Antibiotics Sucess and Failures

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Antibiotics Success and Failures


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Antibiotics Success and Failures :

Dr.T.V.Rao MD Antibiotics Success and Failures


Antibiotics We didn’t have antibiotics before the 1940s. Alexander Fleming helped to develop the first antibiotic from a mold. Antibiotics work to kill infecting bacteria. Natural variations exist within bacterial populations that make some bacteria resistant to antibiotics. Abuse of antibiotics promotes the development of antibiotic-resistant bacteria.

A discovery by accident:

A discovery by accident A fungal spore that the wind might have blown into his lab while Fleming was on vacation in 1928, forever changed the course of medicine... A. Fleming named the substance Penicillin, after the mould Pencillium notatum – but was unable to isolate the substance In the late 1930s and early 1940s, E. Chain & H. Florey managed to produce larger amounts of penecillin, and ran successful trials on mice Nobel prize in 1945

Antibiotic brands:

50 penicillin's 71 cephalosporins 12 tetracycline's 8 aminoglycosides 1 monobactam 5 Carbapenems 9 macrolides 2 streptogramins 3 dihydrofolate reductase inhibitors 1 oxazolidinone 5.5 quinolones Antibiotic brands

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ertapenem tigecyclin daptomicin linezolid telithromicin quinup./dalfop. cefepime ciprofloxacin aztreonam norfloxacin imipenem cefotaxime clavulanic ac. cefuroxime gentamicin cefalotina nalidíxico ac. ampicillin methicilin vancomicin rifampin chlortetracyclin streptomycin pencillin G prontosil The development of anti-infectives … Development of anti-microbials Dr.T.V.Rao MD 5

Antibiotic use and misuse:

Antibiotic use and misuse During the 1940s and 1950s antibiotics were extremely effective They were (and still are) widely prescribed, often for medical conditions that did not require them Antibiotics started to be used in agriculture: dosing cattle with antibiotics increases yield, and battery farming relies on antibiotics to control infection By the 1970s the World was awash with antibiotics.

Evolution of resistance:

Evolution of resistance Antibiotic use represents a strong selection pressure If a population of bacteria with a few resistant individuals is exposed to a lethal antibiotic, the susceptible bacteria will die, but the resistant bacteria will survive In an environment with a lot of antibiotic use, resistance alleles spread rapidly The problem is compounded by horizontal gene transfer and by cross-resistance


Antibiotics Biology and Society About 50% of the antibiotics produced today are used in the livestock industry. What impact does this have on the treatment of human diseases?

ANTIMICROBIAL RESISTANCE: The role of animal feed antibiotic additives:

ANTIMICROBIAL RESISTANCE : The role of animal feed antibiotic additives 48% of all antibiotics by weight is added to animal feeds to promote growth. Results in low, sub therapeutic levels which are thought to promote resistance. Farm families who own chickens feed tetracycline have an increased incidence of tetracycline resistant fecal flora

Chronology of Development of Antibiotic Resistance:

Chronology of Development of Antibiotic Resistance Antibiotic Year introduced Resistance identified Penicillin 1942 1940 Streptomycin 1947 1947 Tetracycline 1952 1956 Erythromycin 1955 1956 Gentamicin 1967 1970 Vancomycin 1956 1987

Prescribing an antibiotic:

Prescribing an antibiotic Is an antibiotic necessary ? What is the most appropriate antibiotic ? What dose, frequency, route and duration ? Is the treatment effective ?

Antibiotic Prescribing Children real Concern:

Antibiotics were prescribed in 68% of acute respiratory tract visits – and of those, 80% were unnecessary according to CDC guidelines Children are of particular concern because they have the highest rates of antibiotic use. Antibiotic Prescribing Children real Concern

We too Contribute for Creating drug Resistance:

Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria. We too Contribute for Creating drug Resistance

Antibiotic Pressure and Resistance in Bacteria What happened to S. aureus ?:

Antibiotic Pressure and Resistance in Bacteria What happened to S. aureus ? Reports of increasing use of third gen cephalosporins and quinolones related to emergence of MRSA . Some data suggest that quinolones enhance expression of methicillin resistance in SA in vitro Outbreaks of MRSA have been reduced by curbing antibiotic use: especially of cephalosporins

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Antimicrobial Resistance: Key Prevention Strategies Optimize Use Prevent Transmission Prevent Infection Effective Diagnosis & Treatment Pathogen Antimicrobial-Resistant Pathogen Antimicrobial Resistance Antimicrobial Use Infection Susceptible Pathogen

Consequences of Antibiotic drug Resistance:

Consequences of Antibiotic drug Resistance People infected with drug-resistant organisms are more likely to have longer and more expensive hospital stays, and may be more likely to die as a result of the infection. They require treatment with second- or third-choice drugs that may be less effective, more toxic, and more expensive. This means that patients with an antimicrobial-resistant infection may suffer more and pay more for treatment.

Antibiotic Pressure and Resistance in Bacteria What factors promote their development and spread ?:

Antibiotic Pressure and Resistance in Bacteria What factors promote their development and spread ? Alteration of normal flora Practices contributing to misuse of antibiotics Settings that foster drug resistance Failure to follow infection control principles

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Inappropriate specimen selection and collection Inappropriate clinical tests Failure to use stains/smears Failure to use cultures and susceptibility tests Practices Contributing to Misuse of Antibiotics

Hospital :

Intensive care units Oncology units Dialysis units Rehab units Transplant units Burn units Hospital Settings that Foster Drug Resistance

Emerging Trends in Antibiotic Resistance:

Emerging Trends in Antibiotic Resistance Reports of methicillin-resistant Staphylococcus aureus (MRSA)—a potentially dangerous type of staph bacteria that is resistant to certain antibiotics and may cause skin and other infections—in persons with no links to healthcare systems have been observed with increasing frequency in the United States and elsewhere around the globe.

Gram negative bacteria a great threat:

Multi-drug resistant Klebsiella species and Escherichia coli have been isolated in hospitals throughout the United States . It is a Universal phenomenon Gram negative bacteria a great threat

Fungi too becoming resistance:

Antimicrobial resistance is emerging among some fungi, particularly those fungi that cause infections in transplant patients with weakened immune systems. Fungi too becoming resistance

Resistance in Virus:

Antimicrobial resistance has also been noted with some of the drugs used to treat human immunodeficiency virus (HIV) infections and influenza. Resistance in Virus

Parasites too are Problematic:

The development of antimicrobial resistance to the drugs used to treat malaria infections has been a continuing problem in many parts of the world for decades. Antimicrobial resistance has developed to a variety of other parasites that cause infection. Parasites too are Problematic

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Identification of The E tiological A gent Laboratory diagnosis I nterpretation of the report W hat is isolated is not necessarily the pathogen W as the specimen properly collected ? I s it a contaminant or colonizer ? S ensitivity reports are at best a guide

Who global strategy on reducing the antibiotic resistance:

Who global strategy on reducing the antibiotic resistance Dr.T.V.Rao MD 26 The WHO Global Strategy for Containment of Antimicrobial Resistance identifies the establishment and support of microbiology laboratories as a fundamental priority in guiding and assessing intervention efforts .

Importance of local antibiotic Resistance data:

Importance of local antibiotic Resistance data Resistance patterns vary From country to country From hospital to hospital in the same country From unit to unit in the same hospital Regional/Country data useful only for looking at trends NOT guide empirical therapy

WHONET Documentation Why We Need It:

WHONET Documentation Why We Need It

Adoption of WHONET :

Adoption of WHONET To enhance the local use of data for local needs: clinical decision support, antimicrobial use policy, infection control and outbreak detection, identifying laboratory test performance, and characterization of local microbial and resistance epidemiology To promote local, national, regional, and global collaborations through the exchange of data and sharing of experiences

What is WHONET:

What is WHONET Dr.T.V.Rao MD 30 WHONET is a free software developed by the WHO Collaborating Centre for Surveillance of Antimicrobial Resistance for laboratory-based surveillance of infectious diseases and antimicrobial resistance. The principal goals of the software are: 1 to enhance local use of laboratory data; and 2 to promote national and international collaboration through the exchange of data.

Growing importance of WHONET:

Growing importance of WHONET World over antimicrobial resistance is a major public health problem. The WHONET software program puts each laboratory data into a common code and file format, which can be merged for national or global collaboration of antimicrobial resistance surveillance Dr.T.V.Rao MD 31

WHONET supports surveillance in over 90 countries indicated below in red. :

WHONET supports surveillance in over 90 countries indicated below in red. Dr.T.V.Rao MD 32

US – New Antibacterial Agents:

US – New Antibacterial Agents Year No. Approved Agents 1991 20± Multiple agents 1992 3 Temafloxacin, lomefloxacin, cefpodoxime 1993 1 Piperacillin/Tazobactam 1994 0 Lowest number of new agents (22) since 1988 1995 2 Dirithromycin, ceftibutin 1996 4 Meropenem, levofloxacin, sparfloxacin, Cefepime 1997 2 Grepafloxacin, Trovafloxacin 1998 0 Rivaled 1994 1999 3 Dalfopristin/quinupristin, gatifloxacin, moxifloxacin 2000 1 Linezolid 2001 2 Ertapenem, ceftidoren 2002 0 89 drugs approved, no antibacterial agents 2003 2 Daptomycin, gemifloxacin

Whonet helps us in ……:

The understanding of the local epidemiology of microbial populations; the selection of antimicrobial agents ; the identification of hospital and community outbreaks; and the recognition of quality assurance problems in laboratory testing . Whonet helps us in …… Dr.T.V.Rao MD 34

Clinicians and microbiologist can do analysis of the data themselves :

Clinicians and microbiologist can do analysis of the data themselves Dr.T.V.Rao MD 35 WHONET has a user-friendly interface permitting many types of analysis. Options include isolate line-listings and summaries, such as organism frequencies over time, antimicrobial susceptibility test statistics, zone diameter antibiotic scatterplots and regression curves, and antibiotic resistance and MIC histograms, profile line listings and summaries . WHONET also has a number of alert features which permit the detection of unlikely or important results as well as possible community outbreaks of bacterial or non-bacterial species.

All the Documented results are analyzed in WHONET:

All the Documented results are analyzed in WHONET The heart of WHONET is a software package designed to collect the results of antibiotic resistance tests. Researchers / Microbiologists feed the results into a computer and look for trends Dr.T.V.Rao MD 36

Clinicians can access data of their patients anytime in the computer just with click of the mouse :

Clinicians can access data of their patients anytime in the computer just with click of the mouse Dr.T.V.Rao MD 37

Our Laboratory Reports are documented in digital format with WHONET:

Our Laboratory Reports are documented in digital format with WHONET


Legacy computer systems, quality improvement teams, and strategies for optimizing antibiotic use have the potential to stabilize resistance and reduce costs by encouraging heterogeneous prescribing patterns and use of local susceptibility patterns to inform empiric treatment. Implementation of WHONET CAN HELP TO MONITOR RESISTANCE Dr.T.V.Rao MD 39

Antibiotics save Lives Save Antibiotics from Misuse:

Antibiotics save Lives Save Antibiotics from Misuse Dr.T.V.Rao MD 40

Physicians Can Impact:

Physicians Can Impact Other clinicians Patients Optimize patient evaluation Adopt judicious antibiotic prescribing practices Immunize patients Optimize consultations with other clinicians Use infection control measures Educate others about judicious use of antibiotics


Conclusions Antibiotic resistance is a major problem world-wide Resistance is inevitable with use No new class of antibiotic introduced over the last two decades Appropriate use is the only way of prolonging the useful life of an antibiotic

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Programme C reated by Dr.T.V.Rao MD for Medical, Paramedical and Health Care Workers in the Developing World Email

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