Smanjena djelotvornost Smanjena djelotvornost antibiotika – jesmo li izgubili antibiotika – jesmo li izgubili

trku s bakterijamatrku s bakterijama

Prof.dr.sc. Arjana Tambić AndraševićKlinika za infektivne bolesti

“Dr. F. Mihaljević”

“But I would like to sound one note of warning.... It is not difficult to make microbes resistant to penicillin in the

laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionaly happened

in the body ...”

Fleming A. Penicillin. Nobel lecture. December 11, 1945

“ Antibiotic therapy: use it and lose it”

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010

Salvarsan,1910

Sulfonamide, 1936

Penicillin, 1943

Aminoglycoside, 1944

Polymyxine, 1948

Tetracycline, 1948

Chloramphenicol, 1949

Macrolide, 1952

Chephalosporine, 1953

Glycopeptide, 1958

Fluoroquinolone, 1983

Carbapenem, 1985

Glycycline, 2005

Lipopeptides, 2005

Ketolide, 2001

Oxazolidinone, 2000

Quinolones, 1962Streptogramins, 1962

Razvoj novih antibiotika

ECMO

Hip replacement

Organ transplants

Cancer chemotherapy

Intensive care

Care of preterm babies

Modern Medicine Is Not Possible Without Effective Antimicrobials

Kako zaustaviti rezistenciju na antibiotikeKako zaustaviti rezistenciju na antibiotike??

7

Razvoj novih antibiotika

Razumna uporaba antibiotika (samo kad su potrebni,

točna doza i duljina primjene)

Kontrola infekcija (higijena ruku,

traženje kliconoša, izolacija)

New systemic antibacterial agentsECDC / EMEA Technical Report 2009

Potrošnja antibiotika korelira sa stopama rezistencije na antibiotike

9

R2=0.66

P<0.001

R2=0.66P<0.001

0

20

40

60

0 2 4 6 8

Antibiotic consumption(Outpatient consumption of macrolides and lincosamides, DDD per 1,000 inh days)

An

tib

ioti

c r

es

ista

nc

e

(%

Ma

cro

lide

-R S

. p

ne

um

on

iae

fro

m c

om

mu

nity

-acq

uire

d R

TIs

)

Outpatient antibiotic use in 25 European countries in 2003*

* For Iceland total data are use; for Poland 2002 data are used.

0

5

10

15

20

25

30

Gre

ece

Fra

nce

Lu

xem

bou

rg

Por

tuga

l

Slo

vak

ia

Ital

y

Bel

giu

m

Cro

atia

Pol

and

Sp

ain

Irel

and

Icel

and

Isra

el

Fin

lan

d

Slo

ven

ia

Hu

nga

ry

Cze

ch R

ep.

Nor

way

UK

Sw

eden

Ger

man

y

Den

mar

k

Au

stri

a

Est

onia

Net

her

lan

ds

DD

D /

1000

inab

itan

ts /

day

Others

Sulfonamides (J01E)

Tetracyclines (J01A)

Quinolones (J01M)

Macrolides (J01F)

Cephalosporins (J01D)

Penicillins (J01C)

↓

Seasonal variation of outpatient antibiotic use in 11 European countries with quarterly data for 1997-2003

0

5

10

15

20

25

30

35

1997 1998 1999 2000 2001 2002 2003

DD

D /

1000

inh

abit

ants

/ d

ay

Greece

Portugal

Belgium

Ireland

Finland

Iceland

Slovenia

UK

Sweden

Denmark

Netherlands

Seasonal variation of outpatient antibiotic use in 10 European countries not able to deliver quarterly data for 1997 - 2003,

but at least for one year in this period

0

5

10

15

20

25

30

35

1997 1998 1999 2000 2001 2002 2003

DD

D /

1000

inh

abit

ants

/ d

ay

Slovakia

Italy

Poland

Croatia

Spain

Hungary

CzechRep.

Austria

Estonia

Germany

EARSS: EARSS: MRSA in 2007MRSA in 2007

Tko utječe na potrošnju antibiotikaTko utječe na potrošnju antibiotika??

14

Doctors – major differences in

antibiotic prescribing

across Europe

Nurses – also prescribing in

some countries

Pharmacists – sell over the

counter in some countries (this practice is not legal in most

cases)

Patients – demanding antibiotics, especially

parents for their children

WHO global strategy for containment of antimicrobial resistance, 2001

1. Patients and the general community education On the appropriate use of antibiotics On the importance of measures to prevent infection

2. Prescribers and dispensers education Diagnostic and treatment guidelines Disease prevention (immunization), infection control Link professional registration requirements to CME

3. Hospitals Infection control programmes Hospital therapeutics committees Hospital antimicrobial formularies Asure access to microbiology laboratories Control pharmaceutical company promotional activities

WHO global strategy for containment of antimicrobial resistance, 2001

4. Use of antimicrobials in food producing animals

5. National government and health systems- make the containment of antimicrobial resistance a national priority- create a national intersectoral task force- allocate resources to promote the implementation of interventions to contain resistance- develop indicators to monitor and evaluate the impact of the antimicrobial resistance containment strategy

6. Drug and vaccine development

7. Pharmaceutical promotion

8. International aspects of containing antimicrobial resistance

Samoliječenje antibioticima

• Antibiotik = antipiretik = analgetik

• Antibiotici dostupni samo na recept

• Ostaci prethodnih terapija, “kućne apoteke”

Miracle Cure?Antibiotics resistance

– Many bacteria have developed the ability to become resistant to antibiotics.

– These bacteria are now a major threat in our hospitals.

– Antibiotic resistant bacteria include Methicillin Resistant Staphylococcus aureus (MRSA)

Antibiotic Resistance The Causes

– Overuse

• Antibiotics used to treat infections when they are not needed or not effective i.e. for the flu

– Misuse

• Not completing a prescribed course

• Using antibiotics not prescribed for you

How antibiotic resistance can be

prevented– Antibiotics should be the last line of defence NOT the

first

• Most common infections will get better by themselves through time, bed rest, liquid intake and healthy living.

– Only take antibiotics prescribed by a doctor

– If prescribed antibiotics, finish the course.

– Do not use other peoples or leftover antibiotics

• they be specific for some other infection

Amy went to school not feeling very well. She had a headache and a runny nose. She soon realised that Natasha was also not well.

Are you OK Natasha?

Not really but my mum said that I have to come to

school *cough* *cough*Mine too. But I’m not

coughing. You really should cover your mouth you

know.

At lunch time, Amy and Natasha went to the toilet. Natasha was hungry and in a hurry to have her lunch.

Come on Amy, I’m Hungry!

Hang on, I need to wash my

hands.

Don’t bother. I never do and it hasn’t done me

any harm.

During lunch Amy was talking to her friend Harry about her headache and runny nose.It really hurts and I think I’m getting a

cough.

Don’t you have any antibiotics at home you can

take?

That’s a good idea. We still have some from when my sister had an ear infection.

I’ll ask my mum.

Go home and get some bed rest, take some painkillers for the

headache if you need to.

But she’s ill, you have to give her some

antibiotics.

I’m sorry, but there’s no need.

When Amy got home, her mother decided to take her to the doctor. He said that she had a bad cold.

You weren’t in school today, are you OK?

No, my knee started to get really painful in the night so my Mum

took me to see the doctor. He said that my cut got infected.

Oh no, did he give you painkillers?

No, he gave me antibiotics to help fight the infection but told me to

take them until they were all finished.

Harry didn’t come to school the next day so Amy called around to see him on her way home from school.

A drug used to take away pain

Very small microbe that can be helpful or harmful

A disease caused by a microbe

Special medicine used to treat bacterial infecions

A sign of illness e.g. headache, diarrhoea and fever

The smallest of the microbes - usually harmful

A drug used to treat a disease or injury

The challenge of public awareness

29

Please indicate whether the following statement is trueor false:”Antibiotics kill viruses as well as bacteria”

False

39.7%

True

41.3%

Do not know

19.0%

Source: Eurobarometer 55.2: Europeans, Science & Technology, May-June 2001

A little learning is a dangerous thing.

Drink deep, or taste not the Pierian spring;

There shallow draughts intoxicate the brain;

And drinking largely sobers us again

Alexander Pope (1688-1744)

Keeping antibiotics effective is everyone’s responsibility !!!!

Banner on Passerelle Belliard, Brussels

European Antibiotics Awareness Day,EAAD, 18 November

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