Introduction to Antimicrobial Resistance Dr Poonam Khetrapal Singh Deputy Regional Director

Outline What is antimicrobial resistance (AMR) and its implications? Why are we worried about AMR in SEA Region? What are the possible solutions? What is WHO doing? What we all can do?

Outline What is antimicrobial resistance (AMR) and its implications Why are we worried about AMR in SEA Region What are the possible solutions What is WHO doing What we all can do

Antimicrobial (Antibiotics) resistance Resistance is unresponsiveness to antimicrobial agents in standard doses A natural biological unstoppable phenomenon which is driven by rampant misuse of antimicrobial agents 50% of antibiotics are prescribed inappropriately 50% of patients have poor compliance 50% of populations do not have access to essential antibiotics 50% of antibiotics in some countries are used for animal growth promotion

Resistance has huge negative impact on health 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 on individual and society Antimicrobial resistance has been recognized as an emerging public health problem because of its various serious implications. These include the longer duration of the illness and treatment which results into high mortality and morbidity associated with economic loss to the patients as well as to the community. Infections with micro-organism resistance to conventional antibiotic have to be treated with expensive nucleus drug which may be more toxic. All these bacteria produce extra burden on the health system and also increase the possibility of communication of resistance organisms to the community through the patients who is suffering from infections due to resistance organisms.

Outline What is antimicrobial resistance (AMR) and its implications Why are we worried about AMR in SEA Region What are the possible solutions What is WHO doing What we all can do

Resistance is negating “wonder drugs” in SEAR Tuberculosis MDR-TB < 3% : 130,000 cases annually, XDR-TB: Reported from 4 countries Kala-azar 60% resistance in pentavalent antimony and 25% in pentamidine Typhoid fever MDR Salmonella Typhi prevalent all over Region Causing 10% Case Fatality Rate (CFR) in children (preantibiotic era: 12.8%) Hospital associated infections Staphylococcus aureus: >50% isolates in hospitals are methicillin-resistant (MDR) Acinetobacter baumannii: >50% of patients infected with resistant strains die Pseudomonas, Klebsiella, Serratia: MDR persist in hospital settings, and cause huge mortality morbidity Malaria 400 million people at risk of infection with resistant parasite

Superbugs* are visible manifestations of our prolonged failure to preserve antibiotics Accumulation of resistance to multiple antibiotics Self medication and poor compliance Known but neglected. Need immediate action Inappropriate use of antibiotics selection & multiplication of resistant strains Weak surveillance & regulatory systems Continuous natural evolution of resistance in bugs Known but inevitable ** 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

Outline What is antimicrobial resistance (AMR) and its implications Why are we worried about AMR in SEA Region What are the possible solutions What is WHO doing What we all can do

Possible solutions Discover new drugs faster than emergence of resistance Promote discovery, development and dissemination of new antimicrobial agents Prevent emergence of resistance by reducing selection pressure by appropriate control measures Rationalize the use of available antimicrobial agents

Antibiotics: Roadway Since the discovery of penicillin in 1928, many new antibiotics have been introduced between 1940 and 1970, the golden era of antibiotic discovery (press spacebar for animation). During the late 1980s and early 1990s, two major groups of antibiotics became available & very commonly used, the third & fourth generation cephalosporins and the fluoroquinolones. Oxazolidinone is the last new antibiotic group introduced with the turn of the century. As is evident from the roadway, discovery of new agents has markedly slowed down in the last 2-3 decades. This has been coupled with emergence of multiple drug resistance in many bacteria, mainly in those common in serious infections in hospital practice. 11

Possible 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

Regional Strategy on AMR and Resolution of RC63 Governance Regulatory Capacity building Community education Research

Outline What is antimicrobial resistance (AMR) and its implications Why are we worried about AMR in SEA Region What are the possible solutions What is WHO doing What we all can do

WHO material for technical support…. Available at www.searo.who.int/AMR

Outline What is antimicrobial resistance (AMR) and its implications Why are we worried about AMR in SEA Region What are the possible solutions What is WHO doing What we all can do

Antibiotics are a precious resource “antimicrobial resistance is possibly the single biggest threat facing the world in the area of infectious diseases”. Antibiotics are a precious resource We need to preserve this resource by working together Use Antibiotics rationally