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ANTIBOITICS TO RESISTANCE. MENACE TO CONTROL.pptx
- 1. ANTIOBIOTICS TO RESISTANCE MENACE TO CONTROL Dr. AP Nandhakumar
- 2. What is antimicrobial resistance (AMR)? Antimicrobial resistance (AMR) occurs when bacteria, parasites, viruses or fungi change to protect themselves from the effects of antimicrobial drugs designed to destroy them. This means previously effective antimicrobial drugs (e.g. antibiotics) used to treat or prevent infections may no longer work. The World Health Organization (WHO) has identified AMR as ‘one of the biggest threats to global health’. The Australia’s National Antimicrobial Resistance Strategy - 2020 and Beyond was released and is Australia’s national AMR strategy. https://www.nps.org.au/medical-info/consumer-info/antibiotic-resistance-the-facts
- 3. Why are antibiotics and antimicrobial resistance important? Antibiotics treat infections caused by bacteria • Currently, antibiotics reduce post-operative infection rates to below 2% • Without effective antibiotics, this could increase to around 40% to 50%. Up to 30% of these patients could die from resistant bacterial infections • The risk of mortality without access to effective antibiotics may make some treatments and surgical procedures too risky to continue Modern medicine, especially surgery and cancer treatments, depends on effective antibiotics to minimise the risk of infection Antimicrobial resistance results in substantial financial cost for patients and healthcare systems. https://www.vox.com/2014/12/12/7382299/new-report-drug-resistant-infections-will-kill-more-people-than
- 5. Antibiotics are a unique medicine In general, the impact of medications are limited to the patient taking them Use of antibiotics has an impact not just for the patient using them but the global community as well Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011 Apr;86(4):304-14. doi: 10.4065/mcp.2010.0575. Epub 2011 Mar 9. PMID: 21389250; PMCID: PMC3068890.
- 6. How has antimicrobial resistance developed? Antimicrobial resistance is a natural phenomenon Overuse, misuse and inappropriate use of antibiotics may accelerate this The delivery of more complex health care which may require longer use of antibiotics Prolonged hospitalisation The potential impact of surgical procedures undertaken overseas • During hospitalisation if infection prevention is poor • Potential for cross-border transmission through increased travel. Resistant pathogens can now spread easily Priyadharsini, Raman Palanisamy. "Antibiotic resistance: what is there in past, present and future?." Journal of Young Pharmacists 11.4 (2019): 333.
- 7. Where do we use antibiotics? • Community • Hospital Humans • Pets • Livestock Animals • Crops • Aquaculture Agriculture Priyadharsini, Raman Palanisamy. "Antibiotic resistance: what is there in past, present and future?." Journal of Young Pharmacists 11.4 (2019): 333.
- 9. Resistance is not new
- 10. Resistance is getting worse 2013 2015 Carbapenem-resistant Enterobacteriaceae
- 11. Antibiotics Stewardship Why, When and How to Conserve the Higher Antibiotics?
- 12. 1.27 millions Deaths Direct Result of Antibiotic Resistance Infections Antimicrobial Resistance Collaborators. Lancet 2022; 399: 629–55
- 13. Volume and Share of Antibiotic Classes Consumed in the Private Sector in India Shaffi Fazaludeen Koya et al. The Lancet Regional Health - Southeast Asia. 2022;4: 100025 DDD – Defined Daily Dose
- 14. Third-generation Cephalosporin-resistant Klebsiella Pneumoniae Antimicrobial Resistance Collaborators. Lancet 2022; 399: 629–55
- 15. Characteristics of the Top Four Antibiotic Class Shaffi Fazaludeen Koya et al. The Lancet Regional Health - Southeast Asia. 2022;4: 100025
- 16. Factors Contributing in Antibiotic Resistance in India • The per-capita private-sector consumption rate of antibiotics in India is relatively low compared to many countries. • Still, India consumes a large volume of broad-spectrum antibiotics that should ideally be used sparingly. • In addition to this, there is a significant share of FDCs from formulations outside NLEM and a large volume of antibiotics not approved by the central drug regulators that calls for significant policy and regulatory reform. Shaffi Fazaludeen Koya et al. The Lancet Regional Health - Southeast Asia. 2022;4: 100025
- 17. Antimicrobial Stewardship Programmes A WHO Practical Toolkit Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries. A practical toolkit. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
- 18. Classification of Use of Antibiotics • The WHO EML AWaRe classification of commonly used antibiotics into three groups – ACCESS WATCH RESERVE Provides a tool to support antibiotic monitoring and AMS activities, with recommendations on when to use
- 19. ACCESS Group of Antibiotics
- 20. WATCH Group of Antibiotics
- 21. RESERVE Group of Antibiotics
- 22. Questions to Address When Applying the Quality Improvement Model For AMS Interventions
- 23. Appropriate Antibiotic Treatment – Indication and Prescribe, Review and Stop Treatment
- 24. Appropriate Antibiotic Surgical Prophylaxis – Indication, and Prescribe and Stop Prophylaxis
- 25. Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB) Among Children: Where We Stand Now?
- 26. Percentage of Cases of Tuberculosis in Pacific Region of the Earth Chowdhury K et al. Cureus 15(2): e35154. doi:10.7759/cureus.35154
- 27. Multidrug-resistant TB and Extensively Drug-resistant TB Chowdhury K et al. Cureus 15(2): e35154. doi:10.7759/cureus.35154
- 28. Various Challenges for Diagnosing and Treating Drug-Resistant Tuberculosis Among the Pediatric Population Chowdhury K et al. Cureus 15(2): e35154. doi:10.7759/cureus.35154
- 29. Factors Causing Raised Caseloads of DR-TB Under- reporting Lack of proper diagnostic tools Less accessibility to the health care system Unavailability of suitable pediatric drugs against DR-TB COVID-19 pandemic Chowdhury K et al. Cureus 15(2): e35154. doi:10.7759/cureus.35154
- 30. Thank you
Editor's Notes
- Antimicrobial resistance is one of the most significant challenges for the provision of safe, high-quality health services across the world. The term ‘antimicrobial resistance’ refers to the failure of an antimicrobial (which includes antibiotics) to inhibit or destroy bacteria, parasites, viruses or fungi for which it has been designed using standard dosing regimens Antimicrobial resistance has a direct effect on patient care and creates a set of critical ongoing challenges to health service delivery. It can increase a patient’s length of hospital stay and severity of patient illness. Severe infections caused by bacteria that do not respond to available ‘last-line’ antimicrobials (including antibiotics) can result in septicaemia and death. Antimicrobial resistance also increases the complexity of treatment, and places a significant burden on patients, health service organisations and the health system. Amina J. Mohammed (Deputy Secretary-General of the UN) was quoted as saying that “Antimicrobial resistance is one of the most pressing issues globally, not only for human health but it is a multi-sectoral problem involving animal health, agriculture, the environment, trade and many other sectors”. Dr Tedros Adhanom Ghebreyesus, Director-General of WHO was quoted as saying “A lack of effective antibiotics is as serious a security threat as a sudden and deadly disease outbreak. Strong, sustained action across all sectors is vital if we are to turn back the tide of antimicrobial resistance and keep the world safe." Prof Dame Sally Davies, England’s chief medical officer was quoted as saying “We will be given the choice of, well you can have an expensive treatment that’s likely to cure you, but you’ll get an infection that is likely to be resistant and you’ll probably die of it,” she told MPs. “Meanwhile all transplants will be out of the window because they are all prone to infections. There will be a lot of suffering and modern medicine will be lost.” NPS MedicineWise maintains a list of important antibiotic resistance myths: https://www.nps.org.au/medical-info/consumer-info/antibiotic-resistance-the-facts
- Consumers are aware that antibiotics treat infections. However, consumers may not be aware that antibiotics are essential in preventing infection after surgical procedures and for patients receiving chemotherapy. Antimicrobial resistance has significant and direct implications on patient care. Antibiotics play an essential role in preventing infection after surgery. For example, people currently undergoing surgery procedures (such as hip and knee replacements) receive standard prophylactic antibiotics and currently experience infection rates of around 0.5-2.0%. If access to effective antibiotics were reduced through antimicrobial resistance, post-operative infection rates could rise to around 40-50%, and up to 30% of these patients could die from these infections. Antimicrobial resistance also impacts on a range of treatment options, such as chemotherapy for cancer patients, which may no longer be a viable or safe option due to the increased risk of complications and infections resulting post treatment. This reduction in safe and viable treatments, and services able to be offered by health facilities, would have a negative effect on the effectiveness of the healthcare system in the long term. In 2014 the UK Government commissioned a review on antimicrobial resistance which investigated the global economic cost of infections caused by resistant bacteria. The work by KPMG and RAND Europe indicated that if the current trend of increasing antimicrobial resistance continues, by 2050 about 10 million people may die every year as a direct result of resistant bacterial infections for which there is no effective antimicrobial (which includes antibiotics). Gross domestic product would also decrease as a result of antimicrobial resistance, which the review indicated would translate to a reduction in global economic output worth between US$60 - US$100 trillion. https://www.vox.com/2014/12/12/7382299/new-report-drug-resistant-infections-will-kill-more-people-than
- Antimicrobial resistance occurs when bacteria develop resistance to an antimicrobial that was previously an effective treatment. Bacteria develop natural defences against antibiotics. When this occurs, potentially due to prolonged exposure to or overuse of a particular antibiotic, the antibiotic’s effectiveness to treat the infection decreases, and may reach a point where the antibiotic has no benefit. The overuse of antibiotics in health (human and animal) and agriculture has increased the amount of exposure bacteria have to them, giving bacteria more opportunity to develop resistance. The process of natural selection (‘survival of the fittest’ – favouring bacteria that develop the strongest natural defences) fuels the increasing prevalence of antimicrobial resistance. New challenges in infection control resulting from more complex health care (for example, outpatient chemotherapy) and increasing domestic and international travel have increased the spread of resistant bacteria both between individuals and between countries. When patients have longer hospital stays, this may increase the chance of patients acquiring resistant organisms from other patients.
- Addressing the rising threat of antimicrobial resistance (AMR) requires a holistic and multisectoral approach – referred to as One Health – because antimicrobials used to treat various infectious diseases in animals may be the same or similar to those used for humans. Resistant bacteria arising in humans, animals or the environment may spread from one to the other, and from one country to another. AMR does not recognise geographic or human–animal borders. - https://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/policy/one-health
- Antibiotics resistance can spread by many vectors.
- In an interview shortly after winning the Nobel Prize in 1945 for discovering penicillin, Alexander Fleming said: “The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism.” You may wish to play this TED talk on antibiotic resistance - https://www.youtube.com/watch?v=o3oDpCb7VqI&app=desktop
- This graph shows Carbapenemase producing Enterobacteriaceae (CPE) becoming more prevalent over a two year period in Europe.