When bacteria resist the effects of an antimicrobial agent, it is referred to as resistant.
If a bacterial strain is exceedingly resistant to almost every known/antibiotics available, it is informally called “a superbug” or “a super bacterium” implying a super fighter against antimicrobial agents (Reinhardt, 2010).
Antimicrobial resistance occurs when microbes evolve a mechanism that protects them from the effects of antimicrobials or antibiotics. Antibiotic resistance is a subset of antimicrobial resistance, as it applies to bacteria that become resistant to antibiotics. Resistant microbes are more difficult to treat, requiring higher doses, or alternative medications that may prove more toxic.
The Johns Hopkins Center for a Livable Future Capitol Hill Briefing: Antibiot...Johns Hopkins University
On 12/2/09 on Capitol Hill, leading experts in economics, public health and public policy and Rep. Louise Slaughter (D-NY), a leading voice on antibiotic resistance, discussed the impact of resistant infections on the U.S. healthcare system and the need to phase out inappropriate use of antibiotics as growth promoters in the production of food animals. The Johns Hopkins Center for a Livable Future (CLF) hosted the event with Rep. Slaughter. This is a complication of the panelists' presentations.
updated statistics about antimicrobial resistance,causes and mechanism of antimicrobial resistances, national antimicrobial policy, national antimicrobial surveillance, new delhi b metallo-lactamase-1 bacteria
Please find the power point on Antimicrobial resistance. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Dr. Cyril Gay - Alternatives to AntibioticsJohn Blue
Alternatives to Antibiotics - Dr. Cyril Gay, Senior National Program Manager, USDA Agricultural Research Service (ARS), from the 2017 NIAA Annual Conference, U.S. Animal Agriculture's Future Role In World Food Production - Obstacles & Opportunities, April 4 - 6, Columbus, OH, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2017_niaa_us_animal_ag_future_role_world_food_production
Antimicrobial resistance occurs when microbes evolve a mechanism that protects them from the effects of antimicrobials or antibiotics. Antibiotic resistance is a subset of antimicrobial resistance, as it applies to bacteria that become resistant to antibiotics. Resistant microbes are more difficult to treat, requiring higher doses, or alternative medications that may prove more toxic.
The Johns Hopkins Center for a Livable Future Capitol Hill Briefing: Antibiot...Johns Hopkins University
On 12/2/09 on Capitol Hill, leading experts in economics, public health and public policy and Rep. Louise Slaughter (D-NY), a leading voice on antibiotic resistance, discussed the impact of resistant infections on the U.S. healthcare system and the need to phase out inappropriate use of antibiotics as growth promoters in the production of food animals. The Johns Hopkins Center for a Livable Future (CLF) hosted the event with Rep. Slaughter. This is a complication of the panelists' presentations.
updated statistics about antimicrobial resistance,causes and mechanism of antimicrobial resistances, national antimicrobial policy, national antimicrobial surveillance, new delhi b metallo-lactamase-1 bacteria
Please find the power point on Antimicrobial resistance. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Dr. Cyril Gay - Alternatives to AntibioticsJohn Blue
Alternatives to Antibiotics - Dr. Cyril Gay, Senior National Program Manager, USDA Agricultural Research Service (ARS), from the 2017 NIAA Annual Conference, U.S. Animal Agriculture's Future Role In World Food Production - Obstacles & Opportunities, April 4 - 6, Columbus, OH, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2017_niaa_us_animal_ag_future_role_world_food_production
Antimicrobial resistance as an emerging food-borne infectious diseaseJean Jacques Bernatas
Food safety is also about acquired antimicrobial resistance in big farms, and its spread in the environment. Be a smart consumer, a smart producer, and a smart patient to contributing to get antimicrobial resistance under control.
Antimicrobial Resistance - AMR
A short presentation on Antimicrobial resistance (AMR) on One health day organized in the Cholistan University of Veterinary and Animal Sciences, Bahawalpur by the Department of Zoology. It's a short go through of the topic AMR.
Question was in my mind how the bacteria learn the biochemical mechanisms of defense against antibiotics , l know it should have gens that produce defense ways , but how they have thes gens , how antibiotics produce resistance in bacteria for them self and another's ?
All that I tried to answer in this seminar and how can be treated or minimized .
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.
One of the most pressing global health issues is the problem of resistance to antimicrobial drugs. Antimicrobial resistance contributes to the uncontrolled increase in the number of pathogenic microorganisms, which leads to higher levels of infectious diseases.
Antibiotics and its importance. Antimicrobials are substances naturals or synthetics that attack infections. In this PPT we are going to talk about antibiotics and introducing to antibiotic resistance.
The perspective of antibiotic resistanceLimon Mirza
Antibiotic, Antibiotic resistance, Causes of antibiotic resistance, History of antibiotic, Bangladesh perspective of antibiotic resistance, Prevention & Control of antibiotic resistance
Multiple Drug Resistance and Antibiotic Misuse In English.Education Front
The report on Multiple Drug Resistance and Antibiotic Misuse.
By: Nadia Hassan, Chandni Yaqoob and Mudassar Iqbal.
School of Biological Sciences, University of the Punjab.
AMR in Animal Origin Products A ChallengeSarzamin Khan
The AMR and its origin from the products of animal based products has been discussed. The AMR as challenge has been described and recommendation to minimize the risk of AMR
Antimicrobial resistance as an emerging food-borne infectious diseaseJean Jacques Bernatas
Food safety is also about acquired antimicrobial resistance in big farms, and its spread in the environment. Be a smart consumer, a smart producer, and a smart patient to contributing to get antimicrobial resistance under control.
Antimicrobial Resistance - AMR
A short presentation on Antimicrobial resistance (AMR) on One health day organized in the Cholistan University of Veterinary and Animal Sciences, Bahawalpur by the Department of Zoology. It's a short go through of the topic AMR.
Question was in my mind how the bacteria learn the biochemical mechanisms of defense against antibiotics , l know it should have gens that produce defense ways , but how they have thes gens , how antibiotics produce resistance in bacteria for them self and another's ?
All that I tried to answer in this seminar and how can be treated or minimized .
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.
One of the most pressing global health issues is the problem of resistance to antimicrobial drugs. Antimicrobial resistance contributes to the uncontrolled increase in the number of pathogenic microorganisms, which leads to higher levels of infectious diseases.
Antibiotics and its importance. Antimicrobials are substances naturals or synthetics that attack infections. In this PPT we are going to talk about antibiotics and introducing to antibiotic resistance.
The perspective of antibiotic resistanceLimon Mirza
Antibiotic, Antibiotic resistance, Causes of antibiotic resistance, History of antibiotic, Bangladesh perspective of antibiotic resistance, Prevention & Control of antibiotic resistance
Multiple Drug Resistance and Antibiotic Misuse In English.Education Front
The report on Multiple Drug Resistance and Antibiotic Misuse.
By: Nadia Hassan, Chandni Yaqoob and Mudassar Iqbal.
School of Biological Sciences, University of the Punjab.
AMR in Animal Origin Products A ChallengeSarzamin Khan
The AMR and its origin from the products of animal based products has been discussed. The AMR as challenge has been described and recommendation to minimize the risk of AMR
AMR challenges in human from animal foods- Facts and Myths.pptxBhoj Raj Singh
This presentation talks about ÄMR: A public health threat, a “silent pandemic”.
Infections caused by Antimicrobial-drug-resistant (AMR) pathogens caused >1.27 million deaths worldwide in 2019 (low level or no surveillance) and increasing year after year which may be > million in coming decades. Covid-19 caused ~6.8 million deaths in >3 years but now the pandemic is ending but the AMR pandemic has no timeline for its ending. Many deaths are also attributed to AMR pathogens.
More antibiotic use (irrespective of the sector) = More AMR.
This presentation also talks about ways and means to mitigate the AMR pandemic. 1. Stopping the blame game. All are equally responsible for the emergence of AMR, the share of developed and educated communities is much more than poor and un-educated communities.
2. Working together: On-Line Real-Time AST Data Sharing Platform for different diagnostic and research laboratories doing AST routinely.
3. Implementing not only antibiotic veterinary and medical stewardship but antimicrobial production and distribution stewardship too.
4. Educating for Environmental health not only human, plant, and animal health.
5. AMR's solution is not in searching for alternatives to antibiotics but in establishing environmental harmony.
6. More emphasis on AMR epidemiology than on AMR microbiology and pharmacology.
7. Development of understanding that bacteria and other microbes are more essential for life on earth than the human race. Microbes can live without humans, but humans can’t without microbes.
Global-Health is of prime importance than economic growth/ greediness.
Unusual causes of emergence of antimicrobial drug resistanceBhoj Raj Singh
Overuse and misuse of antibiotics have long been believed to fuel antimicrobial resistance (AMR), but new research shows that simply lowering consumption is not enough. Poor sanitation, corruption and low public health spending have a bigger role in pushing up drug-resistant infections in low- and middle-income countries, including India.
Herbal antimicrobials are considered as an important alternative to antibiotic and probable tools to mitigate emerging antimicrobial-drug-resistance (AMR). However, it is difficult to accept that microbes may not adapt to herbal antimicrobials as rapidly as to antibiotics. This is now well documented that herbal antimicrobial resistance is also common among common pathogenic microbes and genes are now known to encode herbal drug-resistance too. This lecture gives description how resistance to conventional antimicrobials impacts susceptibility of microbes for herbal antimicrobials. Lecture Scheduled on 21st February 2023, In: Antimicrobial Resistance (AMR) in Foodborne pathogens” sponsored under the ICAR-NAHEP-CAAST project by the MAFSU, Mumbai Veterinary College, at the Division of Veterinary Public Health, ICAR-IVRI from 20th February to 25th February, 2023.
a research presentation done by Augustine Mwaawaaru Level 400) and Matthew Frimpong Antwi (Level 300) students of( Presbyterian University College-Ghana on Antimicrobial resistance and the way foeward in Ghana. contact 0261825262
Randall Singer - Ensuring Healthy Animals and Food Safety – The Need to Prese...John Blue
Ensuring Healthy Animals and Food Safety – The Need to Preserve Antibiotics - Randall Singer, Ph.D, DVM, Associate Professor, Epidemiology, University of Minnesota, from the 2010 Animal Ag Alliance Stakeholder's Summit: Truth, Lies and Videotape: Is Activism Jeopardizing Our Food Security?, April 28 - 29, 2010, Washington, DC, USA.
More presentations at http://www.trufflemedia.com/home/conference/2010-animal-ag-alliance-stakeholders-summit
Dr. Richard Raymond - Antibiotics and Food Safety: Perceptions vs. RealityJohn Blue
"Antibiotics and Food Safety: Perceptions vs. Reality - Dr. Richard Raymond, Former Undersecretary for Food Safety, U.S. Department of Agriculture, from the 2014 Minnesota Pork Congress, January 14-15, Minneapolis, MN, USA.
More presentations at http://www.swinecast.com/2014-minnesota-pork-congress"
Dr. Richard Raymond - Antibiotics and Food Safety: Perceptions vs. RealityJohn Blue
Antibiotics and Food Safety: Perceptions vs. Reality - Dr. Richard Raymond, Former Undersecretary for Food Safety, U.S. Department of Agriculture, from the 2014 Minnesota Pork Congress, January 14-15, Minneapolis, MN, USA.
More presentations at http://www.swinecast.com/2014-minnesota-pork-congress
Dr. Richard Raymond - Food Safety & Antibiotics: Perceptions vs. RealityJohn Blue
Food Safety & Antibiotics: Perceptions vs. Reality - Dr. Richard Raymond, Former Undersecretary for Food Safety, U.S. Department of Agriculture, from the 2014 Iowa Pork Congress, January 22-23, Des Moines, IA, USA.
More presentations at http://www.swinecast.com/2014-iowa-pork-congress
Dr. Richard Raymond - Antibiotics used in animals Raised for Food - Perceptio...John Blue
Antibiotics used in animals Raised for Food - Perception vs. reality - Dr. Richard Raymond, M.D., former U.S. Department of Agriculture Undersecretary for Food Safety, from the 2015 World Pork Expo, June 3 - 5, 2015, Des Moines, IA, USA.
More presentations at http://www.swinecast.com/2015-world-pork-expo
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. What is Superbug ?
► When bacteria resist the effects of an antimicrobial agent, it is referred to as
resistant.
► If a bacterial strain is exceedingly resistant to almost every known/antibiotics
available, it is informally called “a superbug” or “a super bacterium”
implying a super fighter against antimicrobial agents (Reinhardt, 2010).
VET INSIDER
4. Rise of Superbugs
► AMR - existed ten thousand years before modern
man discovery of medicines.
► A 1000 year-old mummies- Inca Empire –resistant
bacteria from gut.
► DNA found in 30, 000-year-old permafrost
sediments from Bering - contain genes that
encode resistance to a wide range of antibiotics
(Balamurugan et al 2018).
5. Superbugs – Emerging Threat
► The effective treatment of infections and diseases- under threat.
► Infections by superbugs claims 700,000 lives annually around the world.
► Every year- 23,000 deaths in America (CDC 2018), 25,000 in Europe and 80,000 deaths
in China -antibiotic-resistant infections.
► 300 million premature deaths are expected over the next 35 years due to AMR
worldwide (WHO 2018).
(Review on Antimicrobial Resistance, December 2014, Antimicrobial Resistance: Tackling a Crisis for the
Health and Wealth of Nations)
6. ► Superbugs would make medical procedures such as organ transplants, surgery
and chemotherapy impossible.
► The rise in super bugs causing Ventilator-Associated Pneumonia (VAP) - major
cause of mortality despite recent advances in management (Quereshi et al 2015).
► Post-antibiotic era-minor injuries - lethal
► Once curable diseases - untreatable.
► If not addressed -expected loss - US$100 trillion (globally), lowering projected
GDP by 2 to 3.5 percent.
► Due to global spread - serious and highly contagious illnesses such as gonorrhoea
and pneumonia, may soon become incurable.
(Review on Antimicrobial Resistance, December 2014, Antimicrobial Resistance: Tackling a Crisis for the
Health and Wealth of Nations)
Emerging Threat……
7. Nightmare superbugs
► In Nevada (USA) woman in her 70s was hospitalized (August 2016) after returning
from an extended trip to India.
► Infected with multidrug-resistant Klebsiella pneumoniae resistant to 26 antibiotics.
► Died in September from multiple organ failure and sepsis.
► Klebsiella pneumoniae was found in patients at Christian Medical College (CMC),
Vellore after they were admitted for sepsis.
► At CMC, Vellore- 31 per cent patients treated for sepsis in the hospital become
infected by a strain of Klebsiella pneumoniae - both resistant to antibiotics and
hypervirulent.
8.
9. India
Every section of the population is at risk.
► More than 23,000 adults die annually due to
AMR.
► Newborns are particularly vulnerable to AMR
because- immune systems are fragile, leaving
little time for doctors to find a drug that works.
► More than 58,000 Indian babies died in 2013 as
a result of AMR - a serious setback to progress
in reducing Indian infant mortality rates.
10.
11.
12.
13.
14. Resistance trends- India
During the period from 2008-2014 in India
► MRSA – from 29% to 47%
► Cabapenam resistant E. coli- from 10 to 13%.
► Flouroquinolones resistant Salmonella isolates from 8% to 28%.
► Kebsiella pneumoniae- pneumonia, meningitis, bloodstream infections and
urinary tract infections - 29% to 57%.
► V. cholerae O1 resistant to ampicillin, furazolidone, ciprofloxacin, and
tetracycline.
Source: The State of Worlds Antibiotics, 2015 Center for Disease Dynamics, Economics and Policy (CDDEP)
National action Plan –AMR 2017
17. Inappropriate use in humans
Over-prescription/Overuse
► In the 76 countries studied consumption increased from 21.2 billion in 2000 to 34.8 billion in
2015.
► Global consumption - set to rise by 67% between 2010-2030.
► In the BRICS countries(Brazil, Russia, India, China, and South Africa)- the estimated increase –
99% - up to seven times projected population growth.
► India-largest consumer of antibiotics for human health. (Laxminarayan et al 2016)
⮚ Patient with preconceived ideas and demand quick relief
⮚ Fear of losing customers - Doctors compelled to give antibiotics
(Chandy et al 2013)
18. In Humans…
Prescription for non-bacterial illnesses
⮚ Common cold, sore throat etc.
Self medication
⮚ To avoid financial burden of expensive allopathic medical visits
⮚ Access to antibiotics without prescription (GARP India 2011; Barker et al 2017)
⮚ Source: previous doctors prescription, leftover medicines from previous illness
19. High consumption of broad spectrum antibiotics
⮚ Diagnostic uncertainties
⮚ Lack of microbiology diagnostic laboratory services
⮚ Incentives to prescribe new broad spectrum antibiotic
⮚ Less time to counsel against use of antibiotic and instead prescribe them
⮚ To dispose near to expire antibiotics (Kotwani et al., 2010; GARP India 2011)
Failure to complete a course of treatment
Prescription/treatment from informal healthcare providers/quacks/pharmacists
⮚ Consider themselves not less than doctor
⮚ Lack knowledge of when to use antibiotics
20. Non -therapeutic use of antibiotics
Overuse In intensive livestock farming
► More antibiotics are given to healthy animals than are used to treat diseases among
human patients (WHO, 2012).
► India accounts for 3% of the global consumption and is the fourth highest in the
world, behind China (23%), the United States (13%) and Brazil (9%) in 2010.
► The consumption of antibiotics in food animals in India will be double by 2030.
(Inter-ministerial Review Meeting on Antimicrobial Resistance, 2016).
Substitute for healthier living conditions (Laxminarayan 2016)
► Routine feeding -to help them endure crowded, dirty, and stressful conditions.
Use of enrofloxacin in FMD vaccines as preservative (Singh 2016)
21. ► As a growth promoter
► Poultry farmers – prevention is better than cure
► Common practice
► Cheap antibiotics
► Antibiotics critical to human health such as tetracycline , doxycycline, ciprofloxacin and
even colistin are commonly used for growth promotion in poultry. (Brower et al 2017; CSE
2014).
► Residues of antimicrobials -detected in chicken meat (Sahu and Saxena 2014).
► Use of polymixins in food animals-Emergence of plasmid mediated mcr-1 gene with (Liu
et al 2016)
► 149 unique resistance genes detected- manure from pigs –China
Non -therapeutic use of antibiotics
22. ► "Some veterinarians' profit margins are bigger than those of cocaine dealers.
When a veterinarian finds a sick chick among 20,000 other chicks, he treats the
discovery as justification to preventively treat the entire flock with antibiotics.
( Der Spiegel 2012)
Report on factory use of antibiotics in Germany, 2012 Spiegel, Addicted to
Antibiotics: How Factory Farm Drug Abuse Makes Vets Rich.
23. Pharmaceutical industry
► The Indian pharmaceutical industry supplied 20 percent of generic drugs – US $15 billion
in 2014 ( Nordea Asset Management, 2014)
► Almost 80 percent of the antibiotics sold by multinational companies on global market are
manufactured in India and China (Sum of Us 2015).
Release of antibiotics into the environment
► Waste water effluents (Lubbert et al 2017)
► Resistance to three major classes of antibiotics- cephalosporins, carbapenems and the
fluoroquinolones detected in water samples from river, sewage treatment plant etc. in and
around pharmaceutical companies in Hyderabad and Chennai (Sum of Us 2015).
► Improper disposal of expired or leftover antibiotics- ideal breeding ground for drug
resistant bacteria.
24.
25. Antibiotic Fixed dose Combination (FDCs)
► Lack of diagnostic precision
► Unavailability of diagnostic laboratory services – increased use of antibiotics FDCs
in India (Gautam and Saha 2008).
► Approximately 118 FDCs are available in India (Shankar et al 2016).
► Of these 118 formulations, 64 per cent are not approved by the national drugs
regulator, the Central Drugs Standard Control Organisation (Business world 2018).
► The lack of investment in new drug discovery.
► In 2004, in the 15 largest pharma companies, only 1.6% of the drugs in the
development stages were antibiotics- none from novel classes, nor were they
targeted to treat multidrug resistant agents.
Pharmaceutical industry
26.
27. Double Standards
► According to pharmaceutical company Zoetis (a former subsidiary of Pfizer )-
They are leader in providing ongoing education to veterinarians and livestock
producers on the proper use of antimicrobial drugs.
► In 2013, Zoetis said it “supports the FDA’s efforts to voluntarily phase out growth
promotion indications for medically important antibiotics.
► But company still sells its antibiotics to Indian farmers - regulation and
enforcement is more lax (Bureau of Investigative Journalism). Ban - European
countries and USA- removed growth promoter labels but continued supply in
India.
► In India Zoetis (Neftin-T), Venkys (Colis-V), Vetline (PROGRO-VET), Kaizen Bio
Sciences, Vet-Needs Labs, NeoSpark (DoxiStin-FS, RimoDox-2%-FS CTC-150-
FS etc.)
► Zoetis recommends feeding Neftin-T to chickens to “improve weight gain and
FCR.
30. Justification provided by companies
► Officially there is no ban in India for the specified usage of colistin in farm animals… As
law abiding company, we will never deviates the law of the land……..Neospark.
► Each country enacts regulations appropriate for their market needs and standards,
and we work with the national regulatory authorities in various countries, including
India, to understand, respect and comply with local regulatory interpretation and
oversight……….Pfizer and Venkys.
► “If an American company follows one policy in America, they should follow the same
policy in India- Chennai Declaration.
Source: The Bureau of Investigative Journalism, The Hindu, The Daily Telegraph
31. Lack of overall hygiene and
sanitation
► Poor sanitation plays major role in the spread of resistant bacteria and ARGs
(antibiotic resistant genes).
► More than 50 percent Indian population lack access to sanitation facilities for
safe disposal of human waste (World Bank 2017).
► Untreated sewage into water bodies - contamination of rivers with antibiotic
residues, antibiotic resistant organisms and ARGs (Marathe et al 2017).
► Risk of asymptomatic colonization with ESBL producing E. coli among Swiss
travelers visiting India was 87 percent (Kuenzli et al 2014).
32. Cultural activities
► Mass bathing in rivers
► blaNDM-1 was found to be 20 times greater in the river during pilgrimage season
than at other times of year in Upper Ganges (Ahammad et al 2014).
► Pilgrimage sites thus can act as hot spots for transmission of resistant bacteria
and genes.
33. Hospital acquired
► Medical equipment, such as ventilators and catheters, might be transmission sites
for these new strains.
► Human-to- human transmission may also be possible, but clinical settings are most
vulnerable.
► For eg; HA-MRSA, infections aquired with use of catheters and other surgical and
diagnostic procedures.
35. MRSA
► Most recognized superbugs - common in many hospitals throughout the world.
► Methicillin- introduced in 1959 -treatment of penicillin-resistant S. aureus.
► MRSA was first detected in 1961 (Ippolito et al., 2010).
► At first- limited to hospitals and healthcare settings -hospital acquired MRSA
infection.
► Since the late 1990s- emergence of community-acquired MRSA strains with
rapid spread and causing fatal diseases (Ippolito et al., 2010).
► Most MRSA strains exhibit resistance to multiple drugs including penicillin,
methicillin, tetracycline, erythromycin and vancomycin (de Lencastre et al.,
1996; Smith et al., 2014).
36. LA-MRSA
► LA-MRSA- increasingly identified in humans and could be associated with very
severe diseases and even death(Chen et al 2018).
► MRSA - reported in diverse species - dogs, cats, sheep, chickens, horses, rabbits,
seals, birds, one turtle, bat, guinea pig and chinchilla (Morgan et al 2008).
► In one report, four dogs suffered postoperative infections with MRSA after a
surgery at veterinary hospital.
► Around 5-7% of veterinary personnel and students found to be nasal carriers in
Netherland and USA.
► LA-MRSA was identified in 78% of 373 MRSA-colonized patients upon admission
to two hospitals during 2008 and 2009 (Bruinsma et al 2015).
► These studies are enough to introduce the challenge to veterinarians in form of
newer and stronger zoonoses.
37.
38. NDM-1
❑ Escherichia coli and Klebsiella pneumoniae harboring New Delhi metallo β-
lactamase (NDM-1)
❑ The NDM-1 gene encodes β-lactamase enzymes carbapenemases -resistance to a
broad range of β-lactams.
❑ Produced by Gram-negative bacteria, in particular E. coli and K. pneumoniae
(Paterson, 2006).
❑ Gene - first detected in a K. peumoniae isolate- Swedish patient who travelled to
New Delhi in 2008 (Yong et al., 2009) and emerged as a newest superbug - most
feared pathogens.
39. ► Apart from the Enterobacteriaceae family NDM-1 has also recently been found in
Acinetobacter species in India, China, and Egypt.
► After NDM- 1 a variant in Egypt is designated as NDM-2.
► Infections caused by bacteria carrying NDM-1 have been reported in many other
countries, including the USA, Canada, Australia, France, Germany, Belgium,
Sweden, Denmark, the Netherlands, Norway, Oman, Kenya, China, South Korea,
Japan(Luo et al., 2013; Yoo et al., 2013).
► Mcr-1 gene conferring resistance against colistin and other polymixins has been
found in multiple countries around the world (Liu et al, 2015; Roschanski et al.,
2016)
NDM-1…..
40.
41. NDM 1 controversy
Don’t blame superbug on India, it’s everywhere
Thursday, Dec 06, 2018 New Delhi °C
VET INSIDER
42. ► “ridiculous to call it NDM-1 when none of the
samples that tested positive were picked in New
Delhi,” - Chairman, Medanta-The Medicity.
► Commercially motivated campaign to hurt India’s
Rs 1,200-crore medical tourism industry.
► Lead researcher from Chennai KK Kumarasamy
got funding from Wyeth, a pharma company,
while another author has shares in companies such
as AstraZeneca, Merck, pfizer and
GlaxoSmithKline.
► A frightening picture not supported by any
scientific data.
► Many British NDM-1 positive patients had no travel
or connection to India : Union Health Ministry
official.
Shrivastva et al 2011
43. Alternatives
► Antimicrobial peptides- host defense peptides-short and generally positively
charged pptides found in variety of life forms from microorganisms to humans.
► Potential therapeutic source of future antibiotics-broad spectrum activities and
different mechanisms of actions (Seo et al 2012).
► Phage therapy
► Intraperitoneal administration of a single phage strain was sufficient to rescue
100% mice in bacteremia model using ESBL producing E. coli and imipenem
resistant P. aeruginosa (Wang et al 2006).
44. Alternatives
► Antimicrobial polymers/polymeric biocides- engineered polymers to mimic
antimicrobial peptides –used by immune system to kill bacteria.
► Positive charge- attach to bacteria –polymer crosses cell membrane-
solidification of proteins and DNA in cell.
► Endophytes
► Microbes colonizing living internal tissues of plant without causing any
immediate overt negative effects.
► Wide range of antimicrobial producing strains-important potential source of
antimicrobial substance (Ryan et al 2008).
45. Containment of AMR
► AMR related policies were initiated in 2011 by publishing the National Policy on
Containment of AMR.
► NGO initiative such as Chennai Declaration-published to create a roadmap to
tackle AMR problem.
► ICMR launched the program on Antimicrobial Stewardship, Prevention of Infection
and Control (ASPIC) in 2012.
► The Antimicrobial Resistance Surveillance Research Network (AMRSN) established by
the ICMR.
► The Red Line Campaign developed along with Organization of Pharmaceutical
Producers of India (OPPI) was launched in New Delhi in February 2016.
► In 2017, a comprehensive National Action Plan for Containment of AMR - launched.
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