Antimicrobial resistance (AMR) occurs when microbes become resistant to antimicrobial drugs like antibiotics, antifungals, and antivirals. AMR happens through genetic mutations that make microbes impervious to standard drug doses. The overuse and misuse of antimicrobials, including taking leftover drugs and not completing full treatment courses, are major causes of growing AMR. As AMR increases, infections become harder and more expensive to treat, and some "wonder drugs" become obsolete. Public health strategies aim to slow AMR through prudent antimicrobial use, developing new drugs, and limiting over-the-counter drug access.

1. Antimicrobial Resistance
AMR

2. Antibiotic
Antifungal
AnthelminthicAntiprotozoal
Antiviral
ANTIMICROBIAL AGENTS

3. How antibiotics work
-Bactericidal :
Kills the bacteria.
-Bacteriostatic :
Prevents the bacteria from dividing.

4. Antibiotics spectrum
-Broad Spectrum :
Kills a wide range of bacteria.
-Narrow Spectrum :
Kills a specific type or group of bacteria.

5. Anaerobes
G-veG+ve

6. What is AMR ?
Its unresponsiveness to antimicrobial
agents in standard doses.

7. Mechanisms of AMR
1-Killing good Bacteria/Normal flora.
2-Modifications(Mutations) within the Bacteria
itself that are transmissible.

11. Causes of AMR
Related to Physicians:
-Standard treatment guidelines not
provided or provided but not adhered
to.

12. Causes of AMR
Related to Patients :
-Self-prescription and over the counter
antibiotics.
-Poor compliance and Misuse.
-Overuse.

13. Causes of AMR
Related to Health system :
-Antibiotics available without
prescription.
-Antibiotics prescribed by others.

14. WHO 2011
-50% of antibiotics in hospitals are
prescribed inappropriately.
-50% of patients have poor compliance.

15. Costs of AMR
-Longer duration of illness.
-Longer treatment.
-Longer hospitalization.
-Higher morbidity and mortality rates.
-Cheap antimicrobials become ineffective.
-Need expensive drugs ( if available) and finance.
-Patients act as reservoir of resistant organisms
which are transmissible to others.
-Need to develop new antimicrobials.

16. WHO 2011

17. How to decrease AMR ?
Related to Physicians :
-Continuous self-education.
-Adhere to the evidence-based antibiotic
guidelines and policies.
-Rationalize the use of available
antimicrobial agents.

18. How to decrease AMR ?
Related to Patients :
-Only take antibiotics prescribed by a
doctor
-If prescribed antibiotics, finish the course.
-Do not use other people’s or leftover
antibiotics.

19. How to decrease AMR ?
Related to Health system :
-Establishment of national alliances against AMR
-Regulatory Surveillance and researches.
-Restrictions on over-the-counter sale of
antimicrobial agents
-Educating for adherence to recommended
regimen.
-Discover new drugs.

20. How to decrease AMR ?
Related to Health system :
-If possible , take cultures before initiating
empirical (blind) antibiotic therapy , and streamline
antibiotic treatment based on the culture results.
-If not possible , then appropriate selection of initial
empirical antibiotic therapy..
-Consulting infectious disease physicians,
microbiologists , pharmacists.

21. Antibiotic associated diarrhea
• Higher incidence in Antibiotic misusers.
• Occur when C.difficele replace normal gut
flora that has been compromised following
antibiotic treatment for unrelated infection.
• Range from mild to life threatening.
• Killed about 29,000 people in USA in 2011.

22. EAAD – 18 November
European Antibiotic Awareness Day :
a campaign to promote prudent use of
antibiotics.

23. 2002 2007
Methicillin-resistant Staphylococcus aureus (MRSA)
No data
<1%
1-5%
5-10%
10-25%
25-50%
>50%
Source: European Antimicrobial Resistance Surveillance System (EARSS), 2008.
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