The document discusses principles of antimicrobial therapy and public health implications of antimicrobial resistance. It provides an introduction to antimicrobial agents and antibiotics. It discusses factors to consider when choosing an antimicrobial agent, including related to the organism, drug, and patient. It describes principles of antimicrobial therapy including combined use, prophylactic use, and adverse effects. It then discusses antimicrobial resistance as a global concern, providing data on deaths and increased healthcare costs attributable to resistance. It summarizes the status of resistance in South Asia and Nepal specifically, noting high resistance to common drugs. It outlines future plans in Nepal to address resistance through policy, guidelines, and public awareness efforts.
An Antimicro is any substance of natural, semisynthetic or synthetic origin that kills or inhibits the growth of microorganisms but causes little or no damage to the host. All antibiotics are antimicrobials, but not all antimicrobials are antibiotics.
General Principles of Antimicrobial Selection - 2018Arwa M. Amin
Module: Pharmacology and Therapeutics III, (Therapeutics part)
Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Undergraduate, B.Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value associated with it
An Antimicro is any substance of natural, semisynthetic or synthetic origin that kills or inhibits the growth of microorganisms but causes little or no damage to the host. All antibiotics are antimicrobials, but not all antimicrobials are antibiotics.
General Principles of Antimicrobial Selection - 2018Arwa M. Amin
Module: Pharmacology and Therapeutics III, (Therapeutics part)
Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Undergraduate, B.Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value associated with it
This presentation focuses on appropriate selection of antibiotics in the ICU and discusses different strategies to optimize this selection with the aim to decrease resistance and improve appropriateness.
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Antibiotics,antibiotics resistances,classification of antibiotics,misuse of antibiotics details discussed here. for more information visit my blog helpful for pharmacy and medical student.thanks.
http://mydreamlan.wordpress.com/category/education/
Antibiotics are most common therapeutic agents used in hospitals across world, however, microbial world is becoming resistant day by day, posing special challenges to clinicians specially working in ICU set ups. There are multiple ways to curb this menace, if approached together in antibiotic stewardship way, can bring about wonders and retain therapeutic potentials of these drugs.
Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals, and antifungals) from working against it.
This presentation focuses on appropriate selection of antibiotics in the ICU and discusses different strategies to optimize this selection with the aim to decrease resistance and improve appropriateness.
abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeel’s face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeel’s shabeelpn trends of antimicrobial usage in dental practice View all
’s abscess abscess advanced trauma life support anterio abscess tooth active orthodontics adolescent advanced trauma life support aesthetic dentistry airway management alignment of teeth amalgam anesthesia in dentistry anesthetics in dentistry anterior open bite antibiotic resistanace antibiotics antibiotics and leukopenia aphthous ulcers apically repositioned flap apicoectomy appliances arch dental arch form orthodontics braces arch length orthodontics braces arch wire orthodontist braces ayurvedha baby teeth bloger boil books braces braces teeth cancer canker sore pain cavity preparation children community based learning congenitally missing teeth cosmetic dentistry csf leaks dental dental anesthetics dental restorations dental teeth dento alveolar fractures disease
Antibiotics,antibiotics resistances,classification of antibiotics,misuse of antibiotics details discussed here. for more information visit my blog helpful for pharmacy and medical student.thanks.
http://mydreamlan.wordpress.com/category/education/
Antibiotics are most common therapeutic agents used in hospitals across world, however, microbial world is becoming resistant day by day, posing special challenges to clinicians specially working in ICU set ups. There are multiple ways to curb this menace, if approached together in antibiotic stewardship way, can bring about wonders and retain therapeutic potentials of these drugs.
Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals, and antifungals) from working against it.
Dr. Jeff Bender - Companion Animal Antimicrobial StewardshipJohn Blue
Companion Animal Antimicrobial Stewardship - Dr. Jeff Bender, Co-Director for the Upper Midwest Agricultural Safety and Health Center and Professor College of Veterinary Medicine and School of Public Health at the University of Minnesota, Chair for the AVMA Task Force for Antimicrobial Stewardship in companion Animal Practice, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Principles of Antimicrobial Therapy
and Public Health Implication of
Antimicrobial Resistance - I
For BPH 1st Year
Dr. Pravin Prasad
Resident 2nd Year, MD Clinical
Pharmacology
Maharajgunj Medical Campus
6th April, 2017 (Chaitra 24, 2073) Thursday
2. Antimicrobial Agents: Introduction
• Antibiotics:
• Substances produced by microorganisms, which
selectively supress the growth or kill the microorganisms
at very low concentrations
• What does it excludes?
3. Antimicrobial Agents: Introduction
• Chemotherapeutic agents and antimicrobial agents:
• Synthetic compounds used to selectively supress the
growth or kill the microorganisms at very low
concentrations
• Synthetic as well as naturally obtained drug that attenuate
microorganisms
4. Antimicrobial Agents: Introduction
•Chemotherapy:
• Treatment of systemic infections with specific drugs that
selectively supress the infecting micro-organism without
significantly affecting the host.
• Why is this term used for cancer therapy?
5. Choice of an Antimicrobial Agent
Organism
related
Drug
related
Patient
related
6. • Age
• Renal or Hepatic Function
• Local factors
• Drug Allergy
• Impaired Host Defence
• Pregnancy
• Genetic Factors
Choice of an Antimicrobial Agent: Patient
Related Factors
7. • Clinical Diagnosis itself directs the choice of the AMA
• A good guess can be made
• Choice based on bacteriological examination
• Bacterial services are not available
• Bacterial services are available but treatment cannot be
delayed
• Bacterial services are available and treatment can be
delayed
Choice of an Antimicrobial Agent: Organism
Related Considerations
8. • Spectrum of activity
• Type of activity
• Sensitivity of organism
• Relative toxicity
• Pharmacokinetic profile
• Route of administration
• Evidence of clinical efficacy
Choice of an Antimicrobial Agent: Drug
Related Factors
9. Combined Use of Antimicrobial Agents
• To achieve synergism
• To reduce severity of adverse effects
• To prevent emergence of resistance
• To broaden the spectrum of antimicrobial action
• Disadvantages??
Static Cidal
Static Additive ?
Cidal ? Additive
10. Prophylactic Use of Antimicrobials
• Prophylaxis against specific organisms
• Prevention of infection in high risk situations
• Prevention of infection in general
11. Adverse Effects of AMA
• Toxicity
• Hypersensitivity reaction
• Drug Resistance
• Superinfection
• Nutritional Deficiencies
• Masking of an infection
12. Principles of Antimicrobial Therapy
and Public Health Implication of
Antimicrobial Resistance- II
For BPH 1st Year
Dr. Pravin Prasad
Resident 2nd Year, MD Clinical
Pharmacology
Maharajgunj Medical Campus
13th April, 2017 (Chaitra 31, 2073) Thursday
13. Antimicrobial Resistance (AMR)
AMR is resistance of a microorganism to an
antimicrobial drug that was originally effective for
treatment of infections caused by it.
-WHO
14. AMR: Global Status
•Present in all parts of the world
•2012: Gradual increase in resistance to HIV drugs (WHO)
•2013: Multidrug-resistant tuberculosis (MDR-TB) and
Extensively drug-resistant tuberculosis (XDR-TB)
•Greater Mekong sub-region, resistance to the artemisinin-
based combination therapies (ACTs) for falciparum malaria
15. AMR: Global Status
•High proportions of antibiotic resistance in bacteria
•Major number of Hospital-acquired infections: drug
resistant organisms
•Treatment failures for Gonorrhea
•Infections caused by drug-resistant bacteria
• At increased risk of worse clinical outcomes, death
• Consumes more health-care resources
16. AMR: Why a Global Concern?
•AMR kills
•Hampers the control of infectious disease
•Increases the costs of health care
•Jeopardizes health care gains to society
17. Deaths Attributable to AMR every year
Ref: Antimicrobial Resistance:Tackling a crisis for the health and wealth of nations; The Review on Antimicrobial Resistance
Chaired by Jim O’Neill December 2014
18. AMR: Status in South East Asian Region
Ref: Regional Report on Antimicrobial Resistance, Bangkok, Thailand 6-10 August, 2012, WHO Regional Office for South East Asia
Tuberculosis
Kala-azar
Typhoid Fever
ARI
S. aureus
A. baumannii
19. AMR: Status in Nepal
• Started in Nepal in 1999 with technical assistance from ICDDR,
Bangladesh.
• National Public Health Laboratory (NPHL) is the focal point
• Now supported by WHO.
• Has conducted surveillance of 7 microorganisms:
• Salmonella, Shigella, V. cholerae, S. pneumoniae, H. influenzae, N.
gonorrhoeae and ESBL E.coli.
20. National Public Health Laboratory (NPHL)
• Working in close coordination with 18 governmental hospitals,
mission hospitals and private medical college hospitals
• Receives, examines, stores local isolates from the participating
laboratories
• Sends the isolates for EQAS every three months
• Participating laboratories send the testing reports to NPHL and the
NPHL sends the feedback
• Conducts quality assurance training, refresher training, workshop to
enhance the diagnostic capacity of the participating laboratories.
21. AMR Resistance Patterns in Nepal
•A total of 1346 isolates were reported in 2011.
•Salmonella is the highest (1018).
• Salmonella resistance against Nalidixic acid (S. paratyphi A
98%; S. typhi 91%).
•Shigella, 75% were resistant to Cotrimoxazole, 70%
resistant to amoxicillin and 44% to nalidixic acid.
22. AMR Resistance Patterns in Nepal
•S. pneumoniae: 22% resistant to multiple drugs.
•H. influenza: 53% resistant to co-trimoxazole (53%)
• Included in the treatment guideline for ARI
•ESBL E. coli: 100% resistance to the quinolones, 99% to
ciprofloxacin and ceftriaxone.
• Increasing resistance for combination of third generation
cephalosporin (cefotaxime, ceftazidime) with clavulanic acid
23. • The Drug Act, 1978 and the rules thereunder: poor implementation
• National Antibiotic Treatment Guidelines: drafted
• Treatment Protocol for TB, leprosy, ARI, HIV/AIDS, malaria and
childhood illness are available.
• The National Health Laboratory Policy 2069 existent
• Little importance to community empowerment for AMR
• posters, pamphlets, publication of bulletin
• No programme for school children for AMR awareness exists.
AMR: Status in Nepal
24. AMR:
Future
Plans
(GoN)
National Steering
Committee
Drug Act, 1978
National Medicine
Policy, 2007
Health Laboratory
Act and Regulation
Strengthening
existing labs
Strengthening
existing labs
National Antibiotic
Policy
Standard Treatment
Guidelines
Public AwarenessRestricted Use
Greatest contribution of 20th century to therapeutics
Are one of the few drugs which can cure
Most frequently used and misused drugs
Other natural substance that inhibit microorganisms but are produced by higher forms (eg. Antibodies) or even those produced by microorganisms but are needed in high concentration (ethanol, lactic acid, H2O2)
Designed to inhibit/kill the infecting organism and to have no/minimal effect on the recipient
Is it necessary?
Considerations:
Patient factors
Organism-related considerations
Drug Factors
Age:
kinetics of AMA varies, age-related toxicity of AMA
Chloramphenicol conjugation and excretion limited in newborn- gray baby syndrome
Sulfonamides displaces bilirubin from proteins- kernicterus in babies
Aminoglycoside T ½ prolonged in elderly, more prone to develop VIII nerve toxicity
Tetracycline deposit in developing bones and teeth- weak and discoloured parts if given before 6 yrs
Drug allergy: penicillin allergic syphilis pt- tetracycline. Lactams, sulphonamides, FQ, nitrofurantoin
Host defence: neutropenic pts, AIDS
Pregnancy safety: penicillins, many cephalosporins and erythromycin
Tetracycline: acute yellow atrophy of liver, pancreatitis & KIDNEY DAMAGE to mother
Aminoglycoside fetal ear damage
FQ, CO-tri, Chloramphenicol, sulfonamides., nitrofurantoin showed fetal damage in animal studies.
Highly sensitive to cidal drugs- response equal to static drug given alone (apparent antagonism)
Low sensitive to cidal drugs – synergism may be seen
To broaden the spectrum of antimicrobial action
Treatment of mixed infection
Initial treatment of severe infections
Topically
Disadvantages??
Acquired resistance: mutation or gene transfer
Natural resistance: cell wall arrangement of gram negative bacteria
Drug tolerant
Drug destroying
Drug impermeable
Greatest contribution of 20th century to therapeutics
Are one of the few drugs which can cure
Most frequently used and misused drugs
2013: about 480 000 new cases of multidrug-resistant tuberculosis (MDR-TB). Extensively drug-resistant tuberculosis (XDR-TB) has been identified in 100 countries.
High proportions of antibiotic resistance in bacteria that cause common infections in all regions of the world.
Major number of Hospital-acquired infections: methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant Gram-negative bacteria.
Treatment failures for gonorrhea have been reported from 10 countries.
Infections caused by drug-resistant bacteria are at increased risk of worse clinical outcomes and death, and consume more health-care resources than patients infected with the same bacteria that are not resistant.
International Centre for Diarrhoeal Disease Research, Bangladesh