Dr. Ashwani K. Sood is a professor and head of the department of pediatrics at IGMC Shimla. The document discusses the growing issue of antimicrobial resistance (AMR) globally and in India. It notes the increasing resistance of common pathogens like E. coli, Klebsiella, Acinetobacter, and Pseudomonas to front-line antibiotics. Studies show over 50% of E. coli and Klebsiella isolates are resistant to commonly used first-line drugs. Acinetobacter and Pseudomonas also demonstrate high resistance rates, making treatment increasingly challenging. The inappropriate and overuse of antibiotics has accelerated the development of AMR, creating a serious public health threat.
Antibiotic resistance : A global concern Rohan Jagdale
The document discusses antibiotic resistance. It begins by defining antibiotics and antibiotic resistance, noting that antibiotic resistance occurs when bacteria change in response to antibiotic use and become harder to treat. It then discusses the scope of the problem, highlighting that antibiotic resistance threatens global health and development. The document also provides timelines of resistance emerging to various antibiotics. It discusses mechanisms of resistance, such as bacteria modifying targets, and reasons for a lack of new antibiotic development, such as scientific and economic challenges.
Antimicrobial resistance (AMR) occurs when microorganisms change when exposed to antimicrobial drugs, becoming 'superbugs' that medicines become ineffective against, allowing infections to persist and spread. This threatens global health by making infections difficult to treat, increasing mortality and healthcare costs. The top 10 most dangerous antibiotic resistant bacteria are described, along with factors contributing to AMR like overuse and misuse of antibiotics in humans, agriculture, personal care products and the environment. Additional precautions are needed when treating infections from antibiotic resistant bacteria. Public measures like handwashing and not sharing personal items can help reduce spread.
Antibacterial resistance is a major global problem as many bacterial infections are becoming increasingly difficult to treat due to antibiotic resistance. There are two main issues - increased antibiotic resistance among bacteria and a declining antibiotic pipeline. Bacteria are developing resistance to existing antibiotics, especially gram-negative rods, leaving some infections with no effective treatment options. Meanwhile, the development of new antibiotics has slowed dramatically in recent years. Novel approaches are being explored to address the antibiotic resistance crisis, such as developing antibiotics from non-culturable bacteria and using bacteriophages and their gene products. However, the problem of antibiotic resistance worldwide remains serious without action.
Antimicrobial Resistance and Roles of Different Stakeholders_Prof saidur rahmanUdderHealthBD
This document summarizes a presentation on antimicrobial resistance and the roles of different stakeholders. It discusses the importance and development of antimicrobial resistance, including how resistance genes can be transferred between microbes and across human, animal, and environmental boundaries. It outlines global trends in antimicrobial consumption and reviews evidence that overuse contributes to resistance. The document also summarizes the limited pipeline of new antimicrobial drugs and calls for optimization of medically important antimicrobial use in animals and humans to preserve drug effectiveness. It identifies stakeholders across human, animal, and environmental domains that must work together to address antimicrobial resistance as a global challenge.
This document discusses multidrug-resistant and extensively drug-resistant organisms (MDROs and XDRs). It defines antibiotic resistance and how bacteria can become resistant through improper antibiotic usage and transmission of resistance genes. Common MDROs include MRSA, VRE, and carbapenem-resistant Enterobacteriaceae. XDR tuberculosis is described as being resistant to nearly all drug classes. Treatment of MDROs and XDRs is difficult as few drug options remain effective. The prevention of further resistance development requires appropriate antibiotic prescribing and hygiene practices to limit transmission.
Antibiotic resistance a global concern part iiRohan Jagdale
Bacteria, not humans or animals, become antibiotic-resistant. These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.
Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality.
The world urgently needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to reduce the spread of infections through vaccination, hand washing, practising safer sex, and good food hygiene.
This document discusses antimicrobial stewardship and the importance of prudent antibiotic use. It notes that while antibiotics have significantly reduced deaths from infectious diseases, overuse and misuse have led to a rise in antibiotic resistance. The document advocates for an antimicrobial stewardship program that incorporates effective infection control, guidelines and algorithms for antibiotic use, audit and feedback on prescribing, and education to optimize antibiotic use and slow resistance. The goals of antimicrobial stewardship are to achieve clinical cure while limiting unintended consequences like toxicity, inhibition of normal flora, and selection of resistant bacteria.
Antibiotic resistance : A global concern Rohan Jagdale
The document discusses antibiotic resistance. It begins by defining antibiotics and antibiotic resistance, noting that antibiotic resistance occurs when bacteria change in response to antibiotic use and become harder to treat. It then discusses the scope of the problem, highlighting that antibiotic resistance threatens global health and development. The document also provides timelines of resistance emerging to various antibiotics. It discusses mechanisms of resistance, such as bacteria modifying targets, and reasons for a lack of new antibiotic development, such as scientific and economic challenges.
Antimicrobial resistance (AMR) occurs when microorganisms change when exposed to antimicrobial drugs, becoming 'superbugs' that medicines become ineffective against, allowing infections to persist and spread. This threatens global health by making infections difficult to treat, increasing mortality and healthcare costs. The top 10 most dangerous antibiotic resistant bacteria are described, along with factors contributing to AMR like overuse and misuse of antibiotics in humans, agriculture, personal care products and the environment. Additional precautions are needed when treating infections from antibiotic resistant bacteria. Public measures like handwashing and not sharing personal items can help reduce spread.
Antibacterial resistance is a major global problem as many bacterial infections are becoming increasingly difficult to treat due to antibiotic resistance. There are two main issues - increased antibiotic resistance among bacteria and a declining antibiotic pipeline. Bacteria are developing resistance to existing antibiotics, especially gram-negative rods, leaving some infections with no effective treatment options. Meanwhile, the development of new antibiotics has slowed dramatically in recent years. Novel approaches are being explored to address the antibiotic resistance crisis, such as developing antibiotics from non-culturable bacteria and using bacteriophages and their gene products. However, the problem of antibiotic resistance worldwide remains serious without action.
Antimicrobial Resistance and Roles of Different Stakeholders_Prof saidur rahmanUdderHealthBD
This document summarizes a presentation on antimicrobial resistance and the roles of different stakeholders. It discusses the importance and development of antimicrobial resistance, including how resistance genes can be transferred between microbes and across human, animal, and environmental boundaries. It outlines global trends in antimicrobial consumption and reviews evidence that overuse contributes to resistance. The document also summarizes the limited pipeline of new antimicrobial drugs and calls for optimization of medically important antimicrobial use in animals and humans to preserve drug effectiveness. It identifies stakeholders across human, animal, and environmental domains that must work together to address antimicrobial resistance as a global challenge.
This document discusses multidrug-resistant and extensively drug-resistant organisms (MDROs and XDRs). It defines antibiotic resistance and how bacteria can become resistant through improper antibiotic usage and transmission of resistance genes. Common MDROs include MRSA, VRE, and carbapenem-resistant Enterobacteriaceae. XDR tuberculosis is described as being resistant to nearly all drug classes. Treatment of MDROs and XDRs is difficult as few drug options remain effective. The prevention of further resistance development requires appropriate antibiotic prescribing and hygiene practices to limit transmission.
Antibiotic resistance a global concern part iiRohan Jagdale
Bacteria, not humans or animals, become antibiotic-resistant. These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.
Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality.
The world urgently needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to reduce the spread of infections through vaccination, hand washing, practising safer sex, and good food hygiene.
This document discusses antimicrobial stewardship and the importance of prudent antibiotic use. It notes that while antibiotics have significantly reduced deaths from infectious diseases, overuse and misuse have led to a rise in antibiotic resistance. The document advocates for an antimicrobial stewardship program that incorporates effective infection control, guidelines and algorithms for antibiotic use, audit and feedback on prescribing, and education to optimize antibiotic use and slow resistance. The goals of antimicrobial stewardship are to achieve clinical cure while limiting unintended consequences like toxicity, inhibition of normal flora, and selection of resistant bacteria.
This document discusses antibiotic resistance and how it arises through natural selection. It provides background on the discovery and early use of antibiotics like DDT and penicillin. However, as bacteria evolved resistance, new antibiotics had to be continually developed to keep ahead of evolving resistance. The overuse and misuse of antibiotics, especially in agriculture, has accelerated this process and reduced the effectiveness of many existing drugs. New approaches are needed that apply principles of evolutionary biology to slow further development of resistance.
This document discusses multiple drug resistance (MDR) in bacteria. It begins by defining drug resistance and how bacteria can develop resistance through natural mechanisms or by acquiring resistance over time when exposed to antibiotics. The key points are:
- Bacteria can become resistant through mutations or gene transfer that make antibiotics unable to bind or enable the bacteria to destroy or pump out antibiotics.
- Multiple drug resistance (MDR) occurs when bacteria resist many different drug classes through various mechanisms like altered cell walls or target sites.
- Common MDR bacteria include MRSA, VRE, and ESBL-producing gram-negative bacteria.
- MDR-TB is also discussed, which is TB resistant to at least is
This document summarizes various methods for detecting methicillin-resistant Staphylococcus aureus (MRSA) in the laboratory, including challenges, considerations, and mechanisms of resistance. It discusses culture-based detection methods like selective media, enrichment broths, and chromogenic agar. It also covers rapid detection tests like PBP2a latex agglutination and molecular methods. The document explores MRSA characteristics like pathogenicity, limited treatment options, and transmissibility. It discusses vancomycin-intermediate S. aureus (VISA), vancomycin-resistant S. aureus (VRSA), and their mechanisms of reduced susceptibility. The importance of accurate and timely MRSA detection is highlighted.
Science Shaping Our World-SHOW: Resistance is Futile: Applying Ecological and...MunevarS
March’s SHOW focused on the growing trend in microbial drug resistance. Pathogenic bacteria resistant to many or all antibiotics already exist. Coupled with the rapid decline in microbiological research at pharmaceutical companies, the rapid rate at which resistance has evolved and spread has demanded a novel approach to addressing this critical human health issue.
This document discusses the rise of antibiotic resistance in bacteria and the threat of "superbugs". It outlines several bacteria that have developed resistance to multiple antibiotics, such as MRSA, ESBL-producing E. coli and Klebsiella, and NDM-1 producing bacteria resistant to nearly all antibiotics. The development of resistance occurs through spontaneous mutation, lateral gene transfer, and selection pressure from antibiotic overuse. Widespread antibiotic resistance poses serious risks to human health through difficult-to-treat infections and increased mortality. New approaches are urgently needed to address the growing superbug threat.
Antibiotics are drugs that treat bacterial infections by either killing or inhibiting the growth of bacteria. There are several classes of antibiotics that work through different mechanisms such as inhibiting cell wall formation, interfering with DNA/protein formation, or preventing folic acid synthesis. While antibiotics are generally effective treatments, overuse and misuse has led to increased antibiotic resistance in bacteria. The document provides a detailed overview of the history, uses, mechanisms, types, and issues related to antibiotic use and resistance.
Anti-microbial resistance has become a world health issue today. Therefore it is imperative to know about the methods of acquiring resistance and ways to deal with the situation and prevent resistance.
This document discusses bacteriophage therapy as an alternative approach to antibiotic resistance. It begins with an introduction to antibiotic resistance and discusses the mechanisms and factors contributing to resistance. It then introduces bacteriophage or phages, describing their classification, life cycles, and mechanisms of infecting bacteria. The document outlines methods for preparing and administering phage therapy. It discusses advantages of phage therapy over antibiotics and provides examples of phage therapy applications in food and agriculture. Finally, it addresses some challenges to phage therapy including host range, bacterial debris in preparations, and lysogeny.
This document summarizes treatment options for Methicillin-resistant Staphylococcus aureus (MRSA) infections. It discusses the evolution of antibiotic resistance in S. aureus and risk factors for MRSA infection. Current treatment options for MRSA skin, soft tissue, and bloodstream infections include vancomycin, linezolid, daptomycin, and newer agents like ceftaroline, dalbavancin, oritavancin, and delafloxacin. Guidelines from the Infectious Diseases Society of America are mentioned. Ongoing research is focused on developing new antibiotics that are more effective than vancomycin for treating MRSA.
This document contains 29 multiple choice questions related to medical microbiology and virology. The questions cover topics such as gram-positive bacterial cell walls, influenza virus antigenic shift, fungal and bacterial infections, antibiotic modes of action, viral hepatitis, HIV and other blood-borne pathogens, tuberculosis drug interactions, and laboratory tests for various microorganisms.
This study analyzed the antibiotic susceptibility patterns of gram-negative bacteria isolated from clinical samples at a large specialty hospital in India from 2014. It found that 81% of bacterial isolates were gram-negative bacilli, led by Enterobacteriaceae species, Acinetobacter spp., and Pseudomonas aeruginosa. Antibiotic resistance rates were high and increasing among these pathogens, particularly to beta-lactams, cephalosporins, fluoroquinolones, and carbapenems. The results demonstrate the growing threat of multidrug-resistant gram-negative infections and emphasize the need for prudent antibiotic use.
Environmental Transmission of Antimicrobial ResistancePranab Chatterjee
This document discusses antibiotic resistance and the role of the environment in the transmission of resistant bacteria. It begins with an overview of antibiotic resistance and how easy it is to make bacteria resistant to penicillin in the laboratory. It then discusses how improper use of antibiotics can educate bacteria to become resistant and infect others. The document notes that any antibiotic use can lead to resistance and discusses some evolutionary advantages bacteria have over humans in developing drug resistance. It also presents a hypothetical case study of a MRSA outbreak in high school students and how one would investigate such an outbreak. Finally, it discusses major drivers of antibiotic resistance in the environment, including biocides, metals, and antibiotics themselves, as well as pathways by which resistance can spread environmentally through
Application of probiotics in complex treatment of tuberculosisIJERA Editor
The probiotic bacteria possessing ability to suppress growth of Mycobacterium B5 are revealed. Antagonistic
activity in selected strains studied during the growth on various nutrient media. Strains adapted to the low pH
exposure. They are steady against a number of the antibiotics, used at tuberculosis treatment. This testifies to the
prospects of further studies on the use of probiotics in the
This document discusses Methicillin Resistant Staphylococcus aureus (MRSA), an emerging veterinary pathogen. MRSA is a strain of Staphylococcus aureus that is resistant to certain antibiotics, including methicillin. It can cause serious infections in both humans and animals. MRSA has developed resistance through genetic mutations and the overuse of antibiotics, which places selective pressure on bacteria to evolve resistance. Diagnosis involves testing for antibiotic resistance through methods like agar dilution, broth microdilution, and disc diffusion tests.
History of the Forgotten Cure - Phage therapyStudent
1) The document provides a history of phage therapy, from its discovery in the late 19th/early 20th century to its decline with the rise of antibiotics and recent rediscovery due to antibiotic resistance. Key figures who discovered and explored phages and phage therapy include Ernest Hankin, Frederick Twort, and Félix d'Herelle.
2) It discusses how phage therapy works, involving using bacteriophages to treat bacterial infections. Advantages over antibiotics include phages' ability to self-replicate and adapt versus antibiotics being fixed molecules.
3) Problems that initially limited phage therapy are addressed, such as host range, bacterial debris in preparations, and lysogeny.
This document discusses the growing threat of antibiotic resistance and explores new approaches to combating resistance. It summarizes that antibiotic resistance arises through bacterial genetic changes and horizontal gene transfer in response to antibiotic stress. Integrons and mobile genetic elements play a key role in disseminating resistance genes between bacteria. The document also explores investigating inhibitors of resistance mechanisms like integrases and the SOS response to potentially prevent resistance. It highlights the increasing spread of resistant bacteria producing NDM-1 and other carbapenemases internationally.
This document discusses various types of multi-drug resistant bacteria including MRSA, VRSA, ESBL-producing bacteria, and KPC-producing bacteria. It provides details on the mechanisms of drug resistance, epidemiology, laboratory detection methods, and treatment recommendations for infections caused by these organisms. Specific topics covered include the worldwide spread of MRSA, mechanisms of methicillin and vancomycin resistance, diagnosis of MRSA and VISA/VRSA, and treatment options. The document also discusses the various beta-lactamase enzymes that confer ESBL and carbapenemase resistance, worldwide distribution of resistance, detection methods for ESBLs and KPC, and reliable drug options for treating ESBL and KPC infections.
Community-acquired respiratory tract infections (CARTIs) are common causes of illness that are difficult to treat due to a range of possible pathogens and increasing antibiotic resistance. Quinolones have evolved over generations to provide broad-spectrum activity against both gram-positive and gram-negative bacteria involved in CARTIs. They inhibit bacterial DNA replication and have excellent pharmacokinetic properties allowing once-daily oral or IV dosing. Clinical studies demonstrate that newer quinolones like moxifloxacin effectively treat CARTIs and reduce recovery time, hospital stays, and healthcare costs compared to other antibiotic regimens.
This document discusses optimizing therapy for vancomycin-resistant enterococci (VRE). It notes that enterococci infections have significantly increased in hospitals over the past two decades, often due to multidrug-resistant strains. Treatment options for VRE infections were limited until the development of newer antimicrobials like linezolid and daptomycin. However, resistance to even these newer drugs has emerged. The optimal treatment of VRE infections, especially endocarditis, remains unclear due to the lack of comparative clinical trials and the emergence of resistance to newer antimicrobials. Non-antimicrobial measures can help reduce treatment needs and resistance risk.
This document discusses antimicrobial resistance and its mechanisms. It defines key terms like minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC). It describes intrinsic and acquired resistance, as well as common pathways of resistance like blocking drug entry, enzymatic destruction, altering target sites, and efflux pumps. The major causes of antibiotic resistance are the abuse and overuse of antibiotics as well as alterations in microbial flora due to antimicrobial use. Examples of resistant organisms discussed include MRSA, VRE, ESBL producers, and penicillin-resistant pneumococci. Antibiotic sensitivity testing methods like dilution and disc diffusion techniques are also summarized.
This document discusses antibiotic resistance and how it arises through natural selection. It provides background on the discovery and early use of antibiotics like DDT and penicillin. However, as bacteria evolved resistance, new antibiotics had to be continually developed to keep ahead of evolving resistance. The overuse and misuse of antibiotics, especially in agriculture, has accelerated this process and reduced the effectiveness of many existing drugs. New approaches are needed that apply principles of evolutionary biology to slow further development of resistance.
This document discusses multiple drug resistance (MDR) in bacteria. It begins by defining drug resistance and how bacteria can develop resistance through natural mechanisms or by acquiring resistance over time when exposed to antibiotics. The key points are:
- Bacteria can become resistant through mutations or gene transfer that make antibiotics unable to bind or enable the bacteria to destroy or pump out antibiotics.
- Multiple drug resistance (MDR) occurs when bacteria resist many different drug classes through various mechanisms like altered cell walls or target sites.
- Common MDR bacteria include MRSA, VRE, and ESBL-producing gram-negative bacteria.
- MDR-TB is also discussed, which is TB resistant to at least is
This document summarizes various methods for detecting methicillin-resistant Staphylococcus aureus (MRSA) in the laboratory, including challenges, considerations, and mechanisms of resistance. It discusses culture-based detection methods like selective media, enrichment broths, and chromogenic agar. It also covers rapid detection tests like PBP2a latex agglutination and molecular methods. The document explores MRSA characteristics like pathogenicity, limited treatment options, and transmissibility. It discusses vancomycin-intermediate S. aureus (VISA), vancomycin-resistant S. aureus (VRSA), and their mechanisms of reduced susceptibility. The importance of accurate and timely MRSA detection is highlighted.
Science Shaping Our World-SHOW: Resistance is Futile: Applying Ecological and...MunevarS
March’s SHOW focused on the growing trend in microbial drug resistance. Pathogenic bacteria resistant to many or all antibiotics already exist. Coupled with the rapid decline in microbiological research at pharmaceutical companies, the rapid rate at which resistance has evolved and spread has demanded a novel approach to addressing this critical human health issue.
This document discusses the rise of antibiotic resistance in bacteria and the threat of "superbugs". It outlines several bacteria that have developed resistance to multiple antibiotics, such as MRSA, ESBL-producing E. coli and Klebsiella, and NDM-1 producing bacteria resistant to nearly all antibiotics. The development of resistance occurs through spontaneous mutation, lateral gene transfer, and selection pressure from antibiotic overuse. Widespread antibiotic resistance poses serious risks to human health through difficult-to-treat infections and increased mortality. New approaches are urgently needed to address the growing superbug threat.
Antibiotics are drugs that treat bacterial infections by either killing or inhibiting the growth of bacteria. There are several classes of antibiotics that work through different mechanisms such as inhibiting cell wall formation, interfering with DNA/protein formation, or preventing folic acid synthesis. While antibiotics are generally effective treatments, overuse and misuse has led to increased antibiotic resistance in bacteria. The document provides a detailed overview of the history, uses, mechanisms, types, and issues related to antibiotic use and resistance.
Anti-microbial resistance has become a world health issue today. Therefore it is imperative to know about the methods of acquiring resistance and ways to deal with the situation and prevent resistance.
This document discusses bacteriophage therapy as an alternative approach to antibiotic resistance. It begins with an introduction to antibiotic resistance and discusses the mechanisms and factors contributing to resistance. It then introduces bacteriophage or phages, describing their classification, life cycles, and mechanisms of infecting bacteria. The document outlines methods for preparing and administering phage therapy. It discusses advantages of phage therapy over antibiotics and provides examples of phage therapy applications in food and agriculture. Finally, it addresses some challenges to phage therapy including host range, bacterial debris in preparations, and lysogeny.
This document summarizes treatment options for Methicillin-resistant Staphylococcus aureus (MRSA) infections. It discusses the evolution of antibiotic resistance in S. aureus and risk factors for MRSA infection. Current treatment options for MRSA skin, soft tissue, and bloodstream infections include vancomycin, linezolid, daptomycin, and newer agents like ceftaroline, dalbavancin, oritavancin, and delafloxacin. Guidelines from the Infectious Diseases Society of America are mentioned. Ongoing research is focused on developing new antibiotics that are more effective than vancomycin for treating MRSA.
This document contains 29 multiple choice questions related to medical microbiology and virology. The questions cover topics such as gram-positive bacterial cell walls, influenza virus antigenic shift, fungal and bacterial infections, antibiotic modes of action, viral hepatitis, HIV and other blood-borne pathogens, tuberculosis drug interactions, and laboratory tests for various microorganisms.
This study analyzed the antibiotic susceptibility patterns of gram-negative bacteria isolated from clinical samples at a large specialty hospital in India from 2014. It found that 81% of bacterial isolates were gram-negative bacilli, led by Enterobacteriaceae species, Acinetobacter spp., and Pseudomonas aeruginosa. Antibiotic resistance rates were high and increasing among these pathogens, particularly to beta-lactams, cephalosporins, fluoroquinolones, and carbapenems. The results demonstrate the growing threat of multidrug-resistant gram-negative infections and emphasize the need for prudent antibiotic use.
Environmental Transmission of Antimicrobial ResistancePranab Chatterjee
This document discusses antibiotic resistance and the role of the environment in the transmission of resistant bacteria. It begins with an overview of antibiotic resistance and how easy it is to make bacteria resistant to penicillin in the laboratory. It then discusses how improper use of antibiotics can educate bacteria to become resistant and infect others. The document notes that any antibiotic use can lead to resistance and discusses some evolutionary advantages bacteria have over humans in developing drug resistance. It also presents a hypothetical case study of a MRSA outbreak in high school students and how one would investigate such an outbreak. Finally, it discusses major drivers of antibiotic resistance in the environment, including biocides, metals, and antibiotics themselves, as well as pathways by which resistance can spread environmentally through
Application of probiotics in complex treatment of tuberculosisIJERA Editor
The probiotic bacteria possessing ability to suppress growth of Mycobacterium B5 are revealed. Antagonistic
activity in selected strains studied during the growth on various nutrient media. Strains adapted to the low pH
exposure. They are steady against a number of the antibiotics, used at tuberculosis treatment. This testifies to the
prospects of further studies on the use of probiotics in the
This document discusses Methicillin Resistant Staphylococcus aureus (MRSA), an emerging veterinary pathogen. MRSA is a strain of Staphylococcus aureus that is resistant to certain antibiotics, including methicillin. It can cause serious infections in both humans and animals. MRSA has developed resistance through genetic mutations and the overuse of antibiotics, which places selective pressure on bacteria to evolve resistance. Diagnosis involves testing for antibiotic resistance through methods like agar dilution, broth microdilution, and disc diffusion tests.
History of the Forgotten Cure - Phage therapyStudent
1) The document provides a history of phage therapy, from its discovery in the late 19th/early 20th century to its decline with the rise of antibiotics and recent rediscovery due to antibiotic resistance. Key figures who discovered and explored phages and phage therapy include Ernest Hankin, Frederick Twort, and Félix d'Herelle.
2) It discusses how phage therapy works, involving using bacteriophages to treat bacterial infections. Advantages over antibiotics include phages' ability to self-replicate and adapt versus antibiotics being fixed molecules.
3) Problems that initially limited phage therapy are addressed, such as host range, bacterial debris in preparations, and lysogeny.
This document discusses the growing threat of antibiotic resistance and explores new approaches to combating resistance. It summarizes that antibiotic resistance arises through bacterial genetic changes and horizontal gene transfer in response to antibiotic stress. Integrons and mobile genetic elements play a key role in disseminating resistance genes between bacteria. The document also explores investigating inhibitors of resistance mechanisms like integrases and the SOS response to potentially prevent resistance. It highlights the increasing spread of resistant bacteria producing NDM-1 and other carbapenemases internationally.
This document discusses various types of multi-drug resistant bacteria including MRSA, VRSA, ESBL-producing bacteria, and KPC-producing bacteria. It provides details on the mechanisms of drug resistance, epidemiology, laboratory detection methods, and treatment recommendations for infections caused by these organisms. Specific topics covered include the worldwide spread of MRSA, mechanisms of methicillin and vancomycin resistance, diagnosis of MRSA and VISA/VRSA, and treatment options. The document also discusses the various beta-lactamase enzymes that confer ESBL and carbapenemase resistance, worldwide distribution of resistance, detection methods for ESBLs and KPC, and reliable drug options for treating ESBL and KPC infections.
Community-acquired respiratory tract infections (CARTIs) are common causes of illness that are difficult to treat due to a range of possible pathogens and increasing antibiotic resistance. Quinolones have evolved over generations to provide broad-spectrum activity against both gram-positive and gram-negative bacteria involved in CARTIs. They inhibit bacterial DNA replication and have excellent pharmacokinetic properties allowing once-daily oral or IV dosing. Clinical studies demonstrate that newer quinolones like moxifloxacin effectively treat CARTIs and reduce recovery time, hospital stays, and healthcare costs compared to other antibiotic regimens.
This document discusses optimizing therapy for vancomycin-resistant enterococci (VRE). It notes that enterococci infections have significantly increased in hospitals over the past two decades, often due to multidrug-resistant strains. Treatment options for VRE infections were limited until the development of newer antimicrobials like linezolid and daptomycin. However, resistance to even these newer drugs has emerged. The optimal treatment of VRE infections, especially endocarditis, remains unclear due to the lack of comparative clinical trials and the emergence of resistance to newer antimicrobials. Non-antimicrobial measures can help reduce treatment needs and resistance risk.
This document discusses antimicrobial resistance and its mechanisms. It defines key terms like minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC). It describes intrinsic and acquired resistance, as well as common pathways of resistance like blocking drug entry, enzymatic destruction, altering target sites, and efflux pumps. The major causes of antibiotic resistance are the abuse and overuse of antibiotics as well as alterations in microbial flora due to antimicrobial use. Examples of resistant organisms discussed include MRSA, VRE, ESBL producers, and penicillin-resistant pneumococci. Antibiotic sensitivity testing methods like dilution and disc diffusion techniques are also summarized.
Management of antibiotic resistance uploadAnimesh Gupta
This document discusses antibiotic resistance and its management. It defines antibiotic resistance as when microorganisms become resistant to drugs that previously treated infections from them. It outlines various mechanisms of antibiotic resistance in microorganisms and lists priority resistant bacteria. It also discusses superbugs and different strategies to manage antibiotic resistance like prudent antibiotic use, infection control, developing new drugs, and reducing agricultural overuse of antibiotics.
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.
This document discusses antibiotic resistance and its causes. It provides definitions of key terms like antibiotic resistance, antimicrobial resistance, intrinsic resistance, and acquired resistance. It notes that antibiotic resistance occurs when bacteria change in response to antibiotic use, and bacteria can become resistant through natural mechanisms or genetic mutations and plasmids. Examples are given of some common antibiotic-resistant bacteria like MRSA. The rise of superbugs like NDM-1 that are resistant to a broad range of antibiotics is also discussed. The document outlines steps taken by WHO and India to address the problem and provides recommendations for appropriate antibiotic use at the individual level.
This document discusses antibiotic resistance and its causes. It notes that antibiotic resistance occurs when bacteria change in response to antibiotic use, allowing bacteria to infect humans that are harder to treat. The overuse of antibiotics in humans, livestock, and agriculture contributes to resistance. Common resistant bacteria mentioned include E. coli, MRSA, and tuberculosis. The mobile gene NDM1 provides broad resistance and is a concern as it can spread between bacteria. Efforts to address resistance include WHO's Global Action Plan and surveillance system, as well as India's National Action Plan. Individuals can help by only taking antibiotics as prescribed and preventing infections.
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.
The document discusses antibiotic resistance and its causes. It notes that antibiotic resistance was first discovered in 1929 by Alexander Fleming and antibiotics were widely used starting in the 1940s. It then discusses how bacteria can become resistant to antibiotics through various mechanisms like denying antibiotic access, modifying the antibiotic target, or pumping antibiotics out of the cell. The document outlines factors that contribute to resistance developing, like improper antibiotic usage, lack of compliance with treatment durations, and overuse of broad-spectrum antibiotics. It provides examples of bacteria that have developed significant resistance issues, like E. coli becoming resistant to third-generation cephalosporins and MRSA developing vancomycin resistance. The document concludes that controlling antibiotic overuse and improving hygiene are important
The document provides a detailed review of antibiotics, including:
1) It traces the history of antibiotics from sulfonamides in the 1930s to newer drugs developed in response to increasing bacterial resistance in the 1960s and onward.
2) It describes different classes of antibiotics like beta-lactams (penicillins and cephalosporins) and summarizes the characteristics, uses, and limitations of representative drugs within each class.
3) It discusses the ongoing challenge of bacterial resistance developing to existing antibiotics and the need for prudent antibiotic use and new drug development to address this threat.
The variants of New delhiMetallo – lactamase-1: A Comparative Assessmentinventy
Research Inventy : International Journal of Engineering and Science is published by the group of young academic and industrial researchers with 12 Issues per year. It is an online as well as print version open access journal that provides rapid publication (monthly) of articles in all areas of the subject such as: civil, mechanical, chemical, electronic and computer engineering as well as production and information technology. The Journal welcomes the submission of manuscripts that meet the general criteria of significance and scientific excellence. Papers will be published by rapid process within 20 days after acceptance and peer review process takes only 7 days. All articles published in Research Inventy will be peer-reviewed.
Antibiotics
History and development of antibiotics
Decline of antibiotics
Bacteriophage: nature’s most abundant antibiotics
Phage specificity, resistance, transduction, lysis
Emergence of phages
Phage Case studies
Challenges to mainstream commercialization
Antimicrobial resistance as an emerging food-borne infectious diseaseJean Jacques Bernatas
This document summarizes the rise of antimicrobial resistance as a growing public health issue linked to overuse of antibiotics in agriculture. It discusses how non-therapeutic use of antibiotics as growth promoters in farm animals has led to widespread resistance in bacteria. Studies show resistant bacteria can spread between animals on a farm and from animals to nearby humans and environment even without antibiotic use. The overuse of antibiotics in medicine and agriculture has accelerated resistance by placing intense selective pressure on bacteria. Widespread antibiotic resistance now compromises treatment of bacterial infections in humans. Solutions proposed include restricting non-therapeutic antibiotic use in animals and more prudent antibiotic prescribing and use by medical professionals and consumers.
Challenges in the management of HAP-VAP include multidrug-resistant pathogens becoming more common. Combination antibiotic therapy is recommended for patients with risk factors for multidrug-resistant infections or septic shock. Newer beta-lactam/beta-lactamase inhibitor combinations such as ceftolozane-tazobactam and ceftazidime-avibactam show promise in treating resistant gram-negative bacteria including ESBL, AmpC, KPC, and OXA-48 producers.
Prevalence and Characterisation of Beta Lactamases in Multi Drug Resistant Gr...iosrjce
This document discusses a study on the prevalence and characterization of beta-lactamases in multidrug resistant gram-negative bacteria isolated from intensive care units (ICUs) in a tertiary care hospital in central India. The study aims to identify gram-negative pathogens from ICU specimens, determine antimicrobial resistance patterns and prevalence of ESBLs, AmpC, and carbapenemases through phenotypic and genotypic methods. A literature review found increasing antimicrobial resistance in ICUs due to selective pressure from antibiotic overuse. ICUs have high rates of multidrug resistant infections. The study aims to detect resistance genes and their co-existence to guide optimal treatment and infection control in ICUs.
Antibiotic prescription and bacterial resistanceMamdouh Sabry
- Overuse of antibiotics, especially in patients with fever of unknown origin, can lead to increased bacterial resistance. When antibiotics are used prudently and appropriately, it can minimize excess use and enhance selecting the right antibiotic for the susceptible bacteria in a given patient.
- As antibiotic prescriptions rise, so does bacterial resistance. Bacteria can develop resistance through mutations, acquiring genetic material from other bacteria, or through selective pressure from antibiotic use that favors resistant strains.
- To combat rising resistance, guidelines should be followed for proper antibiotic indication, culture collection, infecting organism identification, appropriate antibiotic selection, dose, duration and modification after culture results. Prudent antibiotic use can help preserve the effectiveness of our existing antibiotics
The document discusses emerging issues related to antibiotics resistance. It provides an overview of the history and modern discoveries of antibiotics. It then covers various applications of antibiotics, the causes of resistance, and strategies to track the global pipeline of antibiotics in development. It also addresses the threats of resistance, predicted impacts of resistance in terms of deaths and economic costs, and strategies to address the ongoing challenges of antibiotic discovery and resistance.
Pseudomonas aeruginosa is an opportunistic pathogen that is a leading cause of morbidity and mortality in cystic fibrosis patients and immunocompromised individuals. Eradication of P. aeruginosa has become increasingly difficult due to its remarkable capacity to resist antibiotics
Managing MDR/XDR Gram Negative infections in ICUVitrag Shah
The document discusses antimicrobial resistance and multidrug-resistant organisms. It notes certain organisms like Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species have developed resistance to multiple drug classes and have high mortality rates. It defines multidrug resistance, extensive drug resistance, and pan drug resistance based on the number of antimicrobial categories an organism is resistant to. Treating such infections requires less effective, more toxic, and expensive drugs. Combination therapy and optimizing dosing is important to prevent further resistance development.
Antimicrobial resistance has developed as a serious threat due to overuse and misuse of antibiotics. Key bacterial infections like pneumonia, meningitis and tuberculosis are showing resistance to first-line drugs. This results in prolonged illness, higher mortality and increased healthcare costs to use second and third-line drugs. Resistance develops through genetic mutations and transfer of genes between bacteria. Improving antibiotic use can help control the emergence and spread of resistance.
Similar to Combating Antimicrobial Resistance:Aminoglocisides Back To The Future (20)
This document summarizes the increasing problem of antibiotic resistance globally and in India specifically. It notes that over half of K. pneumoniae isolates screened in one study from 2009 were carbapenemase producers, with most being metallo-beta-lactamase producers. There was a significant rise from 2002-2009 in ESBL-producing E. coli and resistance to various antibiotics including carbapenems in K. pneumoniae. Carbapenem resistance is of serious concern as carbapenems are often a last resort for multidrug-resistant infections.
This document discusses universal access to tuberculosis (TB) care in India. It aims to educate private healthcare providers about TB control and notification under the Revised National Tuberculosis Control Programme (RNTCP). It emphasizes the importance of notifying every TB case to local authorities and provides multiple options for notification. It also summarizes the goals and objectives of RNTCP, which include reducing the burden of TB by providing universal access to care and detecting at least 90% of incident TB cases. The document discusses ensuring early diagnosis and treatment to reduce delays. It also covers diagnostic algorithms for pediatric TB and treatment regimens for new and previously treated cases.
The document discusses stress management and Ayurveda. It provides an introduction to Dr. Jitendra Nagpal, a senior psychiatrist who will lead an interactive webinar on the topic. The webinar will cover what stress is, its causes, the effects of prolonged stress, how to analyze and control stressors, and increasing motivation during under-stress periods. It will discuss stress at different levels, sources of stress, coping mechanisms, and stress awareness.
The document discusses factors that can influence doctor performance such as clinical competence, health issues, behaviors, and work context and provides data on the prevalence of performance problems among doctors in the UK, noting that most result from an interaction of factors rather than a single cause. It also outlines frameworks for investigating performance problems and managing them, emphasizing the need to understand multiple contributing factors rather than seeing the doctor as simply difficult.
This document discusses the case of a 7-year-old girl with a history of worsening asthma symptoms including daily coughing, shortness of breath, and awakening at night. Her family history includes maternal asthma and allergies in both parents. On exam she has nasal inflammation and mild wheezing. Based on her daily use of rescue inhalers and history of prednisone courses, her asthma is classified as moderate persistent. The document then reviews approaches for diagnosing and managing asthma of varying severity in children.
Lung Transplantation - Where we are and Where we are goingDoctors Republic
Overview of Lung Transplantation
Changing the practice of clinical lung transplantation
Ex vivo lung perfusion, personalized medicine for the organ, engineering "super organs"
This survey collected responses from 500 doctors across multiple specialties in India regarding their experiences treating pulmonary diseases. The survey found that 53% of doctors had previously prescribed empirical anti-tuberculosis treatment without a confirmed diagnosis. While 67% of doctors felt invasive testing was needed before starting ATT, only 43% believed there were trained surgeons available to perform such procedures. Most doctors agreed that increased training and adoption of new technologies were needed to better manage pulmonary diseases.
Low versus high haemoglobin concentration threshold for blood transfusion for...Doctors Republic
This Cochrane review summarizes evidence from randomized controlled trials comparing restrictive versus liberal transfusion thresholds for very low birthweight infants. The review found:
1) Using a restrictive threshold (lower hemoglobin level to trigger transfusion) modestly reduced transfusions and hemoglobin levels compared to a liberal threshold, with no differences in mortality or morbidity.
2) One trial found better cognitive outcomes at age 18-21 months using a liberal threshold, but this needs confirmation.
3) Using clinical signs rather than hemoglobin levels to guide transfusion had no effect on short-term outcomes.
4) Restrictive thresholds tested were generally 115 g/L for infants <7 days old on respiratory support and
Low versus high haemoglobin concentration threshold for blood transfusion for...Doctors Republic
This Cochrane review summarizes evidence from randomized controlled trials comparing restrictive versus liberal transfusion thresholds in very low birthweight infants. The review found:
1) Using a restrictive transfusion threshold (aiming for lower hemoglobin levels before transfusing) resulted in modest reductions in transfusions and hemoglobin levels compared to a liberal threshold, without increasing mortality or morbidity.
2) There was no difference in death, death or severe morbidity, or death or impaired neurodevelopment when comparing restrictive versus liberal transfusion protocols.
3) One study found better cognitive outcomes at 18-21 months for infants receiving the liberal protocol, but this finding needs confirmation.
4) Using clinical signs rather than hemoglobin levels
Low versus high haemoglobin concentration threshold for blood transfusion for...Doctors Republic
This Cochrane review summarizes evidence from randomized controlled trials comparing restrictive versus liberal transfusion thresholds for very low birthweight infants. The review found:
1) Using a restrictive threshold (lower hemoglobin level to trigger transfusion) modestly reduced transfusions and hemoglobin levels compared to a liberal threshold, with no differences in mortality or morbidity.
2) One study found better cognitive outcomes at age 18-21 months using a liberal threshold, but this finding needs confirmation.
3) Using clinical signs rather than hemoglobin levels to guide transfusion had no effect on short-term health outcomes.
4) Restrictive thresholds tested appeared safe down to certain hemoglobin levels, but safety below these levels
Low versus high haemoglobin concentration threshold for blood transfusion for...Doctors Republic
This Cochrane review summarizes evidence from randomized controlled trials comparing restrictive versus liberal transfusion thresholds for very low birthweight infants. The review found:
1) Using a restrictive transfusion threshold (aiming for lower hemoglobin levels before transfusing) resulted in modest reductions in transfusions and hemoglobin levels compared to a liberal threshold, without increasing mortality or morbidity.
2) There was no difference in short-term health outcomes when transfusions were guided by clinical signs rather than hemoglobin levels alone.
3) Restrictive thresholds used in the trials approximated 115 g/L for infants <7 days old on respiratory support, and 100 g/L for those not on support or older infants. Safety
Low versus high haemoglobin concentration threshold for blood transfusion for...Doctors Republic
This Cochrane review summarizes evidence from randomized controlled trials comparing restrictive versus liberal transfusion thresholds for very low birthweight infants. The review found:
1) Using a restrictive threshold (lower hemoglobin level to trigger transfusion) modestly reduced transfusions and hemoglobin levels compared to a liberal threshold, with no differences in mortality or morbidity.
2) One study found better cognitive outcomes at age 18-21 months using a liberal threshold, but this finding needs confirmation.
3) Using clinical signs rather than hemoglobin levels to guide transfusion had no effect on short-term health outcomes.
4) Restrictive thresholds tested in the trials approximated hemoglobin levels of 115 g/L for
The survey of 1940 pediatricians in India found that 61% observed more celebrations at the birth of baby boys. 52% saw that baby boys had more appropriate weight for their age. 57% clinically observed more malnutrition in girls. 41% found that parents were more inclined to breastfeed baby boys. 61% noticed that school dropouts were more common among baby girls.
5. Antimicrobial Resistance
AMR is the resistance of an microorganism to an
antimicrobial agent to which it was previously
sensitive.
AMR is the consequence of the use, particularly
the misuse, of antimicrobial medicines and
develops when a microorganism mutates or
acquires a resistance gene.
WHO fact sheet N* 194, March 2012
5
6. AMR is a natural biological
phenomenon
Once developed, resistance is usually irreversible or very
slow to reverse1
Resistance is a naturally occurring, continuous but slow
phenomenon1
Irrational use of antimicrobial agents accelerates AMR and
selects resistant sub-populations which soon become the
dominating member of the species1
1. Indian J Med Res. 2010 November; 132(5): 482–486
6
7. Factors for Antimicrobial Resistance
Most important cause is the inappropriate use of antimicrobials1
Too Short a Time
At Too Low a Dose
At Inadequate Potency or
For The Wrong Disease
Absence or non adherence of standard treatment guidelines1
High cost or Poor Access to medicines1
Failure to adhere to recommended regimen1
Self administration of drugs1
1. Indian J Med Res. 2010 November; 132(5): 482–486
7
8. Economic Impact of the Problem
2
Antibiotic resistance
increases the
economic burden
on the entire
healthcare system
Resistant infections
cost more to treat and
can prolong
healthcare use
2 http://www.cdc.gov/getsmart/
8
9. Status of Antibiotics Resistance:
Global and Indian Scenario
MRSA alone infects more than 94,000 people and kills
nearly 19,000 in the US every year (more deaths than are caused by
HIV/AIDS, Parkinson’s disease, Emphysema, and Homicide combined)3
Penicillin-resistant Streptococcal pneumoniae and
Vancomycin Resistant Enterococci (VRE) are more
frequently incriminated from many industrialized countries3
Some non-fermenter Acinetobacter and Pseudomonas are
resistant to all good antibiotics and many
Enterobacteriaceae are resistant to all except
carbapenems3
3. Vipin M Vashishtha. Growing Antibiotics Resistance and the Need for New Antibiotics. Indian Pediatr 2010;47: 505-506
9
10. Status of Antibiotics Resistance:
Global and Indian Scenario
Recent surveys have identified ESBLs in 70–90% of
Enterobacteriaceae in India4
The growing prevalence of ESBL producers is a worldwide
public health concern since there are few antibiotics in reserve
beyond carbapenems4
Already Klebsiella pneumoniae clones with KPC carbapenemase are a
major problem in the USA, Greece, and Israel, and plasmids encoding the
VIM metallo-carbapenemase have disseminated among K pneumoniae in
Greece4
4. Lancet Infect Dis 2010; 10: 597–602
10
11. Status of Antibiotics Resistance: Global
and Indian Scenario
10 years ago, concern centred on Gram +ve bacteria,
particularly MRSA (Methicillin Resistant Staph. Aureus) and
VRE (Vancomycin Resistant Enterococcus)4
Now, however, clinical microbiologists increasingly agree that
multidrug resistant Gram -ve bacteria pose the greatest
risk to public health4
Not only is the increase in resistance of Gram -ve bacteria faster
than in Gram +ve bacteria, but also there are fewer new and
developmental antibiotics active against Gram -ve bacteria4
4. Lancet Infect Dis 2010; 10: 597–602
11
13. Changing Resistance Patterns
Antimicrobial resistance patterns in Indian hospitals differ
from that reported in Western hospitals in having a high
prevalence of resistance among Gram -ve bacteria and a
much lower incidence of resistant Gram +ve bacteria5
Increase in resistance of Gram -ve bacteria is mainly due
to mobile genes on plasmids that can readily spread
through bacterial populations4
Moreover, unprecedented human air travel and migration
allow bacterial plasmids and clones to be transported
rapidly between countries and continents4
5. SUPPLEMENT TO JAPI. 2010 Dec; VOL. 58: 25-31 2. Lancet Infect Dis 2010; 10: 597–602
13
14. Much of this dissemination is undetected,
with resistant clones carried in the normal
human flora and only becoming evident
when they are the source of endogenous
infection
14
15. Percentage of Carbapenem Resistance amongst
ICU blood cultures from 2006-20096
6. Deshpande Payal et al. New Delhi Metallo-b lactamase (NDM-1) in Enterobacteriaceae: Treatment options with
Carbapenems Compromised. JAPI. 2010 March; VOL. 58:147-149
15
16. Resistance Profile of E. coli & Klebsiella
to 1st line Agents7
Well over 50% of E. coli and Klebsiella strains are resistant to commonly
used Gram -ve drugs
7. Varghese K George et al. Bacterial Organisms and Antimicrobial Resistance Patterns. Supplement to JAPI 2010
Dec; Vol 58: 23-24
16
17. Antimicrobial Resistance Rates of
E.coli in community acquired UTI8
N=208
=127
=81
8. Rani Hena et al. Choice of Antibiotics in Community Acquired UTI due to Escherichia Coli in Adult Age groupJournal of .
Clinical and Diagnostic Research. 2011 June, Vol-5(3): 483-485
17
18. Acinetobacter Baumannii
12
Acinetobacter species are aerobic gram -ve
coccobacilli that have emerged as important
opportunistic pathogens, especially among
critically ill patients9
In the last 2 decades, Acinetobacter baumannii
has become an important nosocomial pathogen
throughout the world, and is a major problem due
to multidrug resistance10
Acinetobacter sp are frequently encountered
agents responsible for Hospital Acquired
Pneumonia (HAP) especially the late onset
Ventilator associated Pneumonia (VAP)11
9. Lung India. 2010 Oct–Dec; 27(4): 217–220
10. Scandinavian Journal of Infectious Diseases, 2010; 42: 741–746
11. Annals of Thoracic Medicine-vol 5, issue 2, April-June 2010
12. CDC Fact Sheet. Get Smart About Antibiotics Week Monday, November 15, 2010. http://www.cdc.gov/getsmart/
18
19. Response of Acinetobacter species to
β lactam antibiotics13
PG: Penicillin
AM: Ampicillin
Am: Amoxicillin
PC: Piperacillin
CF: Cefotaxime
Ca: Ceftazidime
Ci: Ceftriaxone
CB: Cefuroxime
All A. baumannii isolates were resistant to penicillin and cefuroxime at 512-1024 μg/ml.
More than 90% isolates were resistant to ampicillin, amoxicillin, and piperacillin at 512-
1024 μg/ml
13. Indian J Med Res 128, August 2008, pp 178-187
19
20. Antimicrobial Resistance Pattern of
Klebsiellae pneumoniae14
Over 60% strains were resistant to chloramphenicol and tetracycline. 28 to 76% of
them were resistant to cephalosporins (ceftizoxime and cefotaxime)
14. Sikarwar S Archana. Challenge to healthcare: Multidrug resistance in Klebsiella pneumoniae. 2011 International
Conference on Food Engineering and Biotechnology IPCBEE vol.9 (2011) Pg. 130-134
20
21. Antimicrobial resistance rates of
Pseudomonas aeruginosa against
Penicillin group15
N=56
15. Javiya, et al.: Antibiotic susceptibility patterns of P. aeruginosa in Gujarat. Indian J Pharmacol . Oct 2008; Vol 40
:230-234
21
22. Antimicrobial resistance rates of
Pseudomonas aeruginosa against
Cephalosporin group15
N=56
The organism showed remarkable resistance against cephalosporin group of antibiotics, ranging from 67.86%
for ceftazidime to 94.64% for cephalexin
15. Javiya, et al.: Antibiotic susceptibility patterns of P. aeruginosa in Gujarat. Indian J Pharmacol . Oct 2008; Vol 40 :230-234
22
23. Is This The End Of The Road For
Antibiotics?
23
24. The Dying Antibiotic Development12
In the past, medicine and
science were able to
stay ahead of the natural
phenomenon of
resistance through the
discovery of potent new
antimicrobials
12. CDC Fact Sheet. Get Smart About Antibiotics Week Monday, November 15, 2010. http://www.cdc.gov/getsmart/
24
25. The 10 X „20 Initiative16
Launched by IDSA (Infectious Diseases Society of America)
Global Commitment to Develop 10 New Antibacterial Drugs by
2020
Recent reports demonstrate that there are few candidate drugs
in the pipeline that offer benefits over existing drugs and few
drugs moving forward that will treat infections due to the so-
called “ESKAPE” pathogens(Enterococcus faecium, Staphylococcus
aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa,
and Enterobacter sp.)
16. Clinical Infectious Diseases 2010; 50:1081–1083 25
27. Resurgence of Aminoglycosides
Aminoglycoside antibiotics are bactericidal drugs that have been at the
forefront of antimicrobial therapy for almost five decades17
Aminoglycosides were widely used in empirical therapy throughout the
1970s and much of the 1980s17
With the advent of broad-spectrum β-lactams (e.g., 3rd and 4th
generation cephalosporins; β-lactam and β -lactamase inhibitor
combinations, such as piperacillin and tazobactam; and
carbapenems, such as imipenem plus cilastatin and
meropenem) and fluoroquinolones, use of aminoglycosides
decreased17
17. Clinical Infectious Diseases 2007; 45:753–60
27
28. Resurgence of Aminoglycosides
In the era of increasingly MDR Gram -ve bacilli, it is important
and often necessary to consider aminoglycosides for
treatment18
MDR Pseudomonas and Acinetobacter infections, as well as infections
caused by ESBL Enterobacteriaeceae sp., are often resistant to most or
even all of the newer agents. Frequently, only the aminoglycosides and
the polymyxins are available for therapy17
Multiple studies have demonstrated the ability to improve the
appropriateness of empirical β-lactam therapy by ∼15% with
the addition of an aminoglycoside18
17. Clinical Infectious Diseases 2007; 45:753–60
18. Antimicrobial Agents And Chemotherapy, June 2010, p. 2750–2751
28
29. Aminoglycosides:
Historical Perspective
Discovery of Streptomycin by Waksman in 1944 initiated Aminoglycosides in
current clinical use19
the era of aminoglycoside antibiotic therapy19
In the 50 years since their discovery, aminoglycosides
have seen unprecedented use20
They were the long-sought remedy for tuberculosis and
other serious bacterial infections20
Side effects of renal and auditory toxicity, however, led to
a decline of their use in the 70s & 80s20
19. International Journal of Antimicrobial Agents 10 (1998) 95–105
20. Audiol Neurootol 2000;5:3–22
29
30. Chemical structure &
Characteristics
Aminoglycosides are low-MW molecules (approx 300–600 daltons)20
Share a similar structure consisting of several, (usually 3) rings20
Hallmark is the presence of amino groups and a hydroxyl group attached to the
various rings which convey the major chemical properties, namely high water
solubility and a basic character20
They are basic, strongly polar compounds that are positively charged (cationic)19
They are highly soluble in water, relatively insoluble in lipids, and have enhanced
antimicrobial activity in alkaline rather than acidic environments19
19. International Journal of Antimicrobial Agents 10 (1998) 95–105
20. Audiol Neurootol 2000;5:3–22
30
31. Chemical structure &
Characteristics19
Aminoglycosides are minimally absorbed from the gut and penetrate the blood–
brain barrier poorly, even when inflammation is present
However, higher concentrations are achieved in synovial fluid, bone, and
peritoneal fluid. They achieve excellent urinary concentrations, typically 25–100
times that of serum
They are excreted unchanged in the urine. Therefore, their half-life is
determined primarily by renal clearance.
They have a relatively narrow therapeutic-to toxic ratio, emphasizing the
need to monitor antibiotic concentrations
19. International Journal of Antimicrobial Agents 10 (1998) 95–105
31
32. Advantages and Disadvantages of
the Aminoglycosides
•Relatively narrow therapeutic
Ratio
•Nephrotoxicity, Ototoxicity, NM
•Familiarity among physicians blockade (rare)
•Broad spectrum of activity •Poor penetration into certain
•Rapid bactericidal action body fluids such as CSF and bile
•Relatively low cost •Lack of enteral absorption
•Chemical stability •Biologic distribution affected by
•Rare association with allergic certain host factors
reactions •Inactivity against anaerobes
•Synergism with β-lactam
antibiotics and vancomycin
32
33. Nephrotoxicity
Aminoglycosides fell out of favor in the 1980s with the advent
of broad spectrum β-lactams, such as carbapenems & broad
spectrum cephalosporins, as well as β-lactams combined with
β-lactamase inhibitors. Part of the move away from the
aminoglycosides came from their nephrotoxicity18
Aminoglycoside toxicity is driven by the uptake by proximal
renal tubular epithelial (PRTE) cells of aminoglycosides from
their luminal surface17
Key issue here is that the uptake is saturable17
17. Clinical Infectious Diseases 2007; 45:753–60
18. Antimicrobial Agents And Chemotherapy, June 2010, p. 2750–2751
33
34. Nephrotoxicity20
Administering the drug once daily instead of in divided doses leads to
slower uptake in the PRTE cell
This means that for any specific duration of therapy, there will be less
aminoglycoside toxicity, when daily administration is employed
Daily administration, by decrementing the likelihood of
toxicity, allows higher doses to be employed with more
acceptable probabilities of toxicity
20 Antimicrobial Agents And Chemotherapy, June 2011, p. 2528–2531
34
35. Comparative Nephrotoxicity
Despite their structural similarities
Aminoglycosides have different affinities
towards brush border membrane of the tubular
cells
This is due to the number of free amino
groups in the chemical structure
Netilmicin has the least number of free
amino groups (3) has the lowest binding
affinity
Ref: Data on file
35
37. Optimization of Aminoglycoside
Therapy21
Aminoglycoside optimization of dose can be defined as the
dose having the highest likelihood of a good outcome and the
lowest likelihood of toxicity
A method for explicitly evaluating ∆ (optimization function) for
different daily doses of drug and different schedules of
administration was developed in the study by Drusano et al.
The metric ∆ is simply the difference between the likelihood of
a good clinical effect and the likelihood of toxicity, with higher
values being better
21. Drusano G.L. and Arnold Louie. Optimization of Aminoglycoside Therapy. Antimicrobial Agents And Chemotherapy, June
2011, p. 2528–2531
37
38. Optimization of Aminoglycoside
Therapy21
Optimization of empirical aminoglycoside therapy with administration every 12 h
Optimization of empirical aminoglycoside therapy with daily administration
Drusano G.L. and Arnold Louie. Optimization of Aminoglycoside Therapy. Antimicrobial Agents And Chemotherapy, June
2011, p. 2528–2531
38
39. Comparative Ototoxicity
Study* comparing the Ototoxicity of Amikacin, Tobramycin & Netilmicin, where
Netilmicin was the least ototoxic in comparison to Amikacin & Tobramycin
22. Gatell JM, Ferran F, Araujo V, et al. Univariate and multivariate analyses of risk factors predisposing to auditory toxicity in patients
receiving aminoglycosides. Antimicrob Agents Chemother. 1987;31:1383-7.
39
41. Antimicrobial Susceptibility of
Isolates from Neonatal Septicemia24
Study Design: Retrospective Analysis study of major aerobic bacterial
isolates from cases of neonatal septicemia at the
Government Medical College Hospital, Chandigarh
Patients: 3,064 blood samples for blood culture were obtained from
neonates over a period of 5 years
Primary Endpoint: To determine the bacterial profile, the antimicrobial
susceptibility of the isolates, and the change in trends over
the 5 year study period
Conclusion: Predominant organism was S. aureus. (35.3%)
Most isolates of S. aureus were resistant to
ampicillin/amoxycillin
Netilmicin was found to be the drug of choice
against S.aureus
24. Agnihotri N, Kaistha N & Gupta V. Jpn J Infect Dis 2004;57:273-5
41
42. Prophylactic role of Netilmicin in
Genitourinary surgery25
Study Design: Prospective, randomized, comparative study of 50 patients undergoing
elective urinary or genital surgery.
Design: Group A (Study Group)-received single dose of netilmicin sulphate 300
mg i.m., 1 hour prior to surgery
Group B (Control Group)-received the first dose of ampicillin sodium 500
mg and of gentamicin sulphate 80 mg i.m. 1 hour prior to surgery and
then, ampicillin sodium 500 mg at 6 -hour intervals and gentamicin
sulphate 80 mg i.m. twice a day for 5 days postoperatively.
Primary Endpoint: To evaluate netilmicin sulphate as a prophylactic antibiotic in
genitourinary surgery and to compare its clinical efficacy and safety with
ampicillin sodium and gentamicin sulphate
Result: None of the patients in the group receiving netilmicin suffered
from UTI post-operatively in comparison to three patients in the
ampicillin and gentamicin group (p <0.05)
None of the patients who received Netilmicin preoperatively
developed any Tinnitus, Hearing impairment, Vertigo or Allergic
reactions
25. Bajaj J, Singh SJ & Bedi PS. Indian J Pharmacol 2007;39(2):121-2.
42
43. Sensitivity pattern of microorganisms (%) isolated from
different specimens obtained from patients admitted in
ICUs 26
Acinetobacter was found
to be multidrug-resistant
and sensitive only to
Netilmicin in 45.5%
isolates
E. Coli was 100%
sensitive to Imepenem,
Meropenem, & Netilmicin
26. Sharma PR & Barman P. Antimicrobial consumption and impact of "Reserve antibiotic indent form" in an intensive care unit. Indian J
Pharmacol 2010;42(5):297-300
43
44. Low and stable resistance pattern of Netilmicin to P.
aeruginosa in LRTI over a period of 3 years as compared
to other antibiotics27
Trends in antimicrobial resistance pattern of P. aeruginosa during 2006–2009 (in %age) (Phase II)
100
90
80
70
60
50
40
30
20
10
0
CTX CTa CTi AC G AK CF Mr PC PT Az NT Of
2006–2007 2007–2008 2008–2009
CTX = Ceftriaxone, CTa = Ceftazidime, CTi = Ceftizoxime, AC = Amoxy-Clav, G = Gentamicin, AK = Amikacin, CF = Ciprofloxacin, Mr
= Meropenem, PC = Piperacillin, PT = Piperacillin tazobactom, Az = Aztreonam, NT = Netilmycin, Of = Ofloxacin
27. Gagneja D, Goel N, Aggarwal R, Chaudhary U. Changing trend of antimicrobial resistance among gram-negative bacilli isolated from
lower respiratory tract of ICU patients: A 5-year study. Indian J Crit Care Med 2011;15:164-7
44
45. Resistance pattern of E. coli to various
antibiotics28
28. Journal of Clinical and Diagnostic Research. 2011 June, Vol-5(3): 486-490
45
46. Netilmicin: Effective and Safest
Aminoglycoside29
Netilmicin has a lower potential for ototoxicity and
nephrotoxicity than the other aminoglycosides
Single dose regimen (SD) of Netilmicin is as effective as the
multiple dose regimen (MD) in the eradication of gram-negative
bacteria and the treatment of systemic infections
An effective and safe single dose regimen of Netilmicin may
permit the outpatient management of some systemic infections,
thus avoiding the cost and inconveniences of hospitalization
29 Limson BM, Genato VX and Yusi G. A Randomized Multicenter Study of the Single Daily Dose Regimen Vs. the Multiple Daily
Dose Regimen of Netilmicin in the Treatment of Systemic Infections. Phil J Microbiol Infect Dis 1989; 18(2):47-52
46
47. Spectrum of Netilmicin30
• E. coli, Klebsiella-Enterobacter-Serratia group,
Citrobacter
• Proteus sp. (indole +ve and indole -ve), including Proteus
mirabilis, P. morganii, P. rettgeri, P. vulgaris,
• Pseudomonas aeruginosa and Neisseria gonorrhoea
Gram –ve • Hemophilus influenzae, Salmonella sp., Shigella sp.
organisms : • Acinetobacter sp
• Penicillinase and non-penicillinase-producing
Staphylococcus including methicillin-resistant strains
(MRSA)
Gram +ve • Some strains of Providencia sp., and Aeromonas sp. are
organisms also sensitive
30. Netromycin Prescribing Information.
47
49. Conclusion31
By all accounts, Aminoglycosides, antibiotics with a rich history, are
experiencing a renaissance
Never having been completely abandoned in the clinic thanks to their
highly desirable antibacterial spectrum, they increasingly fill emerging
needs
Mounting bacterial resistance to other mainstay drugs require
aminoglycosides for successful chemotherapy
The utility of aminoglycosides against resistant bacteria stems in part
from their relatively restrained use during the last decades lowering the
development of global resistance to them
31. Xie, J., Talaska A. and Schacht J., New developments in aminoglycoside therapy and ototoxicity, Hearing
Research 2011; 281. 28-37
49
50. Looking ahead at the problem
of Antimicrobial Resistance
No single strategy can solve the antibiotic resistance problem; a
multi‐pronged approach is required
Emphasize appropriate use of the antibiotics that are currently
available
Educate everyone about the growing threat of antibiotic resistance
and the appropriate use of antibiotics
Patients, healthcare providers, hospital administrators, and policy
makers must work together to employ effective strategies for
improving appropriate antibiotic use – ultimately saving lives
50
Ref: 1. AMR WHO FAQ2. Indian J Med Res. 2010 November; 132(5): 482–486The use of an antimicrobial for any infection, in any dose and over any time period, causes a “selective pressure” on microbial populations. Under optimal conditions, the majority of the infecting microbes will be killed and the body’s immune system can deal with the rest. However, if a few resistant mutants exist in the population under selective pressure and the treatment is insufficient or the patient is immunocompromised, the mutants can flourish. Thus treatment may fail.
U.S. Antibiotic resistant infections are responsible for: • $20 billion in excess healthcare costs • $35 billion in societal costs • 8 million additional hospital days
Growing antibiotic resistance is a global phenomenon in both developed and developing countries. Penicillin-resistant Streptococcal pneumoniae and Vancomycin Resistant Enterococci (VRE)are more frequently incriminated from many industrialized countries forcing frequent changes of recommendations of management of diseases caused by these bugs1NDM-1 can render powerful antibiotics, which are often the last defence against multi-resistant strains of bacteria, ineffectiveRef: 1. Vipin M Vashishtha. Growing Antibiotics Resistance and the Need for New Antibiotics. Indian Pediatr 2010;47: 505-506
The growing prevalence of ESBL producers is sufficient to drive a greater reliance on carbapenems. Consequently, there is selection pressure for carbapenem resistance in Enterobacteriaceae, and its emergence is a worldwide public health concern since there are few antibiotics in reserve beyond carbapenems1Ref: 1.Lancet Infect Dis 2010; 10: 597–602ESBL: extended-spectrum β-lactamase
Bacteria from clinical and non-clinical settings are becoming increasingly resistant to conventional antibioticsRef: Lancet Infect Dis 2010; 10: 597–602MRSA: Meticillin-resistant Staphylococcus aureus
DeshpandePayal et al. New Delhi Metallo-b lactamase (NDM-1) in Enterobacteriaceae: Treatment options with Carbapenems Compromised. JAPI. 2010 March; VOL. 58:147-149
Ref: Ref: Varghese K George et al. Bacterial Organisms and Antimicrobial Resistance Patterns. Supplement to JAPI 2010 Dec; Vol 58: 23-24Data from almost 11,000 samples with a positive yield in almost a third clearly confirm as is well known that Gram negative bacilli are the commonest cause of UTI’s (90%). E.coliaccounted for two-thirds of the gram negative isolates followed by Klebsiella in 18% and Pseudomonas in 8.4%.
A high resistance was seen for beta lactam antibiotics. A very high resistance was seen not only for ampicillin (aminopenicillin) but also for amoxycillin+clavulanic acid which is the combination of aminopenicillin with beta lactamase inhibitor and also a costlier drug. Resistance rate for third generation cephalosporins was significantly high which is indicative of production of extended spectrum beta lactamase (ESBLs) enzyme by the isolates from community.
Ref: 1. Lung India. 2010 Oct–Dec; 27(4): 217–2202. Scandinavian Journal of Infectious Diseases, 2010; 42: 741–7463. Annals of Thoracic Medicine-vol 5, issue 2, April-June 20104. CDC Fact Sheet. Get Smart About Antibiotics Week Monday, November 15, 2010. http://www.cdc.gov/getsmart/
K.pneumoniae strains from clinical cases were found highly susceptible to quinolones and aminoglycoside, amikacin and gentamycin. At the same time over 60% strains were found resistant to chloramphenicol and tetracycline. Twenty-eight to 76% of them were resistant to cephalosporins (ceftizoxime and cefotaxime).
Ref: CDC Fact Sheet, Get Smart About Antibiotics Week Friday, November 19, 2010. http://www.cdc.gov/getsmart/
Ref: 1. International Journal of Antimicrobial Agents 10 (1998) 95–1052. Audiol Neurootol 2000;5:3–22
Ref: 1. AudiolNeurootol 2000;5:3–222. International Journal of Antimicrobial Agents 10 (1998) 95–105A knowledge of aminoglycoside structure is important in understanding their chemical properties
Ref: International Journal of Antimicrobial Agents 10 (1998) 95–105
Ref: 1. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, June 2010, p. 2750–27512. Clinical Infectious Diseases 2007; 45:753–60Less frequent aminoglycoside administration would result in less aminoglycoside uptake and, ultimately, a lower rate of nephrotoxicity occurring during reasonably short courses of therapy
Ref: ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, June 2011, p. 2528–2531Less frequent aminoglycoside administration would result in less aminoglycoside uptake and, ultimately, a lower rate of nephrotoxicity occurring during reasonably short courses of therapy
Once a day dosing results in less drug accumulation and Netilmicin has the lowest binding affinity to the renal proximal tubular cell
The ∆ has an optimal value of 74.8 at an MIC value of 0.25 mg/liter, and the values decline to 69.4 and 55.3 at 0.5 and 1.0 mg/liter, respectively, with 2.0 and 4.0 mg/liter attaining values of 39.5 and 29.0, respectively, because of decrementing values of response probability. Of interest, the ∆ gets considerably worse, on average, when the dose is increased to 7 mg/kg (19.9 at 2.0 mg/liter and 6.5 at 4.0 mg/liter) or 10 mg/kg (∆=0 at both MIC values), even though there is a marginal increase in the response probability. This is because of the increase in mean nephrotoxicity probability at higher doses. In contrast, daily dosing, demonstrates that the 10-mg/kg dose provides an 80% probability of response, even for an MIC of 4.0 mg/ liter, with a negligible likelihood of toxicity.Nephrotoxicity was defined as an increase in the baseline serum creatinine concentration of 0.5 mg/dl or a 50% increase, whichever was greater, on two consecutive occasions any time during therapy or up to 1 week after the cessation of therapy
Incidence of vestibular toxicity is 10.9% for Gentamicin, 7.4% for Amikacin, 3.5% for Tobramycin, and 1.1% for Netilmicin
Ref: Agnihotri N, Kaistha N & Gupta V. Antimicrobial susceptibility of isolates from neonatal septicemia.Jpn J Infect Dis 2004;57:273-5.
i.m. : intramuscularly
In isolates from pus and exudates, the maximum resistance was observed for ampicillin 97(96.0%), followed by cotrimaxazole 84(83.2%), ciprofloxacin 69(68.3%), gentamicin 68(67.3%), amikacin 45(44.6%), cefotaxime 44(43.6%), and netilmicin 23(22.8%)
Ref: 1: Phil J Microbiol Infect Dis 1989; 18(2):47-52
No single strategy can solve the antibiotic resistance problem; a multi‐pronged approach is required Because it will be many years before new antibiotics are available to treat some resistant infections, we must do a better job of emphasizing appropriate use of the antibiotics that are currently available We must educate everyone about the growing threat of antibiotic resistance and the appropriate use of antibioticsPatients, healthcare providers, hospital administrators, and policy makers must work together to employ effective strategies for improving appropriate antibiotic use – ultimately saving lives