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Introduction   Throughout history there has been a continual battle between human beings Introduction   Throughout history there has been a continual battle between human beings

Introduction Throughout history there has been a continual battle between human beings - PowerPoint Presentation

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Introduction Throughout history there has been a continual battle between human beings - PPT Presentation

Antibiotics Antibiotics are powerful medicines that fight bacterial infection Literal translation anti against biotic living things Discovery Alexander Fleming in 1928 He was an extremely messy scientist ID: 742199

antibiotic antibiotics resistant resistance antibiotics antibiotic resistance resistant infection treatment bacteria prevention antimicrobial control bacterial penicillin global dose health

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Slide1

Slide2
Slide3

Introduction

Throughout history there has been a continual battle between human beings and multitude of micro-organisms that cause infection and disease Slide4

Antibiotics

“Antibiotics are powerful medicines that fight bacterial infection”

Literal translation:anti – againstbiotic – living thingsSlide5

Discovery

Alexander Fleming in 1928

He was an extremely messy scientistCame back from holiday to see a mould growing on his

Staphylococcus

agar plates

Noticed that the

Staphylococcus

couldn’t grow anywhere near the mould

The mould prevented bacterial growth!Slide6

How antibiotics work

Antibiotics can be either

Broad SpectrumKill

a wide range of bacteria e.g. Penicillin

Narrow Spectrum

Kill a specific type or group of bacteria e.g.

Isoniazid

Antibiotics work in one of two ways

Bactericidal

Kills the bacteria

Bacteriostatic

Prevents the bacteria from dividingSlide7

Mechanisms of action of antibiotics Slide8

Problems associated with antibiotic therapy

Toxicity (gastric irritation, pain, abscess formation,

neuro/ renal toxicity, hearing loss etc.)

Hypersensitivity reactions (allergic reactions)

Vitamin deficiency (esp. vitamin k & vitamin B complex)

Masking of an infections

S

uper infection

Drug resistanceSlide9

Antibiotic Resistance

“Defined as

micro-organisms that are not inhibited by usually achievable systemic concentration

of an

antimicrobial

agent with normal dosage schedule and / or fall in the minimum inhibitory concentration (MIC) range”.Slide10

In his 1945 Nobel Prize lecture, Fleming himself warned of the danger of resistance

“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body… …and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

History

Nobel Lecture, December 11, 1945

Sir Alexander Fleming

The Nobel Prize in Physiology or Medicine 1945

Slide11

The Causes Overuse

MisuseSlide12

Why We Overuse Antibiotics

Patients:

Need to return to work/schoolExpect antibiotics if they’ve been given them before

Physicians

Think patients expect antibiotics

Concerned about patient

satisfaction

Diagnosis is difficult

Time pressure

(

Clin

Pediatr

. 1998;37:665-672)

Antibiotic PrescriptionSlide13

What is misuse of antibiotics?

13

Misuse of antibiotics can include any of the following

18

:

When antibiotics are prescribed unnecessarily;

When antibiotic administration is delayed in critically ill patients;

When broad-spectrum antibiotics are used too generously, or when narrow-spectrum antibiotics are used incorrectly;

When the dose of antibiotics is lower or higher than appropriate for the specific patient;

When the duration of antibiotic treatment is too short or too long;

When antibiotic treatment is not streamlined according to microbiological culture data results

.

18

.

Gyssens IC, van den Broek PJ, Kullberg BJ, Hekster Y, van der Meer JW.

Optimizing antimicrobial therapy. A method for antimicrobial drug use evaluation. J Antimicrob Chemother. 1992 Nov;30(5):724-7.Slide14

Scenario #1

Jane has a sore throat. Without testing, her health care provider prescribes penicillin “just in case” it’s

strep. Infection

Jane’s symptoms are caused by a virus, but she also has bacteria in her sinuses. Slide15

Unnecessary Antibiotics Cause Resistance

Susceptible bacteria are killed off.

A few hardy survivors are left behind.

X

X

X

X

X

X

X

X

The survivors can withstand penicillin.

R

R

Jane takes penicillin.Slide16

The resistant survivors multiply.

R

R

R

R

R

R

R

R

R

R

R

Treatment with penicillin has no effect.

X

Resistant

Bacteria

Can Multiply and Spread

Jane is now a carrier of

penicillin-resistant bacteria.Slide17

Her parents decide it’s OK to stop.

Ashley takes her medicine for three days.

Ashley feels fine.

Scenario #2Slide18

(Adapted from Levin BR, Clin Infect Dis 2001)

Incomplete Treatment Causes Resistance

R

X

X

X

X

X

Day 3

Symptoms improved, treatment stopped

Day 0

R

Antibiotics prescribed

R

R

R

R

R

R

R

Day 10

Resistant

infection

Meanwhile, the survivors multiply. Slide19

R

R

R

R

R

R

R

Resistant Infections Require Special Treatment

Longer treatment

Higher dosage

More expensive medication

Intravenous (IV) medication,

hospitalization Slide20

WHO -2012

-increase resistance to first line drugs

WHO- 2013

-4,80,000 new multi drug resistant TB detected

-resistance to malaria, UTI, pneumonia, gonorrhea

-high % MRSA

WHO- 2014

-increase the % of resistance to gonorrhea,

Ecoli

, staph

aureus

, intestinal infection by bacteria and 23,000 died due to antibiotic resistance

Problem statement-antibiotic resistanceSlide21

Survey report WHO- 2015

WHO –multi country survey regarding knowledge about antibiotic resistance

12 countries surveyed including India14 questions asked about knowledge regarding antibiotic and antibiotic resistance

online and face to face interviewSlide22

Results64% know about antibiotic resistance, but don’t know the cause and its prevention

64% believe

that antibiotics are effective in all types of infection irrespective of bacterial, viral, fungal etc.

76% believe that body become resistant to antibiotic ( fact is bacteria to antibiotic)Slide23

Results cont..44% believe that antibiotic resistance is a problem for people who take antibiotic regularly (anyone at any age can become resistant to antibiotic)

57% believe that there is no treatment for antibiotic resistance

In India, 76% taken antibiotics for the last 6 month. In that 58% stopped it when they feel betterSlide24

In the News & ArticlesSlide25

Individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop resistance to that antibioticGreatest effect in the month immediately following treatment but may persist for up to 12 months

Costelloe

, C. et al.

BMJ 2010: 340:c2096.Slide26

Are Antibiotics Really Benign?

CDC.

Threat Report 2013.

http://www.cdc.gov/drugresistance/threat-report-2013

/

Slide27
Slide28

Yes……. IT IS GLOBAL CONCERN

Increase death rate

Increase transmission of infectionIncrease cost of health careJeopardize the health care gains of the society such as organ transplantation, cancer chemotherapy, major surgery etc.Slide29

Prevention and control

1)

General public

Regular hand washing, good food hygiene, avoiding close contact with sick people and keeping vaccinations up to date

Only using antibiotics when prescribed by a certified health professional

Always take the full prescription

Never use left-over antibiotics

Never sharing antibiotics with others.

Never miss the dose in between the course of intakeSlide30

Prevention and control cont..

2) Health workers and pharmacists

Good hand, instruments and environmental hygiene

Keep patients’ vaccinations up to date

When a bacterial infection is suspected, perform bacterial cultures and testing to confirm

prescribe and dispense

antibiotics

when they are truly needed

Give the right antibiotic at the right dose for the right duration.Slide31

Prevention and control cont..

3) Policymakers

take national action plan to tackle antibiotic resistance Improve surveillance of antibiotic-resistant infections

Strengthen infection prevention and control measures

Regulate and promote the appropriate use of quality medicines

Make the general public aware about the impact of antibiotic resistance

Reward the development of new treatment options, vaccines and diagnostics.Slide32

Prevention and control cont..

4) Healthcare industry

-Invest new antibiotics, vaccines and diagnostics.*Some of the new antibiotics discovered are,Daptomycin (prevent protein synthesis)

Tigecycline

(

binds to bacterial ribosome, inhibiting bacterial protein synthesis)

Cefepime

(4

th

generation

cefalosporin

)

Aztreonam

(beta

lactum

antibiotic)

Imipenem

Meropenem

dalfopristinSlide33

Prevention and control cnt

..

5) The agricultural sectorOnly under the veterinary supervision, give antibiotics to animals

Vaccinate animals periodically

Maintain hygiene during production and processing of foods from animal and plant sources.

Implement international standards for the responsible use of antibiotics, set out by OIE, FAO and WHO.Slide34

Prevention and control cont..

6) WHO response

*The global action plan has formulated with 5 strategic objectives:To improve awareness and understanding of antimicrobial resistance To strengthen surveillance and research

To reduce the incidence of infection

To optimize the use of antimicrobial medicines

To ensure sustainable investment in countering antimicrobial resistance.Slide35

In response to Objective 1, WHO lead a global, multi-year campaign with the theme “Antibiotics: Handle with care”.

The campaign was launched in the first day of annual World Antibiotic Awareness Week from 16 to 22 November 2015.Slide36

Nurses role

-Give the right antibiotic at the right dose for the right duration.

-instruct clearly to the patient that,

Always take the full prescription

Never use left-over antibiotics

Never sharing antibiotics with others.

Never miss the dose in between the course of intake

maintain the medication records up to dateSlide37

International editorial board

Focus on global spread of antibiotic resistant microbes

Journal of Global Antimicrobial ResistanceSlide38
Slide39

Take home message

“Even though antibiotics are the magical bullet can save the life of a human being…. handle it with care”