In India, bacteria that cause common infections, such as urinary tract and bloodstream infections, are becoming resistant to nearly all antibiotics. This resistance is due to a combination of factors: uncontrolled access to antibiotics, gaps in infection prevention and control (IPC) practices, and high rates of communicable diseases. Antibiotic resistance, or AR, is a serious problem throughout the country, and threatens to reduce the usefulness of antibiotics both in India and around the world. Because of this emerging threat, India is committed to slowing the spread of AR. Two institutions within India’s Ministry of Health – the Indian Council of Medical Research and National Centre for Disease Control – each developed national networks of public and private hospitals to measure AR trends, prevent healthcare-associated infections (HAIs), and enhance appropriate use of antibiotics. The All India Institute of Medical Sciences is coordinating HAI measurement and prevention efforts in both networks. In addition, efforts in the state of Tamil Nadu focus on building district-level IPC capacity to prevent HAIs, focusing on maternal and neonatal patients. The Indian Governamnet is is working closely with partners at the national and state level to: Detect AR pathogens, including novel strains, by developing lab networks and lab expertise. Use standardized surveillance to monitor and track AR infections in healthcare to learn how often these infections occur and to help develop strategies to prevent them. Implement focused IPC activities and training. Optimize use and reduce misuse of critical antibiotics through antibiotic stewardship programs.

1. Dr.BHASKAR.P.REDDY
M.Sc,M.Phil,Ph.D,FICER,FSLSc,FISZS,FISQEM
reddysirr@gmail.com
Antibiotic Resistance: A Global Threat

2. OUTLINE
 INTRODUCTION/ BACKGROUND
 SOURCES OF ANTIBIOTIC RESISTANCE
 DRUG RESISTANCE IN BACTERIA
AMR’S DEVELOPMENT AND SPREAD:
 MECHANISM OF ANTIBIOTIC RESISTANCE
 ACTIONS TO FIGHT ANTIMICROBIAL
RESISTANCE
 CONCLUSIONS

4. Why India should be concerned
about antibiotic resistance:
1.High Disease Burden: India faces a significant
burden of infectious diseases (due to heavy
population and poor health care systems), and
antibiotics are crucial for treating these infections
effectively.
2.Rising Drug Resistance: making it difficult to
combat common ailments.
3.Challenges in Healthcare Settings: Overcrowded
hospitals and limited access to quality healthcare in
rural areas contribute to the misuse and overuse of
antibiotics.
4.Economic Burden: Expensive and prolonged
treatment of drug-resistant infections.
5.Impact on Vulnerable Populations: Vulnerable
groups like children, elderly, and immunocompromised
individuals are at higher risk of severe infections if
antibiotics become ineffective.
6.Agricultural Use of Antibiotics: Widespread use of
antibiotics in agriculture

7. •Longer illness period
•Longer recovery period
•Frequent hospitalization
•Significant increase in healthcare
costs for more expensive
treatments
•Use of different antibiotics that ma
cause different side effects
•Higher risk of transmitting
antibiotic-resistant bacteria to
others
Older people and those
with weakened immune
systems are more likely to
develop serious bacterial
infections that need
antibiotic treatment.

9. Antibiotic usage, residues and resistance genes from food animals to human and
environment:

12. • The use of average antibiotic dose
prescribed. Defined Daily Dose (DDD)
• Help to heal the illness
USE
• Use of a substance for a purpose not consistent with
legal or medical guidelines (WHO, 2006)
• It has a negative impact on health or functioning and
may take the form of drug dependence
• Taking the incorrect dose; taking a dose at the wrong
time; forgetting to take a dose; stopping medicine too
soon
MISUS
E
• Substance abuse refers to the harmful or hazardous use
of psychoactive substances, including alcohol and illicit
drugs.
• The practice or habit of taking too much of a harmful
drug or drinking too much alcohol
ABUS
E
Misuse and overuse of antimicrobials are the main drivers in the development of drug-resistant pathogens
or super bugs

13. SUPER BUG
Natural
Selection/
Adapataion
Antibiotic Use
and Misuse
Incomplete
Treatment
Abuse/Overuse
of Antibiotics
In Agriculture
Spread of
Resistant
Strains/ lack of
effective
disposal
mechanisms
•Having poor
infection
prevention and
control
practices
The Rise Of “Superbugs

14. Multidrug-Resistant Enterococcus (GUT BACTERIA)
resistance may exist to beta-lactams (through beta-lactamase
enzymes and altered binding proteins.
Extended-Spectrum Beta-Lactamase (ESBL)–Producing
Organisms: Many gram-negative species of bacteria
have been found to possess acquired resistance to beta-
lactam antibiotics through the production of beta-
lactamase. This enzyme deactivates the agent’s
antimicrobial properties by hydrolyzing its beta-lactam
ring.
P aeruginosa: Pseudomonas is an opportunistic gram-
negative pathogen responsible for a large number of
nosocomial infections.

15. Present situation- Drug resistance in bacteria
Bacteria Antibiotic Antibiotic uses
Klebsiella pneumoniae Resistance to
carbapenem antibiotics
pneumonia, bloodstream infections, and infections in newborns
and intensive-care unit patients. In some countries, carbapenem
antibiotics do not work in more than half of the patients treated
for K. pneumoniae infections due to resistance.
Mycobacterium
tuberculosis
rifampicin-resistant
Multi drug resistant
MDR-TB requires treatment courses that are longer, less effective
and far more expensive than those for non-resistant TB. Less than
60% of those treated for MDR/RR-TB are successfully cured.
E. coli, Resistance to fluoroquinolone used for the treatment of urinary tract infections, now ineffective
in more than half of patients.
E.coli, Klebsiella, Colistin Bacteria resistant to colistin have also been detected in several
countries and regions, causing infections for which there is no
effective antibiotic treatment at present.
Staphylococcus aureus
(skin)
methicillin- resistant Staphylococcus aureus (MRSA) infections are 64% more
likely to die than people with drug-sensitive infections.
N. gonorrhoeae Resistance to sulphonamides,
penicillin, tetracyclines,
macrolides, fluoroquinolones,
and early generation
cephalosporins.
Currently, in most countries, the injectable extended-spectrum
cephalosporin (ESC) ceftriaxone is the only remaining empiric
monotherapy for gonorrhea.

21. Biofilms are sticky,
protective coatings

22. Key strategies to combat antibiotic resistance effectively:
1.Promote Antibiotic Stewardship: Implement and promote antibiotic stewardship programs in
healthcare settings and veterinary practices. These programs optimize antibiotic use, ensuring
that antibiotics are prescribed only when necessary, at the right dose, and for the appropriate
duration.
2.Enhance Infection Prevention and Control:
3.Improve Diagnostics: Invest in the development and implementation
4.Regulate Antibiotic Use:
5.Encourage Responsible Antibiotic Use:
6.Invest in Research and Development:
7.Promote International Collaboration:
8.Educate the Public:
9.By implementing these strategies collectively, we can work towards combating antibiotic
resistance, preserving the effectiveness of antibiotics, and ensuring better health outcomes for
individuals and communities worldwide.

23. The One Health approach is a
collaborative and
interdisciplinary strategy that
recognizes the
interconnectedness of human
health, animal health, and the
environment. It emphasizes that
the health of humans, animals,
and the environment is
interdependent and linked
through complex ecological
interactions.
The concept of One Health
acknowledges that diseases can
be transmitted between animals
and humans (zoonotic diseases)
and that environmental factors

24.  Probiotics: Living strains of bacteria that add
to the population of good bacteria in your
digestive system.
 Prebiotics: Specialized plant fiber that acts as
food for good bacteria. This stimulates
growth among the preexisting good bacteria.
 A synbiotic is defined as a “mixture of
probiotics and prebiotics that beneficially
affects the host by improving the survival and
activity of beneficial microorganisms in the
gut.”
 Examples
•Bifidobacteria and Fructooligosaccharides
(FOS)
•Bifidobacteria or lactobacilli with FOS or inulins
or galactooligosaccharides (GOS)
•Lactobacillus rhamnosus GG and inulins.
•Polyphenol.
Postbiotics, a sort of probiotic waste or bioactive
compounds produced by food-grade microorganisms
during a fermentation process. It help support
immune, gut, and skin health. Postbiotics may also
reduce the risk of and treat health conditions such as
diabetes, cancer, overweight, and obesity.

26. •Only use antibiotics when prescribed by a certified health professional.
•Never demand antibiotics from your doctor
•Always follow your doctor’s advice when using antibiotics.
•Never share or use leftover antibiotics.
•Prevent infections by regularly washing hands, preparing food
hygienically, avoiding close contact with sick people, and keeping
vaccinations up to date.
• Choose foods that have been produced without the use of antibiotics for
growth promotion or disease prevention in healthy animals.

27. India finalises national action
plan on antimicrobial resistance
Announced by the Union
Minister of Health and Family
Welfare, J P Nadda, on April 19.
Nadda said the government is
ready with a blueprint that
meets global expectations and
that AMR needs to be
addressed comprehensively
under the “One Health
Approach”.

28. Conclusions
 Resistance towards antibiotics is an inevitable part of microbial evolution
 Antibiotic resistance has widespread effects for ecosystems and human health.
 The presence of antibiotics in the environment can lead to the emergence of superbugs that are
challenging to treat.
 Antibiotic pollution disrupts natural microbial communities and ecological processes, impacting
biodiversity and ecosystem functioning.
 Combating antibiotic pollution requires a combination of strict regulatory, technological, and
behavioral measures.
 Fostering public awareness and engaging in international collaboration are crucial in
promoting a One Health approach to combat antibiotic resistance effectively.
 Enhanced infection prevention and control, along with improved diagnostics, can contribute to
the responsible use of antibiotics.
 Investment in research and development of new antibiotics and alternative antimicrobial
therapies
 Surveillance and monitoring of antibiotic resistance trends inform evidence-based decision-
making and policy formulation.
 A collective effort from governments, healthcare professionals, researchers, industries, and the public is essential to
address antibiotic pollution and combat antibiotic resistance effectively.
 By working together, we can safeguard the efficacy of antibiotics, protect the environment, and ensure a healthier