Antibiotics have negative impacts including allergic reactions, side effects from suppression of normal flora, development of antibiotic resistance, drug interactions, and environmental hazards. Long-term issues include the economic burden of resistance on healthcare systems and society, as well as profits realized by pharmaceutical companies from continued antibiotic development and use. Proper disposal of unused antibiotics is important to limit environmental pollution and further development of resistance.

1. negative impacts of antibiotics
Presented by:
Mshaan H. AL-Bgomi

2. outline
• Intro. to Antibiotics.
• Negative Impact.
– Allergy.
– Side Effect.
– Suppression of normal flora
– Resistance.
– Interaction.
– economic burden of antimicrobial
– Companies profits
– Environmental Hazards
• Disposal of antibiotics

3. Antibiotics
• Antibiotics or antibacterials are a type of
antimicrobial used in the treatment and
prevention of bacterial infection.
• Classify
– Action on bacteria
– Spectrum
– Mechanism of action

4. Action on bacteria
• Bacteriostatic:
– inhibits the RNA
synthesis/reproduction Inhibit
growth and reproduction of
bacteria Help the host defenses
to take over
• Bactericidal:
– disrupts the cell wall synthesis-
killing the bacteria Less reliance
on host resistance Drug works
faster than static

5. Spectrum
• Broad spectrum:
– antibacterials are active against both
Gram+ve and Gram-ve organisms.
• Narrow spectrum:
– antibacterials have limited activity
and are primarily only useful against
particular species of
microorganisms.

6. Mechanism of action

7. Negative Impact
– Allergy.
– Side Effect.
– Suppression of normal flora
– Resistance.
– Interaction.
– economic burden of antimicrobial
– Companies profits
– Environmental Hazards

8. Allergy
• Allergic drug reaction, is an adverse drug reaction that results
from a specific immunologic response to a medication.
– Pruritus
– Flushing
– Urticaria
– Angioedema
– Bronchospasm
– Laryngeal edema
– Abdominal distress
– Hypotension

9. Side Effect
• Penicillin's – allergy reaction, anaphylaxis
• Cephalosporin's - allergy reaction, cross reaction
with penicillin
• Tetracycline's – Photosensitivity, permanent
discoloration of the teeth
• Aminoglycosides – ototoxic, nephrotoxic
• Carbapenems – Seizures (especially with imipenem)
Confusion

10. Side Effect
• Macrolides – liver toxicity. GI disturbances,
• Glycopeptide – Ototoxicity, Nephrotoxicity
• Sulfonamides & trimethoprim – GI disturbances –
Photosensitivity
• Metronidazole & tinidazole – GI discomfort,
Headache, depression
• Quinolones – nausea, vomiting, and diarrhea

11. Suppression of normal flora
• normal flora
– Microorganisms that live on or in human bodies,
and ordinarily do not cause human diseases
• Physiological Role of normal flora
– Antagonism: acts as colonization resistance of exogenous
pathogenic microbes
– Trophism: Normal flora in the intestinal tract synthesize
nutrients that can be absorbed
– Immunoenhancement: Normal flora promotes the
development of local lymphatic tissues

12. Resistance
1. Spontaneous Mutation:
happen as cells replicate and acquired resistance.
2. Gene Transfer or Transferred resistance
conjugation

14. Resistance

15. Antibiotics promote resistance
• If a patient taking a course of antibiotic treatment does not
complete it
• Or forgets to take the doses regularly,
• Then resistant strains get a chance to build up
• The antibiotics also kill innocent bystanders bacteria which are
non-pathogens
• This reduces the competition for the resistant pathogens
• The use of antibiotics also promotes antibiotic resistance in
non-pathogens too
• These non-pathogens may later pass their resistance genes on
to pathogens

17. Resistant Infections are Dangerous
• Medication toxicity (side effects)
• Contagious
• Can pass resistance to other organisms
• Worst Case Scenario: The infection may
become resistant to all medications
(untreatable).

18. Interaction
• Alter the normal flora in intestine necessary
for contraceptive abs.
• Increase or inhibit CYP enzymes in liver
changing plasma conc. Of drugs
– Warfarin, digoxin, theophylline.
• Plasma protein binding

19. economic burden of antimicrobial
• The economic impact of antimicrobial resistant
organisms can be assessed from a number of different
perspectives, including that of society, the hospital, a
third-party payer, a government agency and the
patient.
• The total cost of antimicrobial resistance in the USA
is estimated to be approximately US$30 billion
annually

20. economic burden of antimicrobial
• due to the need for the use of more expensive
drugs for second line treatment
• longer stays in hospital
• as well as longer sick leave or even premature
death.

21. Ref. Clinical and
economic burden
of antimicrobial
resistance
Anti Infect. Ther.
6(5), 751–763
(2008)
Costs of treatmen

22. Representative reports of attributable costs, excess lengths of stay
and risk of mortality associated with various antimicrobial-
resistant pathogens.

23. • Treatment failure is the main contributor
to increased costs and can lead to:
1. additional investigations such as laboratory tests and
X-ray examinations
2. additional or alternative treatments, often much more
expensive than drugs used to treat infections caused
by sensitive organisms
3. additional side-effects from more toxic treatments,
which have to be managed
4. longer hospital stay
5. longer time off work
QUALITATIVE CONSEQUENCES
OF RESISTANCE

24. 6. reduced quality of life
7. greater likelihood of death due to inadequate or
delayed treatment
8. increased burden on family of infected individual
9. increases in private insurance coverage
10. additional cost for hospital when hospital- acquired
infection occurs and infection control procedures
are required
QUALITATIVE CONSEQUENCES
OF RESISTANCE

25. 11. increased cost of disease surveillance
12. increased costs to firms of absenteeism
13. possible increase in product prices due to increased
costs to firms
• These consequences, however, relate only to
the direct (and some indirect) impacts of
resistance itself.
QUALITATIVE CONSEQUENCES
OF RESISTANCE

26. Learning from examples
• In 2014, UK prime minister David Cameron set
up the Antimicrobial Resistance Committee,
chaired by Jim O’Neill
“Without new antibiotics, cumulative cost to the
global economy by 2050 could be as much as $100
trillion. (For comparison, the total global GDP in
2014 was some $77 trillion.).He suggests that we
could buy ourselves out of an antibiotic-resistant
world by investing about $40 billion in research
over the next 10 years.”

27. Companies profits
• Pharmaceutical companies have developed the vast
majority of medicines known to humankind, but they
have profited handsomely from doing so

28. Companies profits
World's largest pharmaceutical firms
Company
Total revenue
($bn)
R&D spend
($bn)
Sales and
marketing
spend($bn)
Profit ($bn)
Profit margin
(%)
Johnson &
Johnson (US)
71.3 8.2 17.5 13.8 19
Novartis
(Swiss)
58.8 9.9 14.6 9.2 16
Pfizer (US) 51.6 6.6 11.4 22.0 43
Hoffmann-La
Roche (Swiss)
50.3 9.3 9.0 12.0 24
Sanofi
(France)
44.4 6.3 9.1 8.5 11
Merck (US) 44.0 7.5 9.5 4.4 10
GSK (UK) 41.4 5.3 9.9 8.5 21
AstraZeneca
(UK)
25.7 4.3 7.3 2.6 10
Eli Lilly (US) 23.1 5.5 5.7 4.7 20
AbbVie (US) 18.8 2.9 4.3 4.1 22

29. Environmental Hazards
• Pollution by antibiotic resistance genes can increase the
chances of human pathogens for acquiring resistance.
The release of residues containing human microbiota
into environments containing bacteria enriched in
resistance elements increases the possibility of
acquiring novel resistance determinants by human-
linked bacteria. For this reason, it has been proposed
that the release of residues from hospitals that contain
human commensal and infective bacteria (resistant and
susceptible) as well as antibiotics, should be reduced to
a minimum to avoid interchange of genetic material

30. Disposal of antibiotics
• Quantities of AB despenced to patient should
be enough for the trearment course, not more
not less!!
• According to WHO disposal of AB is in two
forms
– Solid AB:
• Crushed then incinerate
– Liquid AB:
• Diluted then sewage disposal.