1. Bubonic plague, TB , Malaria, hiv have affected significant number of hyman beings and caused mortality and morbidity
Adult humans contains 1014 cells, only 10% are human – the rest are bacteria
Antibiotic use promotes Darwinian selection of resistant bacterial species
Bacteria have efficient mechanisms of genetic transfer – this spreads resistance
Bacteria double every 20 minutes, humans every 30 years
Development of new antibiotics has slowed – resistant microorganisms are increasing

3. Introduction
Throughout history there has been a continual battle between human beings and multitude of micro-organisms that cause infection and disease
Bubonic plague, TB , Malaria, hiv have affected significant number of hyman beings and caused mortality and morbidity
Adult humans contains 1014 cells, only 10% are human – the rest are bacteria
Antibiotic use promotes Darwinian selection of resistant bacterial species
Bacteria have efficient mechanisms of genetic transfer – this spreads resistance
Bacteria double every 20 minutes, humans every 30 years
Development of new antibiotics has slowed – resistant microorganisms are increasing

4. Antibiotics
“Antibiotics are powerful medicines that fight bacterial infection”
Literal translation:
anti – against
biotic – living things

5. Discovery Alexander Fleming in 1928
He was an extremely messy scientist
Came 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!

6. How antibiotics work Antibiotics can be either
Broad Spectrum
Kill 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 dividing

7. Mechanisms of action of antibiotics

8. 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
Super infection
Drug resistance

9. 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”.

10. The Nobel Prize in Physiology or Medicine 1945
History
Nobel Lecture, December 11, 1945
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.”
Antimicrobial agents were viewed as miracle cure when introduced into clinical practice. However it became evident rather soon after the discovery of penicillin that resistance develops quickly terminating the miracle. This serious development is ever present with each new antimicrobial agents and threatens end of antimicrobial area. Today even major class of antibiotics are resistant
Sir Alexander Fleming
The Nobel Prize in Physiology or Medicine 1945

11. The Causes
Overuse
Misuse

12. Why We Overuse Antibiotics
Patients:
Need to return to work/school
Expect antibiotics if they’ve been given them before
Physicians
Think patients expect antibiotics
Concerned about patient satisfaction
Diagnosis is difficult
Time pressure
Antibiotic Prescription
A study published in Clinical Pediatrics in 1998 showed that there are two major variables in the overuse equation: patients and the people prescribing antibiotics for them. This information shows that all of us have a responsibility to use antibiotics carefully and reserve them for times when they’re really needed (to fight bacterial infections).
(Clin Pediatr. 1998;37: )

13. What is misuse of antibiotics?
Misuse of antibiotics can include any of the following18:
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 Nov;30(5):724-7.

14. 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.
So how does resistance develop? Here’s a scenario that may seem familiar.
It’s very common to have bacteria in your sinuses and not show symptoms of bacterial infection.

15. Unnecessary Antibiotics Cause Resistance
Jane takes penicillin.
Susceptible bacteria are killed off.
A few hardy survivors are left behind. X
The survivors can withstand penicillin. R

16. X Resistant Bacteria Can Multiply and Spread
The resistant survivors multiply. R
Treatment with penicillin has no effect. X
Now that Jane is a carrier of resistant bacteria, she can spread resistant infections to others in her family and community.
Jane is now a carrier of penicillin-resistant bacteria.

17. Scenario #2 Ashley takes her medicine for three days.
Ashley feels fine.
Her parents decide it’s OK to stop.
Now we’ll find out why this wasn’t a good decision…

18. Incomplete Treatment Causes Resistance
Day 0 R
Antibiotics prescribed R X
Day 3
Symptoms improved, treatment stopped R
Day 10
Resistant infection
Meanwhile, the survivors multiply.
Quitting treatment too early only kills the susceptible (“weak”) bacteria, leaving the resistant (“strong”) ones to multiply.
(Adapted from Levin BR, Clin Infect Dis 2001)

19. Resistant Infections Require Special Treatment
Longer treatment
More expensive medication
Higher dosage R
Intravenous (IV) medication, hospitalization
Treatments for resistant infections are more dangerous and expensive.

20. Problem statement-antibiotic resistance
WHO increase resistance to first line drugs WHO ,80,000 new multi drug resistant TB detected -resistance to malaria, UTI, pneumonia, gonorrhea -high % MRSA WHO increase the % of resistance to gonorrhea, Ecoli, staph aureus, intestinal infection by bacteria and 23,000 died due to antibiotic resistance

21. Survey report WHO- 2015
WHO –multi country survey regarding knowledge about antibiotic resistance
12 countries surveyed including India
14 questions asked about knowledge regarding antibiotic and antibiotic resistance
online and face to face interview

22. Results
64% 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)

23. 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 better

24. In the News & Articles

25. Individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop resistance to that antibiotic
Greatest effect in the month immediately following treatment but may persist for up to 12 months
Costelloe, C. et al. BMJ 2010: 340:c2096.

26. Are Antibiotics Really Benign?
CDC. Threat Report

28. Yes……. IT IS GLOBAL CONCERN
Increase death rate
Increase transmission of infection
Increase cost of health care
Jeopardize the health care gains of the society such as organ transplantation, cancer chemotherapy, major surgery etc.

29. 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 intake

30. 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.

31. 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.

32. 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 (4th generation cefalosporin)
Aztreonam (beta lactum antibiotic)
Imipenem
Meropenem
dalfopristin

33. Prevention and control cnt..
5) The agricultural sector
Only 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.
Mary juvitta

34. 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.

35. 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.

36. 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 date

37. Journal of Global Antimicrobial Resistance
International editorial board
Focus on global spread of antibiotic resistant microbes

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