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WHD-11_ARM

WHD-11_ARM

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Published by: Jana Wilson on Apr 06, 2011
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02/05/2013

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Prevention and Containment of

Antimicrobial Resistance

USE ANTIBIOTICS RATIONALLY

1|

World Health Day 2011: Antimicrobial Resistance

Resistance in microbes is a natural phenomenon 
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 Resistance

Resistance is accelerated through inappropriate 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 Resistance

Resistance is fallout of inappropriate use of antimicrobials 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

± 50% of antibiotics are prescribed inappropriately ± 50% of patients have poor compliance ± 50% of populations do not have access to essential
antibiotics

4|

World Health Day 2011: Antimicrobial Resistance

Resistant organisms also move rapidly across borders through humans and the food-chain food 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 Resistance

Resistance is negating ³wonder´ drugs

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World Health Day 2011: Antimicrobial Resistance

Status of resistance in
WHO¶s South-East Asia Region South Tuberculosis
± MDR-TB < 3%: 180000 cases annually ± XDR-TB: Reported from Bangladesh, India, Indonesia, Thailand

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World Health Day 2011: Antimicrobial Resistance

Status of resistance in
WHO¶s South-East Asia Region South Malaria

± 400 million people at risk of infection with resistant parasites
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World Health Day 2011: Antimicrobial Resistance

Status of resistance in
WHO¶s South-East Asia Region South HIV and STIs

± Data on HIV resistance being generated ± STIs: Gonorrhoea widely resistant to penicillin & fluoroquinolones
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World Health Day 2011: Antimicrobial Resistance

Status of resistance in
WHO¶s South-East Asia Region South Kala-azar

± 60% resistance in pentavalent antimony and 25% in pentamidine
10 |
World Health Day 2011: Antimicrobial Resistance

Status of resistance in SEAR-2 SEARepidemic prone diseases 
Cholera
± Resistance to Nalidixic acid, fluorazolidone, cotrimoxazole: India ± Tetracycline resistance: India 

Shigellosis
± Multidrug resistant, causing extensive outbreaks 

Typhoid fever
± MDR Salmonella typhi prevalent all over Region ± Causing 10% Case Fatality Rate (CFR) in children (preantibiotic era: 12.8%) 

Acute respiratory infections (pneumonias)
± 69% of Strept pneumoniae resistant to penicillin in Thailand

11 |

World Health Day 2011: Antimicrobial Resistance

Status of resistance in SEAR-3 SEARHospitalHospital-associated infections 
Staphylococcus aureus
± >50% isolates in hospitals are methicillin-resistant ± 48% of patients with bacteraemia died in Thailand 

Acinetobacter baumannii
± >50% of patients infected with resistant strains die 

Pseudomonas, Klebsiella, Serratia
± Multidrug-resistance, persist in hospital settings, and cause huge mortality morbidity

12 |

World Health Day 2011: Antimicrobial Resistance

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
13 |
World Health Day 2011: Antimicrobial Resistance

Resistance: 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

± ± ± ±
14 |

WHA37.33 WHA51.17 WHA54.11 WHA58.27
World Health Day 2011: Antimicrobial Resistance

Resistance is a multifaceted problem 
Biological  Behavioural  Technical  Economic  Regulatory  Educational

15 |

World Health Day 2011: Antimicrobial Resistance

Superbugs* are visible manifestations of our prolonged failure to preserve antibiotics

Known but neglected. Need immediate action

Known but inevitable

16 | ** Methicillin resistant Staph aureus, MDR-and XDR Mycobacteria, ESBL producing Gram negative bacteria and NDM-1 producing World Health Day 2011: Antimicrobial Resistance enterobacteriaceae bacteria are few examples of superbugs because these fail to respond to large number of commonly used antibiotics

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

17 |

World Health Day 2011: Antimicrobial Resistance

?

Bad bugs need new drugs

18 |

World Health Day 2011: Antimicrobial Resistance

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
19 |
World Health Day 2011: Antimicrobial Resistance

Regional 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
20 |
World Health Day 2011: Antimicrobial Resistance

Major activities
Governance
Establishment of national alliances against AMR Designation of national focal points in MoH Constitution of multisectoral National Steering Committee 

Regulatory 

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 Surveillance of antimicrobial use and resistance Training prescribers for rational use of antimicrobials Reducing disease burden and infection control Undertaking operational research Educating for adherence to recommended regimens Discouraging self-prescription
World Health Day 2011: Antimicrobial Resistance

Capacity building

Community participation
21 |

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

22 |

World Health Day 2011: Antimicrobial Resistance

Antibiotics are a precious resource
We need to preserve this resource by working together

Combating antimicrobial resistance: No action today, no cure tomorrow

23 |

World Health Day 2011: Antimicrobial Resistance

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