Antibiotic resistance is a growing public health problem caused by the overuse and misuse of antibiotics. The document discusses the various mechanisms by which bacteria develop resistance, including intrinsic, acquired, and gene transfer-related resistance. It emphasizes the need for prudent antibiotic use to slow resistance, such as only using antibiotics when necessary, completing full treatment courses, and developing new drug classes. All healthcare providers, including physicians, pharmacists and microbiologists, must work together using treatment guidelines to optimize antibiotic prescribing and containment of resistance.
Mechanism Antibiotic Resistance
Intrinsic (Natural)
Acquired
Chromosomal
Extra chromosomal
Intrinsic Resistance
Lack target : No cell wall; innately resistant to penicillin
2. Drug inactivation: Cephalosporinase in Klebsiella
3. Innate efflux pumps:
It is an active transport mechanism. It requires ATP.
Eg. E. coli, P. aeruginosa
Altered target sites
PBP alteration
Ribosomal target alteration
Decreased affinity by target modification
Beta-lactamase
Beta-lactamases are enzymes produced by bacteria that provide resistance to β-lactam antibiotics such as penicillins, cephamycins, and carbapenems
Major resistant Pathogen
1. PRSP- Penicillin resistant Streptococcus pneumoniae2. MRSA/ORSA- Methicillin-resistant Staphylococcus Aureus (Super bug)3. VRE -Vancomycin-Resistant Enterococci4. Carbapenem resistant pseudomonas aeruginosa5. Carbapenem resistant Carbapenem resistant 6. Extended spectrum beta-lactamase (ESBL)-producing bacteria
FLOW OF THE SEMINAR
1. Definition – antibiotic resistance, Multi-resistance, cross-resistance in antibiotics
2. Evolution of resistance
3. Impact of resistance
4. The scenario of resistance: Global, India
5. Factors causing resistance
6. Mechanisms of resistance: Intrinsic and Acquired
7. Acquired mechanism of resistance
8. Quorum sensing
9. Mechanism of resistance in commonly used antibiotics
10. Methods for determining the resistance
11. Strategies to contain resistance
12. Antibiotic stewardship
13. Role of Pharmacologist
14. Initiatives undertaken by India to control resistance
Mechanism Antibiotic Resistance
Intrinsic (Natural)
Acquired
Chromosomal
Extra chromosomal
Intrinsic Resistance
Lack target : No cell wall; innately resistant to penicillin
2. Drug inactivation: Cephalosporinase in Klebsiella
3. Innate efflux pumps:
It is an active transport mechanism. It requires ATP.
Eg. E. coli, P. aeruginosa
Altered target sites
PBP alteration
Ribosomal target alteration
Decreased affinity by target modification
Beta-lactamase
Beta-lactamases are enzymes produced by bacteria that provide resistance to β-lactam antibiotics such as penicillins, cephamycins, and carbapenems
Major resistant Pathogen
1. PRSP- Penicillin resistant Streptococcus pneumoniae2. MRSA/ORSA- Methicillin-resistant Staphylococcus Aureus (Super bug)3. VRE -Vancomycin-Resistant Enterococci4. Carbapenem resistant pseudomonas aeruginosa5. Carbapenem resistant Carbapenem resistant 6. Extended spectrum beta-lactamase (ESBL)-producing bacteria
FLOW OF THE SEMINAR
1. Definition – antibiotic resistance, Multi-resistance, cross-resistance in antibiotics
2. Evolution of resistance
3. Impact of resistance
4. The scenario of resistance: Global, India
5. Factors causing resistance
6. Mechanisms of resistance: Intrinsic and Acquired
7. Acquired mechanism of resistance
8. Quorum sensing
9. Mechanism of resistance in commonly used antibiotics
10. Methods for determining the resistance
11. Strategies to contain resistance
12. Antibiotic stewardship
13. Role of Pharmacologist
14. Initiatives undertaken by India to control resistance
Introduction to bacterial resistance to antibiotics, types of resistance, brief explaining & examples
The lecture was presented at Al-Mahmoudiya General Hospital at Wed, 17th Nov. 2021
Represented & updated as part of the training course for fresh appointed pharmacist at 16/5/2023
Antibiotics Resistance is a new issue in Microbiology-Medicine aspects, taken from Lange Review of Medical Microbiology, this purpose is for education only
a research presentation done by Augustine Mwaawaaru Level 400) and Matthew Frimpong Antwi (Level 300) students of( Presbyterian University College-Ghana on Antimicrobial resistance and the way foeward in Ghana. contact 0261825262
Antibiotic resistance I Mechanism I Types I Contributing factors.kausarneha
Antibiotic resistance in bacteria is a global threat of 21st century. Here is a brief discussion of Antimicrobial resistance or Drug resistance disease. If you want to study via video lecture on this visit on my YouTube channel : Microbiology WISDOM:
Here you can find further more such interesting topics.
Relative or complete lack of effect of antimicrobial agent against a previously susceptible microbe/pathogen.
It is an evolutionary principal that organism adopt genetically to change in their environment.
since the doubling time of bacteria can be as short as 20 mnt, there may be many generations in even a few hours, providing ample opportunity for evolutionary adaptation.
The phenomenon of resistance imposes serious constraints on the options available for the treatment of many bacterial infections.
The resistance to chemotherapeutic agents can also develop in protozoa, in multicellular parasites and in population of malignant cells.
Today there are different strains of S. aureus resistant to almost every form of antibiotic in use.
Question was in my mind how the bacteria learn the biochemical mechanisms of defense against antibiotics , l know it should have gens that produce defense ways , but how they have thes gens , how antibiotics produce resistance in bacteria for them self and another's ?
All that I tried to answer in this seminar and how can be treated or minimized .
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.
Introduction to bacterial resistance to antibiotics, types of resistance, brief explaining & examples
The lecture was presented at Al-Mahmoudiya General Hospital at Wed, 17th Nov. 2021
Represented & updated as part of the training course for fresh appointed pharmacist at 16/5/2023
Antibiotics Resistance is a new issue in Microbiology-Medicine aspects, taken from Lange Review of Medical Microbiology, this purpose is for education only
a research presentation done by Augustine Mwaawaaru Level 400) and Matthew Frimpong Antwi (Level 300) students of( Presbyterian University College-Ghana on Antimicrobial resistance and the way foeward in Ghana. contact 0261825262
Antibiotic resistance I Mechanism I Types I Contributing factors.kausarneha
Antibiotic resistance in bacteria is a global threat of 21st century. Here is a brief discussion of Antimicrobial resistance or Drug resistance disease. If you want to study via video lecture on this visit on my YouTube channel : Microbiology WISDOM:
Here you can find further more such interesting topics.
Relative or complete lack of effect of antimicrobial agent against a previously susceptible microbe/pathogen.
It is an evolutionary principal that organism adopt genetically to change in their environment.
since the doubling time of bacteria can be as short as 20 mnt, there may be many generations in even a few hours, providing ample opportunity for evolutionary adaptation.
The phenomenon of resistance imposes serious constraints on the options available for the treatment of many bacterial infections.
The resistance to chemotherapeutic agents can also develop in protozoa, in multicellular parasites and in population of malignant cells.
Today there are different strains of S. aureus resistant to almost every form of antibiotic in use.
Question was in my mind how the bacteria learn the biochemical mechanisms of defense against antibiotics , l know it should have gens that produce defense ways , but how they have thes gens , how antibiotics produce resistance in bacteria for them self and another's ?
All that I tried to answer in this seminar and how can be treated or minimized .
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.
No doubt that antibiotics are the life saver for us but taking them without prescription of doctor or not completing its course can turn them against us ,more precisely it makes the bacteria more powerful and hard to cure. They are not affected with antibiotic anymore this is known as Antibiotic Resistance
To understand the mechanisms of antimicrobial action and the classification of antimicrobial drugs.
To explain the process of microbial resistance.
To understand the spread of resistant microbes.
Outlines the prevention of microbial resistance.
This slide give you deep knowledge about antimicrobial resistance.
Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. Resistant infections can be difficult, and sometimes impossible, to treat.
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
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
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!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. PROBLEM OF ANTIBIOTIC
RESISTANCE & RATIONAL USE
OF ANTIBIOTICS
SUHAIL K
Lecturer
Crescent college of pharmaceutical sciences
suhailk4@gmail.com
2
3. INTRODUCTION
Throughout history there has been a continual battle
between human beings and multitude of micro-organisms
that cause infection and disease.
ANTIBIOTICS:
Produced by micro organism, which selectively
suppress the growth of or kill other micro organisms at
very low concentrations.
3
4. PROBLEMS WITH USE OF AMAs
1. Toxicity:
Local irritancy
Systemic toxicity
2. Hypersensitivity reactions
3. Superinfection
4. Nutritional deficiencies
5. Masking of an infection
6. Drug resistance 4
5. Drug resistance occurs in :
Bacteria—Antibiotic Resistance
Endoparasites
Viruses—Resistance to antiviral drugs
Fungi
Cancer cells
5
6. In his 1945 Nobel Prize lecture, Fleming himself
warned of the danger of resistance –
“It is not difficult to make microbes resistant to
penicillin in the laboratory by exposing them to
concentrations not sufficient to kill them, and the same
thing has occasionally happened in the body……and by
exposing his microbes to non-lethal quantities of the
drug make them resistant.”
6
7. Why resistance is a concern:
•Resistant organisms lead to treatment failure
•Increased mortality
•Resistant bacteria may spread in Community
•Low level resistance can go undetected
•Added burden on healthcare costs
•Threatens to return to pre-antibiotic era
•Selection pressure
7
8. Antibiotic Resistance
The concentration of drug at the site of infection
must inhibit the organism and also remain below the
level that is toxic to human cells.
Defined as micro-organisms that are not inhibited by
usually achievable systemic concentration of an
antimicrobial agent with normal dosage schedule and /
or fall in the minimum inhibitory concentration (MIC)
range. 8
11. Antibiotic Resistance
Some microorganisms may ‘born’ resistant, some
‘achieve’ resistance by mutation or some have
resistance ‘thrust upon them’ by plasmids
Some are born great, some achieve greatness or
some have greatness thrust upon them.
11
12. Intrinsic Resistance
It occurs naturally.
1. Lack target :
• No cell wall; innately resistant to penicillin
2. Innate efflux pumps:
• Drug blocked from entering cell or ↑ export of drug
(does not achieve adequate internal concentration). Eg.
E. coli, P. aeruginosa
3. Drug inactivation:
• Cephalosporinase in Klebsiella
12
13. Acquired resistance
Mutations
• It refers to the change in DNA structure of the gene.
• Occurs at a frequency of one per ten million cells.
• Eg.Mycobacterium tuberculosis,Mycobacterium lepra
, MRSA.
• Often mutants have reduced susceptibility
13
14. Plasmids
• Extra chromosomal genetic elements can replicate
independently and freely in cytoplasm.
• Plasmids which carry genes resistant ( r-genes) are
called R plasmids.
• These r-genes can be readily transferred from one R-
plasmid to another plasmid or to chromosome.
• Much of the drug resistance encountered in clinical
practice is plasmid mediated
14
16. Biochemical mechanisms of antibiotic resistance
• Prevention of drug accumulation in the bacterium
• Modification/protection of the target site
• Use of alternative pathways for metabolic / growth
requirements
• By producing an enzyme that inactivates the
antibiotic
• Quorum sensing
16
17. Decreased permeability: Porin Loss
Antibiotics normally enter bacterial cells via porin
channels in the cell wall
New porin channels in the bacterial cell wall do not
allow antibiotics to enter the cells
17
20. Structurally modified antibiotic target site
Antibiotics normally bind to specific binding proteins
on the bacterial cell surface
Antibiotics are no longer able to bind to modified
binding proteins on the bacterial cell surface
20
21. Modification/Protection of the Target site
Target sites Resistant Antibiotics
Ribosomal point mutation
eg.: Tetracyclines,Macrolides, Clindamycin
Altered DNA gyrase. Eg: Fluoroquinolones
Modified penicillin binding proteins
(Strepto.pneumonia) Eg: Penicillins
Mutation in DNA dependant RNA polymerase
(M.tuberculosis) Eg: Rifampicin
21
23. a)Inactivation of b-lactam antibiotics
•S. aureus, N. gonorrohoea, H.influenza, Produce
blactamase which cleaves -lactam ring
b)Inactivation of Chloramphenicol
• Inactivated by chloramphenicol acetyltransferase .
• Gram-ve (enzyme present constitutively hence higher
resistance) gram +ve bacteria (enzyme is inducible )
c)Inactivation of Aminoglycosides
• Inactivated by acetyl, phospho & adenylyl transferases
Present in gram +ve and gram –ve .
23
25. Use of alternative pathways for metabolic / growth
requirements
• Resistance can also occur by alternate pathway that
bypasses the reaction inhibited by the antibiotic.
• Sulfonamide resistance can occur from over
production of PABA
25
26. Quorum sensing
• Microbes communicate with each other and exchange
signaling chemicals (Autoinducers)
• These autoinducers allow bacterial population to
coordinate gene expression for virulence, conjugation,
apoptosis, mobility and Resistance.
• Single autoinducer from single microbe is incapable of
inducing any such change
• But when its colony reaches a critical density (quorum),
threshold of autoinduction is reached and gene
26
27. WHY INHIBIT QUORUM SENSING
Proved to be very potent method for bacterial virulence
inhibition.
Several QS inhibitors molecules has been synthesized
which include AHL, AIP, and AI-2 analogues
QS inhibitors have been synthesized and have been
isolated from several natural extracts such as garlic
extract.
27
29. Environmental Factors
Huge populations and overcrowding
• Rapid spread by better transport facility
• Poor sanitation
• Increases community acquired resistance
• Ineffective infection control program
• Widespread use of antibiotics in animal husbandry
and agriculture and as medicated cleansing products
29
30. Drug Related Factors
• Over the counter availability of antimicrobials
• Counterfeit and substandard drug causing suboptimal
blood concentration
• Irrational fixed dose combination of antimicrobials
• Soaring use of antibiotics
30
31. Patient Related Factors
• Poor adherence of dosage Regimens
• Poverty
• Lack of sanitation concept
• Lack of education
• Self-medication
• Misconception
31
32. Prescriber Related Factors
• Inappropriate use of available drugs
• Increased empiric poly-antimicrobial use
• Over use of antimicrobials
• Inadequate dosing
• Lack of current knowledge and training
32
33. Strategy to Contain Resistance
• Develop new antibiotics
– Bypass the drug resistance
• Judicious use of the existing antibiotics:
– Containment of drug resistance
33
34. • Only 15 antibiotics of 167 under development had a
new mechanism of action with the potential to combat
of multidrug resistance.
• Lack of incentive for companies to develop
antibiotics.
34
36. Hope is not exhausted….yet
Phage therapy
• Use of the lytic enzymes found in mucus and saliva
• Agents that target type IIA topoisomerases
• Antimicrobial peptides (AMPs), lipopeptides (AMLPs)
target bacterial membranes, making it nearly impossible to
develop resistance (bacteria would have to totally change
their membrane composition).
36
37. Phage therapy
• Phage Therapy is the therapeutic use of lytic
bacteriophages to treat pathogenic bacteria infections
• Bacteriophages are viruses that invade bacterial cells and
disrupt bacterial metabolism.
• The success rate was 80–95%
• British studies also demonstrated significant efficacy of
phages against Escherichia coli, Acinetobacter sp,
Pseudomonas sp and Staphylococcus aureus.
37
38. Prevention and control
Antibiotic resistance is accelerated by the misuse and
overuse of antibiotics, as well as poor infection
prevention and control.
Steps can be taken at all levels of society to reduce the
impact and limit the spread of resistance.
38
39. 39
Individuals
• Only use antibiotics when prescribed
• Never demand antibiotics if your health worker says
you don’t need them.
• Always follow your health worker’s advice when using
antibiotics.
• Never share or use leftover antibiotics.
40. 40
• Prevent infections by regularly washing hands, preparing food
hygienically, avoiding close contact with sick people, practicing
safer sex, and keeping vaccinations up to date.
• Prepare food hygienically, following the WHO Five Keys to Safer
Food (keep clean, separate raw and cooked, cook thoroughly, keep
food at safe temperatures, use safe water and raw materials) and
choose foods that have been produced without the use of antibiotics
for growth promotion or disease prevention in healthy animals.
41. Poor Clinical Practice
Poor clinical practice that fail to incorporate the
pharmacological properties of antimicrobials amplify
the speed of development of drug resistance
41
42. Faulty Antibiotic Use
• Antimicrobials are over prescribed
• Available without prescription
• Clinician should first determine whether
antimicrobial therapy is warranted for a given
patient
42
43. Empirical Microbial Selection
• Is antimicrobial agents indicated on the basis of clinical
findings?
• Or is it prudent to wait until such clinical findings
become apparent?
•Can some simple bed side test done to confirm your
suspicion?
– Microscopy
– Gram staining
Have appropriate clinical specimens been obtained to
43
44. • What are the likely etiologic agents for the patient’s
illness?
• Is there clinical evidence (e.g. from clinical trials) that
antimicrobial therapy will confer clinical benefit for the
patient? (Evidence-based medicine)
44
45. Definitive Treatment
• Can a narrower spectrum agent be substituted for initial
empiric drug?
• Is one agent or combination of agents necessary?
• What are the
– optimum dose,
– route of administration and
– duration of therapy?
• What specific test to identify patients who will not respond
to treatment? 45
46. • What adjunctive measures can be undertaken to
eradicate infection?
– Vaccination
– Steroid
– Drainage of pus
– Amputation
– Removal of catheter
46
49. Role of Pharmacist in Combating Resistance:
• Promote awareness among the population, for ethical or
proper safe use of antibiotics.
• Must obtain accreditation and training for disbursement
of knowledge about antibiotic.
• Helping physicians with drug selection and deciding on
duration of therapy, designing and promotion of clinical
practice guidelines, implementation of antibiotic switch
programmes, and documentation of the effectiveness of
interventions.
49
50. • All hospitals should have an antibiotic pharmacist who
has the rights to interfere in the treatment which are
associated with antibiotics in the prescription.
• In-order to improve effectiveness and reduce antibiotic
prescribing which will also help in reducing drug-drug
interactions, errors and allergic reactions and adverse
drug reactions associated with the unethical use of
antibiotics.
50
51. GUIDELINES FOR RATIONAL USE OF
ANTIBIOTICS
➢ Use antibiotics only when indicated.
➢ Where appropriate, specimen for gram stain, culture and
sensitivity testing should be obtained before commencing
antibiotic therapy
➢ Choice of agent based on causative organism, safety,
previous clinical response, cost, ease of use and potential.
➢ Adequate dose and duration of treatment is essential.
➢ History of allergy or other ADR should be considered.
51