updated statistics about antimicrobial resistance,causes and mechanism of antimicrobial resistances, national antimicrobial policy, national antimicrobial surveillance, new delhi b metallo-lactamase-1 bacteria
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
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
Dr.sherin elsherbiny
Senior registrar clinical microbiology
AMR coordinator
Infection control auditor
Riyadh region
Meeqat General Hospital ,Madina,KSA
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.
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
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
Dr.sherin elsherbiny
Senior registrar clinical microbiology
AMR coordinator
Infection control auditor
Riyadh region
Meeqat General Hospital ,Madina,KSA
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.
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
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.
AMR in Animal Origin Products A ChallengeSarzamin Khan
The AMR and its origin from the products of animal based products has been discussed. The AMR as challenge has been described and recommendation to minimize the risk of AMR
Antibiotic resistance: causes, consequences and means to limit itGreenFacts
Over the last century, antibiotics have radically changed the
way we treat infections. They are an important tool for modern medicine, but unfortunately their misuse have led to the emergence of bacteria that are resistant to antibiotics.
What has caused it and how can the spread of resistance be limited?
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
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
1. A Threat to Public Health
Presenter
Dr. Gaurav Rajawat
Junior Resident
Moderator
Dr. Meenakshi Kalhan
Professor
PT. B.D.SHARMA, PGIMS, ROHTAK
2. CONTENTS
Overview
Global concern
Antimicrobial Resistance: Mechanism
Antimicrobial Resistance: Causes
New Delhi Metallo-Beta-Lactamase-1(NDM-1)/Super bug
Initiatives taken by India: AMR Surveillance, National
AMR policy
3.
4. Antimicrobial resistance (AMR)
is the ability of a microbe to
resist the effects of medication
previously used to treat them.
DEFINITION
This broader term also covers antibiotic resistance, which
applies to bacteria and antibiotics.
7. There are definitepolicies/guidelines for appropriate
use of antimicrobials at national level in specific
national health programmes being run in the country
e.g. RNTCP, National AIDS Control Programme, etc.
But for other diseases of public health importance like
enteric fever, diarrhoeal disease, respiratory infections,
etc individual hospitals are following their own
antimicrobial policies and hospital infection control
guidelines.
To monitor antimicrobial resistance it is necessary to
have regulations for use and misuse of antibiotics in
the country.
8. The Centers for Disease Control and Prevention (CDC)
estimates more than two million people are infected
with antibiotic-resistant organisms, resulting in
approximately 23,000 deaths annually in the United
States, costing $20-$35 billion annually.
In Europe, an estimated 25,000 deaths are attributable
to antibiotic-resistant infections, costing €1.5 billion
annually.
In India, it is estimated that 58,000 neonatal sepsis
deaths are attributable to drug resistant Infections.
Center for Disease Dynamics, Economics & Policy, 2015.
9. Three agents of greatest concern
associated with both hospital- and
community acquired infections.
E-coli
Klebsiella pneumoniae
Staphylococcus aureus
WHO 2014, reported E. coli
resistance of more than 50 %
fluoroquinolones and 3rd gen.
cephalosporins.
K.pneumoniae resistance rates to 3rd
generation cephalosporins exceed 30-
60%.
MRSA resistance rates exceed 20-
80%.
Percentage of Staphylococcus aureus
isolates that are methicillin resistant
(MRSA), by country (2011-14)
10. Between 2000 and 2010, total global antibiotic
consumption grew by more than 30 percent, from
approximately 50 billion to 70 billion standard units.
In most countries, about 20 percent of antibiotics are
used in hospitals and other healthcare facilities, and
80 percent are used in the community, either
prescribed by healthcare providers or purchased
directly by consumers or caregivers without
prescription.
Center for Disease Dynamics, Economics & Policy, 2015.
11. The countries consuming the
most antibiotics overall in 2010
were India, 13 billion SU; China,
10 billion SU; and the United
States, 7 billion SU.
However, in per capita terms
among these countries, the
United States led in 2010 with 22
SU per person, compared with 11
SU in India and 7 SU in China.
ANTIBIOTIC CONSUMPTION:
WORLD
12. TOTAL ANTIBIOTIC CONSUMPTION IN
SELECTED COUNTRIES, 2000 AND 2010
WHO study, 2011 showed that 53% of Indians were taking
antibiotics without a prescription.
Center for Disease Dynamics, Economics & Policy, 2015.
14. Bacteria resist the effects of antibiotics by using the
following genetic strategies, with thousands of variations:
Producing destructive enzymes to neutralize antibiotics.
Modifying antimicrobial targets, by mutation, so that
drugs cannot recognize them.
Removing antimicrobial agents by pumping them out
(efflux).
Preventing antibiotics from entering by creating a
“biofilm” or otherwise reducing permeability.
Creating by passes that allow bacteria to function
without the enzymes targeted by antibiotics.
Source: Penesyan et al. (2015)
15. Antibiotic resistance traits can be lost, but this reverse
process occurs more slowly.
If the selective pressure that is applied by the presence
of an antibiotic on the bacterial population is removed,
they can potentially go back to a population of bacteria
that responds to antibiotics
Yes
Mira PM, Crona K, Greene D, Meza JC, Sturmfels B, Barlow M (2015) Rational Design of Antibiotic Treatment
Plans: A Treatment Strategy for Managing Evolution and Reversing Resistance. PLoSONE 10(5): e0122283.
doi:10.1371/journal.pone.0122283
16. 1. Inappropriate use & misuse of
antibiotics
2. Indiscriminate use of antibiotics
in agriculture and veterinary
practice
3. Insufficient research and
development
17. Three main types of misuse as underlined by the
European Centre for Disease Prevention and Control
(ECDC) :
The unnecessary prescription of antibiotics for viral
infections.
Frequent prescription of “broad-spectrum antibiotics”,
instead of better targeted antibiotic.
Patient failure to adhere to regimens for prescribed
antibiotics.
20. No drug needed e.g. unnecessary & ineffective
antimicrobials or antidiarrhoeals given instead of Oral
Rehydration Solution.
Unsafe drugs e.g. Analgin (Dipyrone) banned in most
developed countries, but is used in many developing
countries.
Under use of available effective drugs e.g. ORS not used
effectively.
21. Ineffective drugs & drugs with doubtful efficacy e.g.
unnecessary excessive use of tonics & multivitamin
preparations.
Incorrect use of drugs e.g. overuse of Injections
Many viral infection (sore throat, sinusitis, conjunctivitis
etc ) does not need antibiotics for treatment.
22. Antibiotic-resistance genes are
used in genetically modified crops.
Antibiotics are also sprayed onto
fruit trees to prevent and treat
infection.
The use of antibiotics in feed
supplements given to farm animals
to promote animal growth and to
prevent infections (rather than
cure infections).
An estimated 80 percent of all antibiotics consumed in
the United States are used in food animals (U. S. FDA
24. The use of the antibiotic avoparcin as a growth promoter
in food animals in Europe resulted in the development
and amplification of Vancomycin Resistant Enterococci
(VRE) and subsequent colonization in human intestine.
Enerofloxacin was approved for use in food production
animals in many countries. The use of this antibiotic in
food animals has resulted in the development of
ciprofloxacin-resistant strains of Salmonella spp. and
Campylobacter spp.
The use of animal feed supplements with the antibiotic
tylosin has led to the development of erythromycin-
resistant streptococci and staphylococci.
European Union (EU) has banned the use of animal growth promoting
antibiotics (tylosin, spiramycin, bacitracin and virginiamycin)
25. Global antibiotic consumption in livestock was
conservatively estimated at 63,200 tons in 2010,
accounting for nearly two-thirds of the estimated 100,000
tons of antibiotics produced annually worldwide.
By 2030, consumption is projected to rise by two-thirds, to
105,600 tons. Two-thirds of the increase is due to increase
in the number of animals, and the remaining one third is
due to the shift from extensive to intensive farming .
Center for Disease Dynamics, Economics & Policy, 2015.
26. Center for Disease Dynamics, Economics & Policy, 2015.
Antibiotic Consumption In Livestock,
Top Ten Countries 2010–2030 (projected
for 2030)
27. Non-therapeutic uses of antibiotics common in poultry
production. However, currently there is no regulatory
provision regarding the use of antibiotics in livestock.
The prescribed tolerance limit (mg/Kg) of antibiotics use
shall not exceed for sea foods including shrimps, prawns
or any other variety of fish and fishery products (The
Prevention of Food Adulteration Rules, 1995-part XVIII)
a) Tetracycline (0.1) mg/Kg
b) Oxytetracycline (0.1) mg/Kg
c) Trimethoprim (0.05) mg/Kg
d) Oxolinic acid (0.3) mg/Kg
29. Industry uses larges volumes of
detergents and disinfectants - including
quaternary ammonium compounds
(QACs) - known together as biocides
Nearly all domestic cleaning products
and shampoos also contain QACs.
They wash out in large volumes with
the waste water from factories and
homes.
QAC resistance genes are significant
because they are often located with
antibiotic resistance genes on the same
piece of DNA, so exposure to one will co-
select for the other.
30. Pharmaceutical industries do not consider antibiotic
development as an economically wise investment as
antibiotics are used for relatively short duration.
Antibiotics are not as profitable as drugs that treat
chronic conditions, such as diabetes, asthma, psychiatric
disorders.
Fast development of resistant strains also making
antibiotic ineffective soon
31.
32. 4. Regulatory approvals–
Red tapism, no clear rules and
regulations
Differences in clinical trial
requirements among countries
Changes in regulatory and
licensing rules.
33.
34. New Delhi Metallo-beta-lactamase 1 (NDM-1) is a
genetic element with multiple resistance genes that can
be harbored by and transmitted between Gram-negative
bacteria.
NDM-1 was first described by Yong et al in 2009.
http://aac.asm.org/content/53/12/5046.full?view=long&pmid=19770275
35. It was first identified in a Swedish patient returning
from New Delhi, India, in 2008.
The infection was unsuccessfully treated in a New Delhi
hospital and after the patient's repatriation to Sweden, a
carbapenem-resistant Klebsiella pneumoniae strain
bearing the novel gene was identified.
The authors concluded that the new resistance
mechanism "clearly arose in India, but there are few
data arising from India to suggest how widespread it is
36. In Aug,2010 a study by a
multi-national team was
published in a journal ’The
Lancet Infectious
Diseases’ which reported
many NDM-1 resistance
cases in India.
The authors concluded
that India should be
avoided for elective and
cosmetic surgeries because
of NDM-1 bacterial strain
37. This reported 37 cases isolates with NDM-1 in the United Kingdom, 44
in Chennai, 26 in Haryana, and 73 in various other sites in Pakistan
and India.
An environmental point prevalence study conducted between 26
September and 10 October 2010 found bacteria with the NDM-1 gene in
drinking water and seepage samples in New Delhi. (Johnson and Woodford
2013)
38. On 12 January 2011, the editor of The Lancet, Richard Horton,
apologized and acknowledged that naming a superbug after New
Delhi was an "error".“
Following this, Ajai R. Singh, editor of Mens Sana Monographs,
demanded that such 'geographic names giving' be abandoned and
replaced by 'scientific name giving'.
He proposed changing NDM-1 to PCM (plasmid-encoding
carbapenem-resistant metallo-beta-lactamase)
Furthermore name is not changed yet and follows the naming of most
genes of this type.
• VIM: Veronna imipenemase in Italy
• GIM: Germany imipenemase
• DIM: Dutch imipenemase
39. The World Health Organisation (WHO) –“NDM-1 could
be ushering in the dooms day scenario of a world without
antibiotics.“
The NDM-1 gene causes bacteria to produce an enzyme
called a carbapenemase.
Carbapenemase makes nearly every antibiotic ineffective
including Carbapenems.
40. At the moment, the only way to combat the spread of
NDM-1 is through quickly identifying, isolating infected
patients, disinfecting hospital equipment, following hand-
hygiene procedures and surveillance in hospitals.
Patients with NDM-1-related infections have been treated
with a combination of medications, but there is no
effective treatments are available for many of the
infections caused by NDM-1.
41. Better hygiene -preventing infections from happening
in the first place.
To have access to safe water.
Infection control in health-care facilities.
Vaccination- to reduce the need for antibiotics.
To have national action plans on AMR.
Greater innovation and investment are required in
research and development of new antimicrobial
medicines, vaccines, and diagnostic tools.
42. 1. 12th Five Year Plan- Containment of AMR
2. The National Policy for Containment of Antimicrobial
Resistance
3. National Anti-Microbial Resistance Research and
Surveillance Network (AMRRSN)
4. Jaipur declaration (a WHO initiative)
5. Chennai declaration
6. The Drugs and Cosmetic Rule, 1945 were amended in
2013 to include a new Schedule H1.
7. National Treatment Guidelines for Antimicrobial Use in
Infectious Diseases
43. 8. 2016 February, the Union Health Minister
launched a multimedia campaign called
“Medicines with the Red Line” to create
awareness on the rational use of medicines which
carry a red line on their strip
44.
45. A National Programme for containment of AMR has
been initiated with the following objectives:-
To generate awareness among healthcare providers
and in the people regarding rational use of
antibiotics.
To establish a laboratory based surveillance system.
To strengthen infection control guidelines and
practices and
To promote rational use of antibiotics
46. Released in 2011 & yet to be implemented
Key points-
a) Proposed Actions to monitor Sale of Antibiotics
b) Set up an Antibiotic Management Team (AMT)
c) Establishment of inter-sectoral coordination
committee
d) Reducing antibiotic selection pressures by
appropriate control measures
e) Promotion of discovery of newer and effective
antimicrobials based on current knowledge of
resistance mechanisms
47. a) Proposed Actions to monitor Sale of Antibiotics
Schedule H of the drug and cosmetics act contains a list
of drugs which are required to be dispensed on the
prescriptions of a registered medical practitioner.
A separate schedule as Schedule H1 may be introduced
under the Drugs and Cosmetics Rules to regulate sale
of antibiotics exclusively.
A provision could be incorporated for spot suspensions
/cancellation of the sale license for contravention of the
provision of Schedule H1
48. b) Set up an Antibiotic Management Team (AMT) –
This is a Multi disciplinary team with experts in
Infectious diseases, Internal medicine, Clinical
microbiology etc
The functions of the AMT is to develop the hospital
antimicrobial policy.
c) Establishment of inter-sectoral coordination.
Central Council for Scientific and Industrial
Research
Ministry of Health and Family Welfare,
Indian Council for Agricultural Research
Department of Animal Husbandry .
49. The Indian Council of Medical Research began
setting up the Anti-Microbial Resistance
Surveillance Network in 2011.
When complete, its focus will be on:
1. Diarrhea (e.g.,Shigella, Vibrio cholerae)
2. Enteric fever (e.g., Salmonella Typhi , S. Paratyphi)
3. Sepsis caused by Enterobacteriacea (e.g., E-coli, Klebsiella
pneumoniae)
4. Gram-negative organisms (e.g., Pseudomonas aeruginosa,
Acinetobacter baumannii)
5. Gram-positive bacteria (e.g.,MRSA and VRE)
6. Fungal infections (e.g., Candida spp.), and
7. Respiratory pathogens (e.g., Streptococcus pneumoniae).
50. 1. Identification of the pathogens / diseases of public
health importance for surveillance- Extended Spectrum-
lactamases [ESBLs] and Metallo -lactamases [MBLs], NDM-1,
MRSA & VRE
2. Creating a network of AST laboratories- In the first phase,
the following three central Govt. Hospital in Delhi will be
included for AMR surveillance.
a) Sucheta Kriplani Hospital (SKH) & Lady Hardinge Medical College
(LHMC), New Delhi
b) Dr Ram Manohar Lohia (RML) Hospital, New Delhi
c) Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital,
New Delhi
51. 3. Standardize methodology for microbial identification and
AST- Laboratories should be having expertise to do MRSA, ESBL
and Carbapenemase (Modified Hodge test / Imipenem + EDTA E
test) testing.
4. AST Data analysis - WHONET 5 for AST data reporting and
analysis
5. Dissemination of AMR data- The AMR data generated by the
respective network laboratories should be sent to the coordinating
center, regularly on a quarterly basis.
6. Development of National Repository of Bacterial strains /
cultures - Institute of Microbial technology (IMTECH),
Chandigarh has the requisite infrastructure and expertise to do the
same.
52. A one day sensitization workshop for the senior
microbiologists of the network laboratories.
2-3 days training workshop for junior microbiologist/
data reporting personnel on various aspects of AST
specially quality control and data analysis/
transmission.
Followed by regular monitoring and review meetings
once in 6/12 months
53. New and simple surveillance tools with the capability to
detect AMR at the lowest capable health centre should
be developed and its ability to track the infection should
be established.
All surveillance activities should be linked with
epidemiological studies particularly surveillance around
relevant vaccination programs.
A National Health Policy Unit should be entrusted with
analysis of the surveillance data and provide advisory
for framing of policies for use of antibiotics according to
region, nation or hotspots.
54. The drug testing laboratories in the country should be
strengthened in terms of infrastructure, number and
also training of drug inspectors.
The supply of a drug mentioned in Schedule H1 shall be
recorded in a separate register at the time of the supply.
It contains the name and address of the prescriber, the
name of the patient, the name of the drug and the
quantity supplied and such records shall be maintained
for three years and be open for inspection.
55. The drug specified in Schedule
H1 shall be labeled with the
symbol Rx which shall be in red
and clearly displayed on the left
top corner of the label, and shall
also be labeled with drug
warning.
Drug Inspectors may conduct
surprise raids at the chemist
shops to ensure that the
provision of the Drugs and
Cosmetics Rules especially in
respect of Schedule H1 are
strictly complied by the
licensees.
56. Incentives should be given to pharmacies for not
selling antibiotics without prescription and
appropriate regulation for the same should be
formulated.
Appropriate steps will be taken to curtail the
availability of fixed dose combination of antibiotics
in the market, by and large combinations should be
discouraged except for naturally interactive ones
like Cotrimoxazole, Amoxyclave, etc.
57. Two of the best known national campaigns took place in
France and Belgium.
In France, which once had the highest rate of antibiotic
consumption in Europe, the government launched an
awareness campaign called “Antibiotics are not
automatic” in 2001, as a part of a program to preserve
antibiotic effectiveness.
This campaign achieved a reduction in antibiotic
prescribing of 27 percent over five years in all regions of
the country, with the greatest decline, 36 percent, in
children 6 to 15 years of age.
Belgium, the Belgian Antibiotic Policy Coordination
Committee established a national media campaign in
2000 that succeeded in reducing antibiotic prescribing
by 36 percent over seven years.
58. Drug division of Haryana has worked for promotion
of rational use of Medicines during the 2012-2013
Activities-
a. Prescription audits
b. Trainings and workshops on rational drug use
c. Publication of material on rational drug use
3. Audit of drug stores
4. Setting up Centralized Medicine Testing Unit.
59. Incomplete format of Prescriptions- In 58% prescriptions,
all drugs were written in generic names. In 27% of
prescriptions a mix of generic and brand naming of drugs
were used.
Polypharmacy- It was found that the number of drugs
prescribed per encounter in hospital was 3.4 and higher
than the WHO recommended values of 1.6-1.8
Treatment was incomplete in respect of dosage form,
strength, frequency and duration of the treatment.
60. No mention of drug strength - In 71% prescriptions, none
of the drugs that were prescribed mentioned the
strength.
Overuse of analgesics and antibiotics-
54 % prescriptions were having antibiotics as compared to
the WHO standard of 15-25%. While, 57% of the
prescriptions were having analgesics.
61. • Using antibiotics, prescribed by a doctor
• Completing the full antibiotic course, even if they feel better
• Not sharing antibiotics with others or using leftover
prescriptions.
• Public health education and awareness
• Stopping the use of antibiotics as growth-promoters in farm
animals.
People
• Enhancing infection prevention and control
• Prescribing and dispensing antibiotics only when they are
truly needed, after antibiotic sensitivity testing, when
possible.
• Prescribing and dispensing the right antibiotics to treat the
illness.
• Ban on over- the counter sale of antibiotics
• Compliance with rules and regulations
Health workers and pharmacists
How to tackle resistance- Contribution from all
stakeholders
62. • Having national plans and guidelines on antimicrobial
resistance
• Strengthening resistance tracking and laboratory
capacity;
• Regulating and promoting appropriate use of medicines.
• Increase spending on innovation and infrastructure
Policymakers
• Promoting innovation and research and development of
new tools
• Promoting Cooperation and Information Sharing Among
all Stakeholders.
Industry
Cont..
63.
64. National policy for containment of antimicrobial resistance
India 2011.Pdf
Global action plan on antimicrobial resistance 2015.pdf
Center for Disease Dynamics, Economics & Policy, 2015.pdf
HSHRC Annual Report 2012-13.pdf
Editor's Notes
Penicilline was discovered by alexander fleming in 1928 and in 1945 he said that
The 1st antimicrobial resistance was observed in 1940 against sulfonamide
Gonococcal
now we are depended on combination tharapy to treat gonococcal cases like ceftriaxone with azithromycine
creation of national surveillance system for antibiotic resistance, mechanism of monitoring prescription audits, regulatory provision for monitoring use of antibiotics in human, veterinary & industrial sectors and identification of specific intervention measures for rational use of antibiotics
estimates of economic losses in the developing like india world are not available
As of 2015, the WHO has 194 member states
In India, a steep increase in MRSA, from 29 percent of S. aureus isolates in 2009 to 47 percent in 2014 (CDDEP 2015b)
3.7% of new cases and 20% of previously treated cases are estimated to have MDR-TB
fluoroquinolone resistance in Salmonella typhii, 8% in 2008 to 24% in 2014 while carbapenem resistance in Klebsiella pneumoniae, 2% to 52% between 2002 and 2009
based on data from 71 countries, including most high population countries (Van Boeckel et al. 2014)
As defined by IMS, a standard unit is a measure of volume based broadly on the smallest identifiable dose given to a patient, dependent on the
pharmaceutical form (a pill, capsule, or ampoule).
Bacteria may be inherently resistant to a particular antibiotic.
For example- An organism may lack the target site of the antibiotic molecule ,so that no binding of antibiotic takes place.
Both overuse, underuse and misuse of medicines contribute to the problem.
Our normal flora is important to maintain intestinal balance and because of it’s inhibition resistance pathogens are unable to grow
1.Optimise the use of existing antimicrobial agents
2.Prevent the transmission of drug-resistant organisms through infection control
3.Improve environmental decontamination
Cancel in june 2013......revokes in march 2014
Help growing animals so they can digest their food more efficiently
Extensive Farming; Is defined by using more land with lower yield to produce the same amount of food. Intensive Farming; is defined by using less area of land, but have a large amount of fertilizers and machinery, as well as it requires large labor and capital inputs for farming
Consumption in Brazil, Russia, India, China, and South Africa (the BRICS) is expected to double by 2030 as their population increases by 13 percent.
Baned- sweaden , Denmark. Norway
No ban- china Russia india south affrica argentina
Partial ban- Australia, brazil, maxico
Voluntary witdrawl- Canada and usa
No data – Africa , peru coloumbia, malasia Indonesia , thiailand , greenland
13-25 years
companies that are optimistic about the discovery of new antibiotics, obtaining regulatory sanction is often an obstacle.
The number of new antibiotic developed and approved has decreased over past three decades(although four new drugs were approved in 2014), leaving less options to treat resistant bacteria
Empty pipeline
Mr walsh
Later on the authors concluded that indian hospitals are no more safe because of ndm1 resistance bacterial infection
A National Programme containment of AMR has been initiated
Jaipur 6 sept 2011
Chennai aug 2012
However, little was done to implement the policy and the recommendations were considered to be difficult to implement and there was no clear action plan
Antibiotic susceptibility testing
drug resistant strains (including molecular components like DNA / plasmids) isolated from the different lab
Fermented technology, cell biology, microbial genetic, crystallography
Schedule H of the drug and cosmetics act contains a list of 536 drugs which are required to be dispensed on the prescriptions of a registered medical practitioner.
In order to have separate regulation to check unauthorized sale of antibiotics, a separate schedule as
Rx: A medical prescription. The symbol "Rx" is usually said to stand for the Latin word "recipe" meaning "to take." It is customarily part of the superscription (heading) of a prescription.
nRx .If the drug is a narcotic controlled under the NDPS Act, it has to be indicated by the word nRx.