Managing Resistance to Anthelmintics - OIE:...
Transcript of Managing Resistance to Anthelmintics - OIE:...
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What are the anthelmintics? CLASSESBenzimidazolesLevamisoleMacrocyclic lactones
• Avermectins• Milbemycins
Amino acetonitrile derivativeSpiroindoles(Ops, piperazine, closantel)What is
resistance? Greater frequency of individuals in a population able to
tolerate doses of a compound than in a normal population of the same species.
Efficacy is less that 90% (or 95% in sheep).
Kill or control:Nemathelminthes (roundworms)
Platyhelminthes (flatworms)
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Anthelmintic Resistance
R Mechanisms specific to drug class
Appear to be target site related
Mendelian inheritance - chromosomal genes (sexual reproduction)
Parasite species specific
Can infect other hosts within host range eg.
donkeys pasture horses,
goats pasture sheep
Range of resistance mechanisms
Genetic transfer of R factors between bacterial species occurs
Transfer of organisms between host species eg.:
pigs humans
humans dogs
Antimicrobial Resistance
Ivermectin -resistant Trichostrongylus: sheep faeces humans
Tricladendazole-resistant Fasciola: cattle faeces snails water plants humans
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Hosts Resistant parasites
SheepGoatsCattle
HaemonchusTeladorsagiaTrichostrongylusOstertagiaCooperiaFasciola
Dogs DirofilariaAncylostoma
HorsesDonkeys
CyathosominaeParascaris
Pigs Oesophagostomum
Camel ?
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Resistance in scour worms
% of farms with <95% FECR
Drug BZ LEV ML (IVM) ALL 3 None
NZ(Waghorn et al 2006)
41 24 36 8 36
Spain(Alvarez-Sanchez)
13 35 16 0 -AustraliaPlayfordet al 2013
88 84 25-76 23 rare
Note: in some regions resistance is CRITICAL
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Measuring resistance• In vivo
• FECR
• Problems with interpretation
• In vitro• Development of freeliving stages
• But: Time delay, validation
• Molecular• PCR
• Lack of knowledge of mechanisms
CAGACGAAACTTTCTGTATTCAGACGAAACTT*CTGTATTCAGACGAAACTTACTGTATTCAGACGAAACTTTCTGTATTCAGACGAAACTTACTGTATT
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A case study –ivermectin resistance
1980 New drug class with outstanding in potency and spectrum
1990 Outcomes:• Some parasite species are virtually eradicate• In others, eg.Trichostongylus, resistance is rare.• Ostertagia (Teladorsagia) and Haemonchus develop
resistance in 2 to 5 years, IVM-R appears to be a dominant phenomenon.
1995 More potent and persistent chemicals of the same class (eg. moxidectin) followed IVM on to the market - resistance quickly developed to those compounds too.
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To manage resistance we need to understand the risk factors
Factor ExampleWorm biology Presence of R gene at some levelSurvive treatment Underdosing allows marginally R individuals
to surviveLow level daily dosing in horses
High treatmentfrequency
More opportunities for selection
Few organisms in the environment (low refugia)
Most worms in the metapopulation are selected
Activities that allow resistance genes: to be selected and reach the next worm generation
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Guide to managing resistanceFactor PrinciplesWorm biology inherent property of the parasite species
Do not import resistance- quarantine treatNot surviving treatment
Give full doses of effective* compoundsOral or injection preferredUse short acting drugs not long acting preps
Reduce treatmentfrequency
Use non chemical control such as:Pasture rotation to prevent reinfectionSelect animals for immunityImprove immunity with nutrition
Organisms in the environment (high refugia)
Use targeted treatment – monitor for infection and treat at thresholdLeave some animals untreatedDo not ‘treat and move’
Intermediate hosts Control other hosts to break life cycle
* Quality, storage, rotation between classes. Prescription
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Some approaches• Using mathematical models to understand
• Better diagnosis
• Targeted treatment
• Combination therapy
• Rotational systems, especially for the tropics
• Advice and decision support
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Mathematical models
05
1015202530
0 2 4 6 8 10Years
R fr
eque
ncy
(%)
drought
nodrought
• Need information on parasite pop. Dynamics
• Outputs are burdens, resistance frequency etc.
• Can ask ‘What if?’
Sangster and Dobson 2002
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Better diagnosis of resistance
0
0.2
0.4
0.6
0.8
1
1.2
-0.5 0.5 1.5 2.5 3.5
susceptible
resistant
log drug concentration
proportion responding
susceptible
resistant
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Targeted treatment
Treat when pathology appears
Treat when burden reaches threshold
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Combination therapy
-10
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50
60
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80
0 5 10 15 20
Years
R fr
eque
ncy
(%)
rotation(1,2,1…)
combination
Components: • High efficacy (no resistance)• Independent action • Similar half life• Coadministration
Sangster and Dobson (2002)
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Rotational grazing management• In warm and moist environments larvae become infective in 5 days
• In these conditions larvae die in 60 days on pasture
• 15 cells grazed for 4 days - achieves zero transmission
Zero grazing forage systems (Chandrawathani et al 2004)
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Advice and decision support
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Plenty to chew on:- Better measurement of resistance- Understand the risk factors and minimise them- Lower chemical use (use combinations)- Break the life cycle
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