WORLD HEALTH DAY

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By: dazu (45 month(s) ago)

Thanks for the presentation .Good exposure on World Health Day & awareness on Antibiotics HNS Rao

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WORLD HEALTH DAY 7TH April Antimicrobial Resistance :

WORLD HEALTH DAY 7 TH April Antimicrobial Resistance Dr.T.V.Rao MD Dr.T.V.Rao MD 1

WHO – World Health Day:

WHO – World Health Day World Health Day is celebrated every year on 7 April, under the sponsorship of the World Health Organization (WHO). Dr.T.V.Rao MD 2

Beginning of World Health Day:

Beginning of World Health Day In 1948, the World Health Organization held the First World Health Assembly. The Assembly decided to celebrate 7 April of each year, with effect from 1950, as the World Health Day. The World Health Day is celebrated to create “awareness of a specific health theme to highlight a priority area of concern for the World Health Organization (WHO)”. Activities – related to that particular theme and the resources provided – continue beyond 7 April, that is, the designated day for celebrating the World Health Day. Dr.T.V.Rao MD 3

World Health Day 2011:

World Health Day 2011 For World Health Day 2011, WHO will launch a worldwide campaign to safeguard these medicines for future generations. Antimicrobial resistance - the theme of World Health Day 2011 - and its global spread, threatens the continued effectiveness of many medicines used today to treat the sick, while at the same time it risks jeopardizing important advances being made against major infectious killers. Dr.T.V.Rao MD 4

Antibiotic Resistance Threat to Humans and Animals:

Antibiotic Resistance Threat to Humans and Animals Antibiotic resistance has become a serious problem in both developed and underdeveloped nations. By 1984 half of those with active tuberculosis in the United States had a strain that resisted at least one antibiotic.In certain settings, such as hospitals and some childcare location Dr.T.V.Rao MD 5

Themes of previous World Health Days:

Themes of previous World Health Days # 2011: anti-microbial resistance # 2010: Urbanization and health # 2009: Save lives, Make Hospitals Safe in Emergencies # 2008: Protecting health from the adverse effects of climate change # 2007: International health security # 2006: Working together for health # 2005: Make every mother and child count # 2004: Road safety # 2003: Shape the Future of Life: Healthy Environments for Children Dr.T.V.Rao MD 6

Themes of previous World Health Days:

Themes of previous World Health Days # 2002: Move for Health # 2001: Mental Health: Stop Exclusion, Dare to Care # 2000: Safe Blood Start with Me # 1999: Active Aging Makes the Difference # 1998: Safe Motherhood # 1997: Emerging Infectious Diseases # 1996: Healthy Cities for Better Life # 1995: Global Polio Eradication Dr.T.V.Rao MD 7

The magic bullets - Antibiotics:

The magic bullets - Antibiotics Antibiotics revolutionised medicine The first antibiotic, penicillin, was discovered by Alexander Fleming in 1929 It was later isolated by Florey and Chain It was not extensively used until the 2nd World War when it was used to treat war wounds After 2nd World War many more antibiotics were developed Today about 150 types are used Most are inhibitors of the protein synthesis, blocking the 70S ribosome, which is characteristic of prokaryotes © Dr.T.V.Rao MD 8

Resistance:

Resistance It took less than 20 years for, bacteria to show signs of resistance Staphylococcus aureus , which causes blood poisoning and pneumonia, started to show resistance in the 1950s Today there are different strains of S. aureus resistant to every form of antibiotic in use Dr.T.V.Rao MD 9

Multiple resistance:

Multiple resistance It seems that some resistance was already naturally present in bacterial populations The presence of antibiotics in their environment in higher concentrations increased the pressure by natural selection Resistant bacteria that survived, rapidly multiplied They passed their resistant genes on to other bacteria ( both disease causing pathogens and non-pathogens) Dr.T.V.Rao MD 10

Resistance gets around:

Resistance gets around When antibiotics are used on a person, the numbers of antibiotic resistant bacteria increase in other members of the family In places where antibiotics are used extensively e.g. hospitals and farms antibiotic resistant strains increase in numbers Dr.T.V.Rao MD 11

Our Vision to save Antibiotics:

Our Vision to save Antibiotics we live in an era of medical breakthroughs with new 'wonder drugs' available to treat conditions that a few decades ago, or even a few years ago in the case of HIV/AIDS, would have proved fatal. For World Health Day 2011, WHO will launch a worldwide campaign to safeguard these medicines for future generations Dr.T.V.Rao MD 12

Are we loosing advantage of our Achievements:

Are we loosing advantage of our Achievements Antimicrobial resistance - the theme of World Health Day 2011 - and its global spread, threatens the continued effectiveness of many medicines used today to treat the sick, while at the same time it risks jeopardizing important advances being made against major infectious killers. Dr.T.V.Rao MD 13

Slide 14:

Dr.T.V.Rao MD 14

Too many drugs – contribute to Misuse of Drugs:

Too many drugs – contribute to Misuse of Drugs Currently, about 20 000 medicines are sold on the global market. WHO's List of Essential Medicines, which includes examples of medicines addressing all the major diseases of public health importance, contains 316 products. The wide range of very similar medicines that exist for the same condition can lead to irrational use and all the negative consequences this brings with it. Dr.T.V.Rao MD 15

Factors contributing Misuse of Antibiotics:

Factors contributing Misuse of Antibiotics # More than 50% of all medicines are prescribed, dispensed or sold inappropriately, and half of all patients fail to take medicines correctly. # The overuse, underuse or misuse of medicines harms people and wastes resources. # More than 50% of all countries do not implement basic policies to promote rational use of medicines. Dr.T.V.Rao MD 16

Factors contributing Misuse of Antibiotics:

Factors contributing Misuse of Antibiotics * In developing countries, less than 40% of patients in the public sector and 30% in the private sector are treated according to clinical guidelines. * A combination of health-care provider education and supervision, consumer education, and an adequate medicines supply is effective in improving the use of medicines, while any of these interventions alone has limited impact. Dr.T.V.Rao MD 17

Incorrect use of medicines:

Incorrect use of medicines WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. This incorrect use may take the form of overuse, underuse and misuse of prescription or non-prescription medicines. Dr.T.V.Rao MD 18

Drugs Have Become Part of Our Life?:

Drugs Have Become Part of Our Life? Dr.T.V.Rao MD 19

Incorrect prescriptions have great impact on Drug Resistance:

Incorrect prescriptions have great impact on Drug Resistance Medical doctors, including veterinarians and dentists, often incorrectly prescribe antibiotics: they prescribe the wrong antibiotics or the incorrect dosage of an antibiotic for a particular infection; they prescribe antibiotics for non-bacterial infections (e.g. colds, coughs, or influenza); they prescribe antibiotics prophylactically (in a low dosage for months at a time to prevent future infections; for example, for young children with a history of multiple ear infections). Dr.T.V.Rao MD 20

Broad Spectrum Antibiotics are major contributors to Antibiotic Resistance:

Broad Spectrum Antibiotics are major contributors to Antibiotic Resistance Many doctors also prescribe broad-spectrum antibiotics , which kill many different types of bacteria, rather than run a diagnostic lab test so they can prescribe a narrow-spectrum antibiotic that would specifically target the bacteria causing the infection. • In many other countries, antibiotics are freely available over the counter, without a doctor’s prescription, leading to widespread misuse . Dr.T.V.Rao MD 21

Patents too contribute to Antibiotic Resistance:

Patents too contribute to Antibiotic Resistance Patients themselves also contribute to the problem when they feel better after a few days, and then stop taking the antibiotics, instead of continuing with the full cycle prescribed to them. In a 1995 Gallup poll, it was estimated that more than half of American adults taking antibiotics f ailed to complete their prescribed dosage . Dr.T.V.Rao MD 22

Antimicrobial resistance with Overuse of Antibiotics:

Antimicrobial resistance with Overuse of Antibiotics Antimicrobial resistance. Overuse of antibiotics increases antimicrobial resistance and the number of medicines that are no longer effective against infectious disease. Many surgical procedures and cancer therapies are not possible without antibiotics to fight infection. Resistance prolongs illnesses and hospital stays, and can even cause death, leading to costs of US$ 4–5 billion per year in the United States of America1 and €9 billion per year in Europe. Dr.T.V.Rao MD 23

Scientific Basis of Antibiotic Resistance:

Scientific Basis of Antibiotic Resistance Generally , antibiotic resistance is spread through a process called horizontal gene transfer, the simple passing of genes from one individual to another. Bacteria are very adept at this, thus the interest among scientists in identifying biological pathways that limit horizontal gene transfer, particularly the process called conjugation, which is most commonly associated with the spread of antibiotic resistance. Dr.T.V.Rao MD 24

What can be done to improve Rational use of Medicines?:

What can be done to improve Rational use of Medicines ? # a national body to coordinate policies on medicine use and monitor their impact; # evidence-based clinical guidelines for training, supervision and supporting decision-making about medicines; # lists of essential medicines used for medicine procurement and insurance reimbursement; # drug (medicines) and therapeutics committees in districts and hospital Dr.T.V.Rao MD 25

What can be done to improve rational use of medicines?:

What can be done to improve rational use of medicines? # problem-based training in pharmacotherapy and prescribing in undergraduate curricula; # continuing medical education as a requirement of licensure; # publicly available independent and unbiased information about medicines for health personnel and consumers; # public education about medicines; # elimination of financial incentives that lead to improper prescribing, such as prescribers selling medicines for profit to supplement their income; # regulations to ensure that promotional activities meet ethical criteria; and # adequate funding to ensure availability of medicines and health personnel. Dr.T.V.Rao MD 26

Is an antibiotic necessary ?:

Is an antibiotic necessary ? Useful only for the treatment of bacterial infections Not all fevers are due to infection Not all infections are due to bacteria There is no evidence that antibiotics will prevent secondary bacterial infection in patients with viral infection Dr.T.V.Rao MD 27

Think before - Prescribing an antibiotic:

Think before - Prescribing an antibiotic Is an antibiotic necessary ? What is the most appropriate antibiotic ? What dose, frequency, route and duration ? Is the treatment effective ? Dr.T.V.Rao MD 28

Choice of regimen:

Choice of regimen Oral vs parenteral Traditional view “serious = parenteral” previous lack of broad spectrum oral antibiotics with reliable bioavailability Improved oral agents higher and more persistent serum and tissue levels for certain infections as good as parenteral Dr.T.V.Rao MD 29

Slide 30:

We can alter RESISTANCE Maintain sufficiently high levels of the drug in the tissues  inhibit original population and first-step mutants. Simultaneous administration of two drugs that do not give cross-resistance  delay emergence of mutants resistant to the drug (e.g. INH + Rifampicin) Limit the use of a valuable drug  avoid exposure of the organism to the drug Dr.T.V.Rao MD 30

Slide 31:

What Is Antimicrobial Stewardship? • A commination of infection control and antimicrobial management • Mandatory infection control compliance • Selection of antimicrobials from each class of drugs that does the least collateral damage • Collateral damage issues include – MRSA – ESBLs – C difficile – Stable derepression – MBLs and other carbapenemases – VRE • Appropriate de-escalation when culture results are available Dellit TH, et al. Clin Infect Dis. 2007;44:159-177 . Dr.T.V.Rao MD 31

Slide 32:

IDSA Guidelines – Definition of Antimicrobial Stewardship • Antimicrobial stewardship is an activity that promotes – The appropriate selection of antimicrobials – The appropriate dosing of antimicrobials – The appropriate route and duration of antimicrobial therapy Dr.T.V.Rao MD 32

Slide 33:

The Primary Goal of Antimicrobial Stewardship • The primary goal of antimicrobial stewardship is to – Optimize clinical outcomes while minimizing unintended consequences of antimicrobial use • Unintended consequences include the following – Toxicity – The selection of pathogenic organisms, such as C difficile – The emergence of resistant pathogens Dr.T.V.Rao MD 33

Between 1962 and 2000, no major classes of antibiotics were introduced :

Between 1962 and 2000, no major classes of antibiotics were introduced Fischbach MA and Walsh CT Science 2009 Dr.T.V.Rao MD 34

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 Dr.T.V.Rao MD 35

Slide 36:

12 Steps to Prevent Antimicrobial Resistance 12 Break the chain 11 Isolate the pathogen 10 Stop treatment when cured 9 Know when to say “no” to vanco 8 Treat infection, not colonization 7 Treat infection, not contamination 6 Use local data 5 Practice antimicrobial control 4 Access the experts 3 Target the pathogen 2 Get the catheters out 1 Vaccinate Prevent Transmission Use Antimicrobials Wisely Diagnose & Treat Effectively Prevent Infections Campaign to Prevent Antimicrobial Resistance in Healthcare Settings Dr.T.V.Rao MD 36

Microbes are evolving to save themselves:

Microbes are evolving to save themselves Unfortunately, because we ignored evolution for so long, we are in a crisis of antibiotic resistance . Granted, even if antibiotics had been used wisely from the very beginning, bacterial populations would still have evolved resistance eventually; however, it would have taken much longer, we would have known it would happen, Dr.T.V.Rao MD 37

Teach Hand Washing a Habit to Everyone:

Teach Hand Washing a Habit to Everyone Dr.T.V.Rao MD 38

Antibiotics save Lives Save Antibiotics from Misuse:

Antibiotics save Lives Save Antibiotics from Misuse Dr.T.V.Rao MD 39

Document your Antibiotic Resistance and Sensitivity Patterns with WHONET:

Document your Antibiotic Resistance and Sensitivity Patterns with WHONET 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. Dr.T.V.Rao MD 40

Medical Teaching Needs Change on Rationalism of Antibiotic Use:

Medical Teaching Needs Change on Rationalism of Antibiotic Use The society needs educated on the Role of Antibiotics in Health and Science. In the Developing world there should be a change in perceptions on Antibiotics through more dedicated Teaching, better national policies. Dr.T.V.Rao MD 41

Global United Efforts Can Reduce Antibiotic Misuse:

Global United Efforts Can Reduce Antibiotic Misuse Dr.T.V.Rao MD 42

Slide 43:

Created by Dr.T.V.Rao MD for “e” learning resources for Developing World Email doctortvrao@gmail.com Dr.T.V.Rao MD 43

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