US$ 1 trillion additional healthcare costs by 2050,
and US$ 1 trillion to US$ 3.4 trillion gross domestic
product (GDP) losses per year by 2030

17. Multi-drug resistance is increasingly common
•Streptococcus pneumoniae
•Staphylococcus aureus
•Enterococcus, E coli, Pseudomonas aeruginosa
•Acinetobacter baumannii
•Tuberculosis

18. Resistant Strains Spread Rapidly
0
10
20
30
40
50
60
1980 1985 1990 1995 2000 2003
MRSA
VRE
FQRP
Source: Infectious Diseases Society of America
Percent
of
Isolates

19. Few New Antibiotics
Source: Infectious Diseases Society of America

20. Developing a New Drug is Expensive
0.1
0.3
0.8
1.3
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1979 1991 2000 2005
Cost
in
Billions
of
Dollars
Adjusted
for
Inflation,
expressed
as
2000
dollars
Source: DiMasi JA, Hansen RW, Grabowski HG. The price of innovation: new
estimates of drug development costs. Journal of Health Economics 2003; 22:151-185.

21. Consequences
World Health Organization:
“Antibiotic resistance is one of
the three biggest threats to
human health”

22. How can resistance be prevented?

27. Community Pitfalls
Poor Laboratory Support (Culture and Sensivity)
Present with prior antibiotic intake
Irrational of antibiotic (e.g. Viral RTI,Viral meningitis ,
Viral Febrile seizure,etc)
Improper duration of antibiotic therapy
Choice of inappropriate antibiotic group

28. More emphasis on history taking and proper examination
Proper investigation
Ameliorate laboratory support
Deep knowledge regarding antibiotic therapy for specific
micro-organism
Establish precise and rigorously defined institutional
antibiotic protocol
Specific Intervention

29. Recent ICMH Examples (Ped.)
Organism (Diseases) Culture Sensitive Antibiotic
Escherichia coli (UTI) Ciprofloxacin, levofloxacin,
Nitrofurantoin, Meropenem, imipenem
Pseudomonas (septicemia,
pneumonia)
Ciprofloxacin, colistin , imipenem
Acinetobacter Ceftazidime, gentamicin, amikacin
Salmonella (Typhoid) Seftriaxone , Ciprofloxacin,
Meropenem
Staphylococcus (septicemia) Linezolid
Streptococcus (septicemia) Linezolid

30. Know when to say “no” to
vancomycin,carbepenems
and cehalosporin IV Gen.
Isolate pathogn
Break the chain of
contagion- Keep your
hands clean
Target definitive therapy
to known pathogen
Take Home Message
Treat infection,Not
contamination
Treat infection, Not
colonization

32. Antibiotic resistance is at all-time high in all the parts of the world.
Antibiotic resistance is a threat to human and animal health
worldwide, and key measures are required to reduce the risks
posed by antibiotic resistance genes that occur in the
environment. These measures include the identification of critical
points of control, the development of reliable surveillance and risk
assessment procedures, and the implementation of technological
solutions that can prevent environmental contamination with
antibiotic resistant bacteria and genes. Despite measures taken by
some member states of WHO, antibiotic use in humans, animals,
and agriculture is increasing. The high economic burden in the
healthcare sector has become a burning issue, due to
extended hospital stays, isolation wards, stringent infection
control measures and treatment failures. The public health
leaders should establish a pan surveillance system coordinated at
national and international levels, ongoing analysis and a mandatory
reporting system for antibiotic resistance. Both domestic and global
policies need to be conventional and adhered to stop the overuse
and misuse of antibiotics
CONCLUSION

33. Although the full magnitude of the consequences for society is still
unclear, awaiting more data before taking further action to contain the
development of resistant bacteria is not an appealing option. Continued
complacency is unjustifiable and even unethical in contexts where the lack
of effective antibiotics is most imminent. International collective action is
essential, yet responsibility for health remains predominantly national.
Consequently, there is a potentially significant disparity between the
problems and potential solutions associated with antibiotic
resistance and the institutions and mechanisms available to deal
with them. Comprehensive recommendations on rationalizing antibiotic
use, from the World Health Organization, the European Union and other
multilateral organizations, get lost when it comes to translating them into
action plans in individual countries. The difficulties of enforcing these
recommendations on a global level are evident. Presently, the links
between the well-formulated strategies at the level of global society and
their acceptance by national policy makers are weak. To identify these
barriers so as to prevent the message from repeatedly being
returned to sender is a major challenge. To reverse the downward
trend in research and development of new antibiotics is another
CONCLUSION