NEW

INSIGHT TO
ANTIBIOTIC
RESISTANCE
BY
DR/ FATMA OMAR
KHALIL
ASSOCIATE PROFESSOR OF MEDICAL
MICROBIOLOGY & IMMUNOLOGY
 Antimicrobial resistance (AMR)
is one of the most severe and
complicated health issues
globally, AMR has been projected
to cost the global economy about
one hundred trillion dollars per
annum, driven by interrelated
dynamics in humans, animals, and
environmental health sectors .
Challenges:
The problem is likely to worsen soon due to the
following challenges:
1- Indiscriminate (over and miss) use of antibiotics
2-various epidemiological factors as: poor sanitary
conditions, poor water quality, suboptimal health care
system exasperated by crude diagnostic practices and
lack of capacity-building programs, poor surveillance
and stewardship programs.
3- a limited pipeline for new antimicrobials
4- the transmission of drug-resistant organisms.
5-the lack of sufficiently trained infection control
personnel.
6-The role of civil society organizations in facing
AMR is limited.
 Strategies To Reduce AMR

• I- International efforts:
• Increased collaboration between governments, non-govermental organizations,
professional groups and international agencies
• New networks that undertake surveillance of antimicrobial use and AMR.
• International approach for control of misuse of antimicrobials
• Incentives for the research and development of new drugs and vaccines.
• Forming new and reinforcing existing programmes to contain AMR.
 2. National strategies
• 2.1 National committee with intersectoral coordination and regulatory actions:
• WHO recommends that such committee would formulate AMR policy; provide
guidance on standards, regulations, training and awareness on antibiotic use and
AMR.
• Establishing and implementing national standard treatment guidelines, having
essential drug list (EDL), enhancing coverage of immunization are other essential
strategies desired at national level.
• 2.2 National Antimicrobial Resistance Policy:
• A national policy for containment of AMR was introduced in 2011. The policy aims
to understand emergence, spread and factors influencing AMR, to setup
antimicrobial program
• 3. action at community level
• globally, infectious diseases continue to be significant cause of morbidity and
mortality, affecting more the countries where health services are not sufficiently
accessible
• 3.1 Rational use of antibiotics
• Irrational use of medicines is a serious global problem. in developing countries, at
primary level, less than 40% patients in public sector and less than 30% patients
in private sector are treated in accordance with standard treatment guidelines
• 3.2 Over-the-counter (OTC) antibiotics
• Measures that preserve efficacy of antimicrobials are mainly directed towards the
hospitals and drug providers and missing antibiotic use without prescription. in
systematic review of non-prescription antimicrobial use.
• 3.3 Guidelines for use of antibiotics at local levels
• About use of antibiotics in common situations, Bhagwati A. discussed that an
empirical antibiotic therapy should be started considering the clinical condition
of the patient and prevalent pathogen and resistance pattern in a locality.
• 3.4 Standards of hygiene
• Use of alcohol-based hand rubs or washing hands has proven efficacy in
prevention of infection. This factor can restrict the spread of infection and
thereby the AMR. Willingness to put up with high standards of hygiene is the
need of an hour
• 3.5 Other approaches
• These include identifying residents with MDR infections and use of standard
treatment regime for their management,
• 4. At hospital or health care setting
• A person or a patient in a health care facility is at higher risk of
infection with common pathogens. for control and containment of
AMR, experts recommend some of the measures.
• 4.1 infection prevention and control within health-care facilities
infection prevention and control measures are designed to reduce
• The spread of pathogens including resistant ones within healthcare
Facilities and to the wider community. this can prevent further
Infections and AMR spread.
• Recommended measures to prevent and control infection in a
health-care facility.
• Establishing an infection prevention and control committee (IPC).
• Good hand hygiene practices.
• Effective diagnosis and treatment of infection.
• Rational antimicrobial use.
• Surveillance of antibiotic resistance and antibiotic use.
• Improving the antimicrobial quality and supply chain.
• Good microbiology practices
• 5. At personal / patient level
• 5.1 Role of physician along with providing direct patient care,
complying with local infection control and antibiotic use policies and
timely notifyingresistant cases to IPC, the physician can play a major
role in combating AMR
• 5.2 Role of nurses/health care providers since nurses/health care
providers are in direct contact with the patients, they are amongst those
related in either spread or control of infection and AMR. educating
nurses and health care providers about the AMR and aseptic practices
may help in control of spread of infections
• 5.3 Role of pharmacist:
• in their review discussed the pharmacist-directed antibiotic
stewardship programs (ASPs) as an approach to improve the
utilization of antibiotics. pharmacists can counsel patients
with viral infections about the ineffectiveness of
antibacterial and can recommend appropriate OTC
medication for supportive care. referral to physician is must
if a bacterial infection is suspected. above all.
• 5.4 At patient level:
• (a) Aseptic protocol for any procedures:
reported that MDR microbes caused 30.2% of the catheter-related blood-stream
infections and empirical treatment had no role in prevention of such infections. this
mandates use of aseptic protocol to minimize local or systemic infections
associated with any procedures.
• (b) Breaking the chain of infectivity: by simple means like covering mouth
while coughing or sneezing, infection spread can be reduced.
• (c) Compliance to the antimicrobial regime and antibiotic: improved
compliance can improve the rate of infection control. patient education on
compliance with antibiotics is must. using established regimes for prophylactic
use of antibiotics in high-risk cases and for the shortest duration possible can
minimize risk of AMR.
• 6.1 Pharmaceutical promotion:
• It recommends that pharmaceutical firms should strictly
adhere to the standards of drug promotion, direct-to-
consumer advertising and advertising the internet. there is
need to identify and prohibit any incentives promoted by
pharmaceutical companies that possibly encourage
inappropriate antimicrobial use
• 6.2 Antibiotic use in animals
• use of antibiotic avoparcin in food of the animals in Europe was the
cause of development of vancomycin-resistant enterococci (VRE)
and consequent colonization in human intestine, thus highlighting
its importance. who specifically called for stricter legislation to
minimize antimicrobial usage in animals. improved sanitation,
provision of probitotics or nutritional supplements in feed and
vaccination for common animal diseases can help reduce the
antimicrobial use in animals
• 6.4 Innovation in new drugs and technology:
• Concerns of increased antibiotic resistance led to the urgent need of
concentrating on the issue of new drugs and vaccines development to
combat AMR. collaborated efforts of national, international,
government and academic networks are needed to identify new
classes of antibiotics and diagnostic technologies. providing research
funding for development of new antimicrobials to pharmaceutical
companies for diseases of public health importance can advance the
new drug development.
 CONCLUSION
• antimicrobial resistance is a complex problem with many
diverse contributing factors. it is major cause of health
concerns adding cost to oneself and to the community,
directly or indirectly. prevention is still the best tool to
reduce the infection spread and thereby amr. along with
rational use of existing antimicrobial drugs, development
of new effective compounds and new diagnostic
technology is the need. joint efforts from patients,
prescribers and individuals to international regulators and
policy makers are needed to fight against the globally
spreading antimicrobial resistance.
THANK YOU