2. Background
Drug resistance
• Inappropriate prescription
• Availability of “Over the counter” (OTC) antibiotics
• Sale not restricted to medical prescription only.
• Improper use of antibiotics
3. What’s Improper use
of Antibiotics?
• DOSAGE: Incorrect dosage
• DURATION: too short or too long
• DELAY: antibiotic administration in critically ill pts.
• DATA: Lack of a database on AMR
5. “But I would like to sound one note of warning.
Penicillin is to all intents non-poisonous so there is no need to
worry about giving an overdose and poisoning the patient.
There may be a danger, in underdosage which exposing the
microbes to non-lethal quantities of the drug, makes them resistant.”
Sir Alexander Fleming
http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf
6. AMR: Problem statement
• Government health sectors
• Civil hospitals
• AFMS hospitals
• Private health sectors
“most accredited hospitals, though having a well written antibiotic
policy on paper, are not compliant in practice.”
80% of infections – resistant bacteria
Fabricated as per NABH assessors
7. WHAT’S NEW??
Newer Antibiotics
Newly identified microbes
Newer approaches to handle antimicrobial resistance
• Infection control
• Rethinking the way to fight AMR
8. ∂ Miracle Drugs
∂ Why will we always need new antibiotics?
∂ AMR: Naturally occurring, modes of transfer of Resistance
∂ Increase in Incidence of AMR
∂ The most effective and most recently approved drugs gradual
decline in their efficacy
∂ Do we have anything new in our armoury?
Newer Antibiotics
10. What would a post-antibiotic era look like?
∂ Top ten causes of death
35 %
11. WHAT’S NEW??
Newer Antibiotics
Newly identified microbes
Newer approaches to handle antimicrobial resistance
• Infection control
• Rethinking the way to fight AMR
12.
13. Newly Identified Resistant Microbes
∂ XDR-TB (Line Probe Assay), Pan drug resistant(PDR)
Acinetobacter.
∂ E S K A P E group of organisms with new resistance genes
∂ VITEK’s contribution
14. WHAT’S NEW??
Newer Antibiotics
Newly identified microbes
Newer approaches to handle antimicrobial resistance
• Infection control
• Rethinking the way to fight AMR
16. Activities of an optimal infection control
program
• Surveillance of nosocomial infections
• Outbreak investigation and control
• Policy development, review and compliance monitoring
• Isolation practices
• Hand hygiene
• Sterilisation / disinfection of eqpt and supplies
• Housekeeping
• Laundry
• Food
IMPACT
18. WHAT’S NEW??
∂ Newer Antibiotics
∂ Newly identified microbes
∂ Newer approaches to handle antimicrobial resistance
• Infection control
• Rethinking the way to fight AMR
19. Rethinking the way to fight Bacterial
Resistance
The use of bacteriophages
Quorum Sensing inhibitors
Probiotics: repopulate the microbiota of a
recipient
22. • National Antibiotic Policy, published in 2011, still
available on the Website.
• Publically withheld by the Health Minister,
immediately after its publication.
• Complete ban on OTC sale of Antibiotics
• The decision to restrict usage of third line
antibiotics only to tertiary care hospitals
23. Chennai Declaration
• “A Roadmap to Tackle the Challenge of
Antimicrobial Resistance”
• A 5-year strategy to control antibiotic
resistance was proposed
24.
25. Coordinator: DCI/State
Drug Controller
24 antibiotics
included in restricted
list
60% of antibiotics
90% of all
antibiotics
(strategy as per the
chennai declaration
recommendation)
Coordinator:
Hospital infection control
committee
All tertiary Care
hospitals to have
an antibiotic policy
All secondary care
and primary care
facilities to have an
antibiotic policy
26. Introduce STEP BY STEP regulation
of antibiotic usage,
• concentrating on higher end
antibiotics first
• then slowly extending the list to
second and first line antibiotics
………
28. Conclusion
∂ AMR increasing alarmingly and no new approved drugs
∂ Drug resistance- evolutionary phenomenon: Impossible to
completely eliminate, can slow it down by prudent Ab usage
∂ Rethinking the way we fight the “BAD BUGS”
∂ India needs “An implementable antibiotic policy” and NOT
“A perfect policy”.- CHENNAI DECLARATION
Editor's Notes
As one expert puts it, “When it comes to prescribing antibiotics, most doctors use the canon, when a gun can be used to kill the same enemy.”
Misuse of antibiotics can include any of the following
Paul Erhlich, a German-born physician and scientist in the fields of hematology, immunology, and chemotherapy and Nobel Prize winner in 1908, recognized early on that drug-resistance was a complicating issue when treating certain disease states. Now, although his statement of “Drug Resistance follows the drug like a faithful shadow” was more relevant at that time to cancer-chemotherapy, he recognized this as being important for antimicrobial therapy as well – he originally discovered Arsphenamine, or Salvarsan, the first known medical treatment of syphilis.