Prevention and Containment of Antimicrobial...
Transcript of Prevention and Containment of Antimicrobial...
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World Health Day 2011: Antimicrobial Resistance1 |
Prevention and Containment of
Antimicrobial ResistanceAntimicrobial ResistanceAntimicrobial ResistanceAntimicrobial ResistancePrevention and Containment of
Antimicrobial ResistanceAntimicrobial ResistanceAntimicrobial ResistanceAntimicrobial Resistance
USE ANTIBIOTICS RATIONALLY
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World Health Day 2011: Antimicrobial Resistance2 |
Resistance in microbes is a natural Resistance in microbes is a natural Resistance in microbes is a natural Resistance in microbes is a natural phenomenonphenomenonphenomenonphenomenon
Resistance in microbes is a natural Resistance in microbes is a natural Resistance in microbes is a natural Resistance in microbes is a natural phenomenonphenomenonphenomenonphenomenon
� Resistance is unresponsiveness to antimicrobial
agents in standard doses
� A natural biological unstoppable phenomenon
� Resistance is generally slow to reverse or
irreversible
� All antimicrobial agents have the potential to
select drug-resistant subpopulations of
microorganisms
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World Health Day 2011: Antimicrobial Resistance3 |
Resistance is accelerated through Resistance is accelerated through Resistance is accelerated through Resistance is accelerated through inappropriate use of antimicrobialsinappropriate use of antimicrobialsinappropriate use of antimicrobialsinappropriate use of antimicrobialsResistance is accelerated through Resistance is accelerated through Resistance is accelerated through Resistance is accelerated through inappropriate use of antimicrobialsinappropriate use of antimicrobialsinappropriate use of antimicrobialsinappropriate use of antimicrobials
– Standard treatment guidelines not provided to physicians or provided but not adhered to
– Drugs available without prescription
– Accessible but poor quality
– Inadequate monitoring
– Irrational self-administration or prescription
� Antimicrobial resistance
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World Health Day 2011: Antimicrobial Resistance4 |
RRRReeeessssiiiissssttttaaaannnncccceeee iiiissss ffffaaaalllllllloooouuuutttt ooooffff iiiinnnnaaaapppppppprrrroooopppprrrriiiiaaaatttteeee uuuusssseeee ooooffff antimicrobials in different settingsantimicrobials in different settingsantimicrobials in different settingsantimicrobials in different settings
RRRReeeessssiiiissssttttaaaannnncccceeee iiiissss ffffaaaalllllllloooouuuutttt ooooffff iiiinnnnaaaapppppppprrrroooopppprrrriiiiaaaatttteeee uuuusssseeee ooooffff antimicrobials in different settingsantimicrobials in different settingsantimicrobials in different settingsantimicrobials in different settings
� In animals and plants:
– Therapeutic and non-therapeutic (e.g. as growth promoters)
� In community acquired infections
� In hospital-associated infections
� Irrational use of antibiotics is the greatest driver of resistance
– 50505050%%%% of antibiotics are prescribed inappropriately
– 50505050%%%% of patients have poor compliance
– 50505050%%%% of populations do not have access to essential
antibiotics
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World Health Day 2011: Antimicrobial Resistance5 |
RRRReeeessssiiiissssttttaaaannnntttt oooorrrrggggaaaannnniiiissssmmmmssss aaaallllssssoooo mmmmoooovvvveeee rrrraaaappppiiiiddddllllyyyy aaaaccccrrrroooossssssss borders through humans and the foodborders through humans and the foodborders through humans and the foodborders through humans and the food----chainchainchainchainRRRReeeessssiiiissssttttaaaannnntttt oooorrrrggggaaaannnniiiissssmmmmssss aaaallllssssoooo mmmmoooovvvveeee rrrraaaappppiiiiddddllllyyyy aaaaccccrrrroooossssssss borders through humans and the foodborders through humans and the foodborders through humans and the foodborders through humans and the food----chainchainchainchain
� Two outbreaks of methicillin-resistant Staph. aureus (MRSA) in hospitals in Canada
– Origin in North India
� Multidrug-resistant typhoid fever in USA
– Originated in 6 countries (including India)
� MDR Salmonella schwarzengrund
– Imported through Thai food into Denmark and the USA
� Multidrug resistant Mycobacteria
� Resistant malaria at Thai-Cambodia border
� Resistance in H1N1 and HIV are global concerns
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World Health Day 2011: Antimicrobial Resistance6 |
Resistance is negating “wonder” drugsResistance is negating “wonder” drugsResistance is negating “wonder” drugsResistance is negating “wonder” drugs
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World Health Day 2011: Antimicrobial Resistance7 |
Status of resistance in Status of resistance in Status of resistance in Status of resistance in WHO’s SouthWHO’s SouthWHO’s SouthWHO’s South----East Asia RegionEast Asia RegionEast Asia RegionEast Asia Region
Status of resistance in Status of resistance in Status of resistance in Status of resistance in WHO’s SouthWHO’s SouthWHO’s SouthWHO’s South----East Asia RegionEast Asia RegionEast Asia RegionEast Asia Region
� TuberculosisTuberculosisTuberculosisTuberculosis
– MDR-TB < 3%: 180000 cases annually
– XDR-TB: Reported from Bangladesh, India, Indonesia, Thailand
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World Health Day 2011: Antimicrobial Resistance8 |
Status of resistance in Status of resistance in Status of resistance in Status of resistance in WHO’s SouthWHO’s SouthWHO’s SouthWHO’s South----East Asia RegionEast Asia RegionEast Asia RegionEast Asia Region
Status of resistance in Status of resistance in Status of resistance in Status of resistance in WHO’s SouthWHO’s SouthWHO’s SouthWHO’s South----East Asia RegionEast Asia RegionEast Asia RegionEast Asia Region
– 400 million people at risk of infection with resistant parasites
� MalariaMalariaMalariaMalaria
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World Health Day 2011: Antimicrobial Resistance9 |
Status of resistance in Status of resistance in Status of resistance in Status of resistance in WHO’s SouthWHO’s SouthWHO’s SouthWHO’s South----East Asia RegionEast Asia RegionEast Asia RegionEast Asia Region
Status of resistance in Status of resistance in Status of resistance in Status of resistance in WHO’s SouthWHO’s SouthWHO’s SouthWHO’s South----East Asia RegionEast Asia RegionEast Asia RegionEast Asia Region
� HIV and STIsHIV and STIsHIV and STIsHIV and STIs
– Data on HIV resistance being generated
– STIs: Gonorrhoea widely resistant to penicillin & fluoroquinolones
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World Health Day 2011: Antimicrobial Resistance10 |
Status of resistance in Status of resistance in Status of resistance in Status of resistance in WHO’s SouthWHO’s SouthWHO’s SouthWHO’s South----East Asia RegionEast Asia RegionEast Asia RegionEast Asia Region
Status of resistance in Status of resistance in Status of resistance in Status of resistance in WHO’s SouthWHO’s SouthWHO’s SouthWHO’s South----East Asia RegionEast Asia RegionEast Asia RegionEast Asia Region
� KalaKalaKalaKala----azarazarazarazar
– 60% resistance in pentavalent antimony and 25% in pentamidine
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World Health Day 2011: Antimicrobial Resistance11 |
Status of resistance in SEARStatus of resistance in SEARStatus of resistance in SEARStatus of resistance in SEAR----2222epidemic prone diseasesepidemic prone diseasesepidemic prone diseasesepidemic prone diseases
Status of resistance in SEARStatus of resistance in SEARStatus of resistance in SEARStatus of resistance in SEAR----2222epidemic prone diseasesepidemic prone diseasesepidemic prone diseasesepidemic prone diseases
� CholeraCholeraCholeraCholera
– Resistance to Nalidixic acid, fluorazolidone, cotrimoxazole: India
– Tetracycline resistance: India
� ShigellosisShigellosisShigellosisShigellosis
– Multidrug resistant, causing extensive outbreaks
� Typhoid feverTyphoid feverTyphoid feverTyphoid fever
– MDR Salmonella typhi prevalent all over Region
– Causing 10% Case Fatality Rate (CFR) in children (preantibiotic era: 12.8%)
� Acute respiratory infections (pneumonias)Acute respiratory infections (pneumonias)Acute respiratory infections (pneumonias)Acute respiratory infections (pneumonias)
– 69% of Strept pneumoniae resistant to penicillin in Thailand
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World Health Day 2011: Antimicrobial Resistance12 |
Status of resistance in SEARStatus of resistance in SEARStatus of resistance in SEARStatus of resistance in SEAR----3333HospitalHospitalHospitalHospital----associated infectionsassociated infectionsassociated infectionsassociated infections
Status of resistance in SEARStatus of resistance in SEARStatus of resistance in SEARStatus of resistance in SEAR----3333HospitalHospitalHospitalHospital----associated infectionsassociated infectionsassociated infectionsassociated infections
� Staphylococcus aureusStaphylococcus aureusStaphylococcus aureusStaphylococcus aureus
– >50% isolates in hospitals are methicillin-resistant
– 48% of patients with bacteraemia died in Thailand
� Acinetobacter baumanniiAcinetobacter baumanniiAcinetobacter baumanniiAcinetobacter baumannii
– >50% of patients infected with resistant strains die
� Pseudomonas, Klebsiella, SerratiaPseudomonas, Klebsiella, SerratiaPseudomonas, Klebsiella, SerratiaPseudomonas, Klebsiella, Serratia
– Multidrug-resistance, persist in hospital settings, and cause huge mortality morbidity
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World Health Day 2011: Antimicrobial Resistance13 |
RRRReeeessssiiiissssttttaaaannnncccceeee hhhhaaaassss hhhhuuuuggggeeee nnnneeeeggggaaaattttiiiivvvveeee iiiimmmmppppaaaacccctttt oooonnnn healthhealthhealthhealth
� Longer duration of illness
� Longer treatment
� Higher mortality
� Treatment with expensive drugs
� Increased burden on health system
� Negates technological advances in medical sector
– Complex surgeries
– Transplantations and other interventions
� Patient acts as reservoir of resistant organisms which are passed to community and health-care workers
� Huge economic impact
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World Health Day 2011: Antimicrobial Resistance14 |
Resistance: A global public health issueResistance: A global public health issueResistance: A global public health issueResistance: A global public health issueResistance: A global public health issueResistance: A global public health issueResistance: A global public health issueResistance: A global public health issue
� ECDC:”antimicrobial resistance is possibly the single biggest threat facing the world in the area of infectious diseases”.
IHR (2005)
– PHEIC
� World Alliance on Patient Safety Challenge III
� MDGs (HIV, TB and Malaria)
� Essential Drugs List (use in 120 countries)
� Several WHA Resolutions on rational use of drugs/antimicrobial resistance but little progress
– WHA37.33
– WHA51.17
– WHA54.11
– WHA58.27
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World Health Day 2011: Antimicrobial Resistance15 |
Resistance is a multifaceted problemResistance is a multifaceted problemResistance is a multifaceted problemResistance is a multifaceted problemResistance is a multifaceted problemResistance is a multifaceted problemResistance is a multifaceted problemResistance is a multifaceted problem
� Biological
� Behavioural
� Technical
� Economic
� Regulatory
� Educational
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World Health Day 2011: Antimicrobial Resistance16 |
Superbugs* are visible manifestations of our prolonged failure to preserve antibiotics
** Methicillin resistant Staph aureus, MDR-and XDR Mycobacteria, ESBL producing Gram negative bacteria and NDM-1 producing enterobacteriaceae bacteria are few examples of superbugs because these fail to respond to large number of commonly used antibiotics
Known but neglected. Need immediate action
Known but inevitable
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World Health Day 2011: Antimicrobial Resistance17 |
Possible solutionsPossible solutionsPossible solutionsPossible solutionsPossible solutionsPossible solutionsPossible solutionsPossible solutions
� Discover new drugs faster than emergence of Discover new drugs faster than emergence of Discover new drugs faster than emergence of Discover new drugs faster than emergence of
resistanceresistanceresistanceresistance
� Rationalize the use of available antimicrobial agents
� Prevent emergence of resistance by reducing selection
pressure by appropriate control measures
� Promote discovery, development and dissemination of
new antimicrobial agents
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World Health Day 2011: Antimicrobial Resistance18 |
?
Bad bugs need new drugs
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World Health Day 2011: Antimicrobial Resistance19 |
Possible solutionsPossible solutions
� Discover new drugs faster than emergence of resistance
� Rationalize the use of available antimicrobial agents
� Prevent emergence of resistance by reducing selection
pressure by appropriate control measures
� Promote discovery, development and dissemination of
new antimicrobial agents
Implementation requires a strategy with comprehensive
national initiatives/plans
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World Health Day 2011: Antimicrobial Resistance20 |
Regional Strategy on Antimicrobial ResistanceRegional Strategy on Antimicrobial Resistance
Goal: To minimize the morbidity and mortality
due to antimicrobial-resistant infection and
to preserve the effectiveness of
antimicrobial agents in the treatment and
prevention of microbial infections.
Rational Use of Antibiotics
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World Health Day 2011: Antimicrobial Resistance21 |
Major activitiesMajor activities
�Establishment of national alliances against AMR
�Designation of national focal points in MoH
�Constitution of multisectoral National Steering Committee
Governance
�Development and application of standard treatment guidelines
in health and veterinary sectors
�Discourage non-therapeutic use of drugs in animals
�Restrictions on over-the-counter sale of antimicrobial agents
Regulatory
�Surveillance of antimicrobial use and resistance
�Training prescribers for rational use of antimicrobials
�Reducing disease burden and infection control
�Undertaking operational research
Capacity building
�Educating for adherence to recommended regimens
�Discouraging self-prescriptionCommunity participation
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World Health Day 2011: Antimicrobial Resistance22 |
Will it work???(There are success stories from Finland, France and some hospitals in the SEA Region)
Will it work???(There are success stories from Finland, France and some hospitals in the SEA Region)
Seppalla et al. The Effect of Changes in the Consumption of Macrolide Antibiotics on
Erythromycin Resistance in Group A Streptococci in Finland: New Eng J Med Volume 337:441-446 August 14, 1997
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World Health Day 2011: Antimicrobial Resistance23 |
We need to preserve this resource by working
together
Combating antimicrobial resistance: No action today,
no cure tomorrow
Antibiotics are a precious resource