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
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Slide1
Slide2Slide3
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
/
Slide27Slide28
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 ResistanceSlide38Slide39
Take home message
“Even though antibiotics are the magical bullet can save the life of a human being…. handle it with care”