chennai Declaration, Antibiotic resistance in AFMS

1. Antibiotic Resistance:
What’s New
Capt Md Ashraf Ali
Gd Spl Microbiology

2. Background
Drug resistance
• Inappropriate prescription
• Availability of “Over the counter” (OTC) antibiotics
• Sale not restricted to medical prescription only.
• Improper use of antibiotics

3. What’s Improper use
of Antibiotics?
• DOSAGE: Incorrect dosage
• DURATION: too short or too long
• DELAY: antibiotic administration in critically ill pts.
• DATA: Lack of a database on AMR

4. “Drug resistance follows the
drug like a faithful shadow.”
Paul Erhlich in 1908

5. “But I would like to sound one note of warning.
Penicillin is to all intents non-poisonous so there is no need to
worry about giving an overdose and poisoning the patient.
There may be a danger, in underdosage which exposing the
microbes to non-lethal quantities of the drug, makes them resistant.”
Sir Alexander Fleming
http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf

6. AMR: Problem statement
• Government health sectors
• Civil hospitals
• AFMS hospitals
• Private health sectors
“most accredited hospitals, though having a well written antibiotic
policy on paper, are not compliant in practice.”
80% of infections – resistant bacteria
Fabricated as per NABH assessors

7. WHAT’S NEW??
Newer Antibiotics
Newly identified microbes
Newer approaches to handle antimicrobial resistance
• Infection control
• Rethinking the way to fight AMR

8. ∂ Miracle Drugs
∂ Why will we always need new antibiotics?
∂ AMR: Naturally occurring, modes of transfer of Resistance
∂ Increase in Incidence of AMR
∂ The most effective and most recently approved drugs gradual
decline in their efficacy
∂ Do we have anything new in our armoury?
Newer Antibiotics

9. Do we have anything new?

10. What would a post-antibiotic era look like?
∂ Top ten causes of death
35 %

11. WHAT’S NEW??
Newer Antibiotics
Newly identified microbes
Newer approaches to handle antimicrobial resistance
• Infection control
• Rethinking the way to fight AMR

13. Newly Identified Resistant Microbes
∂ XDR-TB (Line Probe Assay), Pan drug resistant(PDR)
Acinetobacter.
∂ E S K A P E group of organisms with new resistance genes
∂ VITEK’s contribution

14. WHAT’S NEW??
Newer Antibiotics
Newly identified microbes
Newer approaches to handle antimicrobial resistance
• Infection control
• Rethinking the way to fight AMR

15. Newer Infection Control Strategies
Optimal ICP Intensified ICP

16. Activities of an optimal infection control
program
• Surveillance of nosocomial infections
• Outbreak investigation and control
• Policy development, review and compliance monitoring
• Isolation practices
• Hand hygiene
• Sterilisation / disinfection of eqpt and supplies
• Housekeeping
• Laundry
• Food
IMPACT

17. Implementation of WHONET can help
monitor resistance

18. WHAT’S NEW??
∂ Newer Antibiotics
∂ Newly identified microbes
∂ Newer approaches to handle antimicrobial resistance
• Infection control
• Rethinking the way to fight AMR

19. Rethinking the way to fight Bacterial
Resistance
The use of bacteriophages
Quorum Sensing inhibitors
Probiotics: repopulate the microbiota of a
recipient

20. Patient saves Money
Doctors save Lives.

22. • National Antibiotic Policy, published in 2011, still
available on the Website.
• Publically withheld by the Health Minister,
immediately after its publication.
• Complete ban on OTC sale of Antibiotics
• The decision to restrict usage of third line
antibiotics only to tertiary care hospitals

23. Chennai Declaration
• “A Roadmap to Tackle the Challenge of
Antimicrobial Resistance”
• A 5-year strategy to control antibiotic
resistance was proposed

25. Coordinator: DCI/State
Drug Controller
24 antibiotics
included in restricted
list
60% of antibiotics
90% of all
antibiotics
(strategy as per the
chennai declaration
recommendation)
Coordinator:
Hospital infection control
committee
All tertiary Care
hospitals to have
an antibiotic policy
All secondary care
and primary care
facilities to have an
antibiotic policy

26. Introduce STEP BY STEP regulation
of antibiotic usage,
• concentrating on higher end
antibiotics first
• then slowly extending the list to
second and first line antibiotics
………

27. Sharing of expertise
Microbiologist
Bacterial sensitivity
test and find out the
Possible cause of
development
CLINICIAN
Treat infection
Antibiotic policy

28. Conclusion
∂ AMR increasing alarmingly and no new approved drugs
∂ Drug resistance- evolutionary phenomenon: Impossible to
completely eliminate, can slow it down by prudent Ab usage
∂ Rethinking the way we fight the “BAD BUGS”
∂ India needs “An implementable antibiotic policy” and NOT
“A perfect policy”.- CHENNAI DECLARATION