Post Antibiotic Era

Emerging Concern to Humanity

Dr.T.V.Rao MD

Health care Challenge of st 21 Centaury

Serious infections caused by bacteria that have become resistant to commonly used antibiotics have become a major global healthcare problem in the 21st century.

Antibiotic Resistance a Reality

The World Health Organization says antimicrobial resistance which includes drugresistant bacteria, viruses, fungi and parasites is seen in every region of the world.

An impending threat to Humanity

In a "postantibiotic era", where people die from simple infections that have been treatable for decade

Emerging of Superbugs

In recent times new mechanisms of resistance have resulted in the simultaneous development of resistance to several antibiotic classes creating very dangerous multidrug-resistant (MDR) bacterial strains, some also known as superbugs

Indiscriminate and inappropriate use of antibiotics leading cause to Superbugs

The indiscriminate and inappropriate use of antibiotics in outpatient clinics, hospitalized patients and in the food industry is the single largest factor leading to antibiotic resistance. In recent years

Society at Risk

The potential negative consequences of all these events are relevant because they put society at risk for the spread of potentially serious MDR bacterial infections.

Many other Reasons for Antibiotic Resistance

Many Reasons for Antibiotic Resistance

WHO Releases the New

Report

The newly-released World Health Organization document finds that in every region of the world, the growing rate of antimicrobial and antibiotic resistance is a serious threat to human health. Minor infections that were once considered beaten could kill again, and lengthier stays in hospitals and higher healthcare costs are a near-guarantee.

Resistance to UTI

Reports of resistance to UTI medicine are particularly alarming because it has happened so quickly. When UTI medicine was first introduced in the 1980s, resistance to them was virtually zero; now, there are parts of the world where treatment is basically ineffective, the WHO said.

Drug Resistance in Gonorrhoea

When more than 1 million people are infected with gonorrhoea everyday, pause for a moment to think about the fact that treatment for the disease has failed for more than half of patients in several countries in recent years, including Canada, France, and the U.K. In 2011, gonorrhoea was the second most commonly reported infection

Today we are losing the efficacy of Antibiotics

Without

urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,

Key findings of the report

The report, "Antimicrobial resistance: global report on surveillance", notes that resistance is occurring across many different infectious agents but the report focuses on antibiotic resistance in seven different bacteria responsible for common, serious diseases such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea. The results are cause for high concern, documenting resistance to antibiotics, especially last resort antibiotics, in all regions of the world

Penicillin and S.pneumoniae

Reduced susceptibility to penicillin was detected in S.pneumoniae in all WHO regions, and exceeded 50%in some reports. The extent of the problem and its impact on patients is not completely clear because of variation in how the reduced susceptibility or resistance to penicillin is reported, and limited comparability of laboratory standards

Klebsiella pneumoniae Carbapenems

Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumoniaecarbapenem antibioticshas spread to all regions of the world. K. pneumoniae is a major cause of hospitalacquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients

E. coliFluoroquinolones

Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli fluoroquinolonesis very widespread.

Fluoroquinolones in Salmonella and Shigella

The resistance to fluoroquinolones among two of the major causes for bacterial diarrhoea, non typhoidal Salmonella(NTS) and Shigella species, were comparatively lower than in E.coli.

Tuberculosis a Great Concern

Globally, 3.6% of new TB cases and 20.2% of previously treated cases are estimated to have multidrug-resistant TB (MDR-TB), with much higher rates in Eastern Europe and central Asia. Despite recent progress in the detection and treatment of MDR-TB, the 84 000 cases of MDR-TB notified to WHO in 2012 represented only about21% of the MDR-TB cases estimated to have emerged in the world that year. Among MDR-TB patients who started treatment in 2010, only 48%(range 46%56%across WHO regions) were cured after completion of treatment (with 25% lost to follow-up). The treatment success rate was lower among extensively drugresistant (XDR-TB) cases.

MDR -TB (Multidrug Resistant Tuberculosis) under reported

Although multidrugresistant TB is a growing concern, it is largely underreported, compromising control efforts

Artemisinin and Malaria

Foci of artemisinin resistance in malaria have been identified in a few countries. Further spread, or emergence in other regions, of artemisinin-resistant strains could jeopardize important recent gains in malaria control

Resistance to Antiretroviral Drugs

Increasing levels of transmitted anti-HIV drug resistance have been detected among patients starting antiretroviral treatment.

Growing Resistance to Antiretroviral Therapy

Available data suggest that 10%17% of patients without prior ART in Australia, Europe, Japan and the United States of America (USA) are infected with virus resistant to atleast one antiretroviral drug

Fast progressing Resistance from 1980 to 2014

In the 1980s, when these drugs were first introduced, resistance was virtually zero. Today, there are countries in many parts of the world where this treatment is now ineffective in more than half of patients.

Gonorrhoea
Third generation cephalosporins

Treatment failure to the last resort of treatment for gonorrhoeathird generation cephalosporinshas been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.

MRSA (methicillin-resistant Staphylococcus aureus)

Antibiotic resistance causes people to be sick for longer and increases the risk of death. For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection. Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required.

Growing Resistance to Oseltamivir

Although the frequency of oseltamivir resistance in currently circulating A(H1N1)pdm09 viruses is low(1%2%), the emergence and rapid global spread in2007/2008 of oseltamivir resistance in the former seasonal A(H1N1) viruses has increased the need for global antiviral resistance surveillance.

Resistance in systemic Candidiasis

Resistance to fluconazole, a common antifungal drug, varies widely by country and species. Resistance to the newest class of antifungal agents, the echinocandins, is already emerging in some countries

How to tackle Antibiotic Resistance

People can help tackle resistance by:

using antibiotics only when prescribed by a doctor; completing the full prescription, even if they feel better; never sharing antibiotics with others or using leftover prescriptions. Follow the Prescriptions

Health workers and pharmacists can help tackle resistance by

Enhancing infection prevention and control; only prescribing and dispensing antibiotics when they are truly needed; prescribing and dispensing the right antibiotic(s) to treat the illness.

Strengthening resistance tracking and laboratory capacity; regulating and promoting appropriate use of medicines.

Policymakers can help tackle resistance by:

Policymakers and industry can help tackle resistance by:

Fostering innovation and research and development of new tools;promoting cooperation and information sharing among all stakeholders

The Report on Antibiotic Resistance advises to tackle

The reportwhich also includes information on resistance to medicines for treating other infections such as HIV, malaria, tuberculosis and influenza provides the most comprehensive picture of drug resistance to date, incorporating data from 114 countries.

WHO South-East Asia Region

The reports results show high levels of E. coli resistance to third generation cephalosporins and fluoroquinolonestwo important and commonly used types of antibacterial medicinein the Region. Resistance to third generation cephalosporins in K. pneumoniae is also high and widespread. In some parts of the Region,

Need to improve Diagnostic Laboratories

Important actions include preventing infections from happening in the first placethrough better hygiene, access to clean water, infection control in health-care facilities, and vaccinationto reduce the need for antibiotics. WHO is also calling attention to the need to develop new diagnostics, antibiotics and other tools to allow healthcare professionals to stay ahead of emerging resistance.

MRSA a Prominent Threat

more than one quarter of Staphylococcus aureus infections are reported to be methicillin-resistant (MRSA), meaning that treatment with standard antibiotics does not work

The WHOs action plan, including:

1 better use of vaccines;

2 basic hand hygiene to reduce infections, such as washing hands;

3 reduction of non-health uses of antimicrobial drugs;

4 support of research that will lead to new and better diagnostic tests; 5 Better surveillance, to get a better overall global antimicrobial resistance.

We need Approaches

These approaches will include new antibiotics, but should also include studies to develop new rapiddiagnostic devices, fundamental research to understand how microbes become resistant to drugs, and how human behaviour influences the spread of resistance

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