Dr. Ts hokey

Cons ultant Clinical Microbiologis t

J DWNRH

Antibiotic Resistances: Implications

Infectious Diseases Vs Other Diseases

HOS T Environmen

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HOS T

Environmen

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Pathoge

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Infectious Diseases Vs Other Diseases

❖Other disease are due to malfunctioning or destruction of host cells / Cellular structures

Heart Failure, MI, Malignancies,

Cure – often with residual impairment

❖Infectious diseases – due to action of pathogens/or their toxins

Recovery or death,

Recovery– without sequele- full function is restored most of the time

Most infectious diseases are treated with

antibiotics….

Antibiotics are……Substances secreted by other living organisms.

They act on bacterial cells – with very minimal or no effect on host cells - selective advantage

Introductions Discovery of penicillin and other antibiotics in 1940s –

the “magic bullet”

The “golden age of antibiotics”-multiple choices- Luxury

Introduction…..

So much success and hope in the field of infectious diseases

“Most experts believe that by the year 2000 viral and bacterial infections will have disappeared from our life”.

- US Surgeon General, Time Magazine, 25/2/66

❖But – most experts now say that – looking at the diversity of infections and the unavailability of antibiotics and vaccines that time, it was a miracle for people born before 1940s to escape those infections and survive.

Impact of Penicillin on society…….

Impact of antibiotics on Disease

burden…..

Evolution: The history

• 3.85 billion years old: Bacteria

• 210 million years old: Real Mammals

• 60 million years old: Human-like Mammals

• 30 million years old: Monkeys

• 2.5 million years old: Direct Ancestors

• 0.2 million years old: Neanderthals

• 0.125 million years old: Homo Sapiens

“Evolution is cleverer than you are”.

- Orgel’s second rule

Evolution: The history

80 years old: Antibiotics

Vs

3.85 billion years old: Bacteria

Our bugs stronger than our drugs Bacteria are the dominant species on the earth

– Rapid multiplication rate– Natural mutation rate– Ability to transfer or move from one to another

“Super Bugs- No Drugs”

decreasing research and development for new classes of antibiotics

1990s - 2000s, 225 new molecular entities - for FDA for approval. Only seven were antimicrobials.

Approximately 10 years to develop a new agent.

Costs between $800 million to $1.7 billion dollars – a huge investment without a guarantee for return due to rapid resistance

Not like other drugs – a week vs Lifelong

All possible materials for antibiotics already explored

Companies dropped out of antibiotic business

Due to increased travel, medical tourism, trade –

“Resistance in one place is resistance everywhere” –International concern

“Super-bugs fly” everywhere

Whose responsibility

YOURS?

MINE?

Doctors?

Nurses?

Vets?

Patients?

OURS

What each of us can do?

❖ It is a MULTI-DISCIPLINARY TASK

As Healthcare practitioners:

- Use antibiotics rationally – overuse/misuse

- Educate public in general/patients in particular

- Prevent emergence/spread – Infection control, vaccines

- AR has to be detected as they emerge – Dxtic support

- Develop & implement a coordinated national plan for AR Surveillance

- Ensure the availability of reliable drug susceptibility data for surveillance

- Monitor patterns of antimicrobial drug use

What we can……

As Agriculturists/Animal Health

- Control animal feeds containing antibiotics

- Use antibiotics rationally in animals

- Monitor AR in agricultural settings to protect the public’s health by ensuring a safe food supply as well as animal and plant health.

-

What we can do.…..

Hos pital adminis trators

- Good Infection Control system

- Antibiotic Control through – antibiotic stewardship and surveillance

- Proper antibiotic policy and manuals/guidelines

- Good administrative support to Control and monitoring activities

150K over the next two years, if mutant strains of S. aureus

resistant to all antibiotics become established.

Law makers: Politics and Biology

Legislations and policies on antibiotics at national level

Budgetary and administrative support at all levels

Multi-sectoral involvement

International and national, Institutional collaborations

Copyright ©2008 BMJ Publishing Group Ltd.

Delamothe, T. BMJ 2008;337:a524

Public opinion on the bigges t is s ues facing the UK 1982-2008

UK politics

Tony Blair - Labour Margaret Thatcher - Conservative

1997-2007 1979-1990

Top reasons for buying private

insurance in the UK 2007

1. Clean hospital

2. No waiting list

3. Less pain/faster recovery

4. Faster access to specialist

5. Better quality treatment.

As patients/Public

Try your best to be knowledgeable on drugs

Ask and be conscious of your prescriptions

Don’t demand antibiotics for colds/minor illness

Complete the course when prescribed an antibiotic

Do not promote OTC antibiotics