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    Antibiotics: Success and Failures

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    tummalapalli venkateswara rao
    The document discusses antibiotics, their discovery, development, and increasing issues with antibiotic resistance. It describes how Alexander Fleming discovered penicillin in 1928 and how later researchers were able to produce it in larger quantities. However, overuse and misuse of antibiotics has led to growing antibiotic resistance in bacteria. The emergence of resistant strains is a major public health concern and requires monitoring antibiotic use and resistance patterns to help guide treatment. Tracking resistance data through the WHONET software allows for analysis of local and global resistance trends over time.

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    Antibiotics: Success and Failures

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    69 views43 pages
    The document discusses antibiotics, their discovery, development, and increasing issues with antibiotic resistance. It describes how Alexander Fleming discovered penicillin in 1928 and how later researchers were able to produce it in larger quantities. However, overuse and misuse of antibiotics has led to growing antibiotic resistance in bacteria. The emergence of resistant strains is a major public health concern and requires monitoring antibiotic use and resistance patterns to help guide treatment. Tracking resistance data through the WHONET software allows for analysis of local and global resistance trends over time.

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    The document discusses antibiotics, their discovery, development, and increasing issues with antibiotic resistance. It describes how Alexander Fleming discovered penicillin in 1928 and how later researchers were able to produce it in larger quantities. However, overuse and misuse of antibiotics has led to growing antibiotic resistance in bacteria. The emergence of resistant strains is a major public health concern and requires monitoring antibiotic use and resistance patterns to help guide treatment. Tracking resistance data through the WHONET software allows for analysis of local and global resistance trends over time.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    Download as pptx, pdf, or txt
    69 views43 pages

    Antibiotics: Success and Failures

    Uploaded by

    tummalapalli venkateswara rao
    The document discusses antibiotics, their discovery, development, and increasing issues with antibiotic resistance. It describes how Alexander Fleming discovered penicillin in 1928 and how later researchers were able to produce it in larger quantities. However, overuse and misuse of antibiotics has led to growing antibiotic resistance in bacteria. The emergence of resistant strains is a major public health concern and requires monitoring antibiotic use and resistance patterns to help guide treatment. Tracking resistance data through the WHONET software allows for analysis of local and global resistance trends over time.

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    of 43

    ANTIBIOTICS

    SUCCESS AND FAILURES


    Dr.T.V.Rao MD

    ANTIBIOTICS
    We didnt have antibiotics before the 1940s. Alexander Fleming helped to develop the first antibiotic from a mold. Antibiotics work to kill infecting bacteria. Natural variations exist within bacterial populations that make some bacteria resistant to antibiotics. Abuse of antibiotics promotes the development of antibiotic-resistant bacteria.

    A DISCOVERY BY ACCIDENT
    A fungal spore that the wind might have blown into his lab while Fleming was on vacation in 1928, forever changed the course of medicine... A. Fleming named the substance Penicillin, after the mould Pencillium notatum but was unable to isolate the substance In the late 1930s and early 1940s, E. Chain & H. Florey managed to produce larger amounts of penecillin, and ran successful trials on mice Nobel prize in 1945

    ANTIBIOTIC BRANDS
    50 penicillin's
    71 cephalosporins

    9 macrolides
    2 streptogramins

    12 tetracycline's
    8 aminoglycosides 1 monobactam 5 Carbapenems

    3 dihydrofolate reductase inhibitors


    1 oxazolidinone 5.5 quinolones

    Development of anti-microbials
    The development
    of anti-infectives

    ertapenem tigecyclin daptomicin linezolid telithromicin quinup./dalfop. cefepime ciprofloxacin aztreonam norfloxacin imipenem cefotaxime clavulanic ac. cefuroxime gentamicin cefalotina nalidxico ac. ampicillin methicilin vancomicin rifampin chlortetracyclin streptomycin pencillin G

    prontosil

    1920
    DR.T.V.RAO MD

    1930

    1940

    1950

    1960

    1970

    1980

    1990

    2000
    5

    ANTIBIOTIC USE AND MISUSE


    During the 1940s and 1950s antibiotics were extremely effective They were (and still are) widely prescribed, often for medical conditions that did not require them Antibiotics started to be used in agriculture: dosing cattle with antibiotics increases yield, and battery farming relies on antibiotics to control infection

    By the 1970s the World was awash with antibiotics.

    EVOLUTION OF RESISTANCE
    Antibiotic use represents a strong selection pressure If a population of bacteria with a few resistant individuals is exposed to a lethal antibiotic, the susceptible bacteria will die, but the resistant bacteria will survive In an environment with a lot of antibiotic use, resistance alleles spread rapidly The problem is compounded by horizontal gene transfer and by cross-resistance

    ANTIBIOTICS
    Biology and Society

    About 50% of the antibiotics produced today are used in the livestock industry. What impact does this have on the treatment of human diseases?

    ANTIMICROBIAL RESISTANCE: THE ROLE OF ANIMAL FEED ANTIBIOTIC ADDITIVES

    48% of all antibiotics by weight is added to animal feeds to promote growth. Results in low, sub therapeutic levels which are thought to promote resistance. Farm families who own chickens feed tetracycline have an increased incidence of tetracycline resistant fecal flora

    CHRONOLOGY OF DEVELOPMENT OF ANTIBIOTIC RESISTANCE


    Antibiotic
    Penicillin Streptomycin Tetracycline Erythromycin Gentamicin

    Year introduced
    1942 1947 1952 1955 1967

    Resistance identified
    1940 1947 1956 1956 1970

    Vancomycin

    1956

    1987

    PRESCRIBING AN ANTIBIOTIC
    Is an antibiotic necessary ?
    What is the most appropriate antibiotic ? What dose, frequency, route and duration ? Is the treatment effective ?

    ANTIBIOTIC PRESCRIBING CHILDREN REAL CONCERN


    Antibiotics were prescribed in 68% of acute respiratory tract visits and of those, 80% were unnecessary according to CDC guidelines Children are of particular concern because they have the highest rates of antibiotic use.

    WE TOO CONTRIBUTE FOR CREATING DRUG RESISTANCE


    Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drugresistant bacteria.

    ANTIBIOTIC PRESSURE AND RESISTANCE IN BACTERIA WHAT HAPPENED TO S. AUREUS ?

    Reports of increasing use of third gen cephalosporins and quinolones related to emergence of MRSA. Some data suggest that quinolones enhance expression of methicillin resistance in SA in vitro
    Outbreaks of MRSA have been reduced by curbing antibiotic use: especially of cephalosporins

    Antimicrobial Resistance:
    Susceptible Pathogen Pathogen Antimicrobial-Resistant Pathogen
    Prevent Transmission

    Key Prevention Strategies


    Prevent Infection

    Antimicrobial Resistance
    Optimize Use

    Infection
    Effective Diagnosis & Treatment

    Antimicrobial Use

    CONSEQUENCES OF ANTIBIOTIC DRUG RESISTANCE


    People infected with drug-resistant organisms are more likely to have longer and more expensive hospital stays, and may be more likely to die as a result of the infection. They require treatment with second- or third-choice drugs that may be less effective, more toxic, and more expensive. This means that patients with an antimicrobial-resistant infection may suffer more and pay more for treatment.

    ANTIBIOTIC PRESSURE AND RESISTANCE IN BACTERIA


    WHAT FACTORS PROMOTE THEIR DEVELOPMENT AND SPREAD ?

    Alteration of normal flora Practices contributing to misuse of antibiotics

    Settings that foster drug resistance


    Failure to follow infection control principles

    Practices Contributing to Misuse of Antibiotics


    Inappropriate specimen selection and collection
    Inappropriate clinical tests Failure to use stains/smears Failure to use cultures and susceptibility tests

    Settings that Foster Drug Resistance

    HOSPITAL

    Intensive care units


    Oncology units

    Dialysis units
    Rehab units

    Transplant units
    Burn units

    EMERGING TRENDS IN ANTIBIOTIC RESISTANCE

    Reports of methicillin-resistant Staphylococcus aureus (MRSA)a potentially dangerous type of staph bacteria that is resistant to certain antibiotics and may cause skin and other infectionsin persons with no links to healthcare systems have been observed with increasing frequency in the United States and elsewhere around the globe.

    GRAM NEGATIVE BACTERIA A GREAT THREAT


    Multi-drug resistant Klebsiella species and Escherichia coli have been isolated in hospitals throughout the United States. It is a Universal phenomenon

    FUNGI TOO BECOMING RESISTANCE


    Antimicrobial resistance is emerging among some fungi, particularly those fungi that cause infections in transplant patients with weakened immune systems.

    RESISTANCE IN VIRUS
    Antimicrobial resistance has also been noted with some of the drugs used to treat human immunodeficiency virus (HIV) infections and influenza.

    PARASITES TOO ARE PROBLEMATIC


    The development of antimicrobial resistance to the drugs used to treat malaria infections has been a continuing problem in many parts of the world for decades. Antimicrobial resistance has developed to a variety of other parasites that cause infection.

    Identification of The Etiological Agent


    Laboratory diagnosis Interpretation of the report What is isolated is not necessarily the pathogen
    Was the specimen properly collected ?

    Is it a contaminant or colonizer ? Sensitivity reports are at best a guide

    WHO GLOBAL STRATEGY ON REDUCING THE


    ANTIBIOTIC RESISTANCE

    The WHO Global Strategy for Containment of Antimicrobial Resistance identifies the establishment and support of microbiology laboratories as a fundamental priority in guiding and assessing intervention efforts.
    DR.T.V.RAO MD

    26

    IMPORTANCE OF LOCAL ANTIBIOTIC RESISTANCE DATA

    Resistance patterns vary


    From country to country From hospital to hospital in the same country

    From unit to unit in the same hospital

    Regional/Country data useful only for looking at trends NOT guide empirical therapy

    WHONET DOCUMENTATION WHY WE NEED IT

    ADOPTION OF WHONET
    To enhance the local use of data for local needs: clinical decision support, antimicrobial use policy, infection control and outbreak detection, identifying laboratory test performance, and characterization of local microbial and resistance epidemiology To promote local, national, regional, and global collaborations through the exchange of data and sharing of experiences

    WHAT IS 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.

    The principal goals of the software are:


    1 to enhance local use of laboratory data; and 2 to promote national and international collaboration through the exchange of data.
    DR.T.V.RAO MD

    30

    GROWING IMPORTANCE OF
    World over antimicrobial resistance is a major public health problem. The WHONET software program puts each laboratory data into a common code and file format, which can be merged for national or global collaboration of antimicrobial resistance surveillance
    DR.T.V.RAO MD

    WHONET

    31

    WHONET SUPPORTS SURVEILLANCE IN OVER 90 COUNTRIES INDICATED BELOW IN RED.

    DR.T.V.RAO MD

    32

    US NEW ANTIBACTERIAL AGENTS


    Year 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 No. Approved 20 3 1 0 2 4 2 0 3 1 2 0 2 Multiple agents Temafloxacin, lomefloxacin, cefpodoxime Piperacillin/Tazobactam Lowest number of new agents (22) since 1988 Dirithromycin, ceftibutin Meropenem, levofloxacin, sparfloxacin, Cefepime Grepafloxacin, Trovafloxacin Rivaled 1994 Dalfopristin/quinupristin, gatifloxacin, moxifloxacin Linezolid Ertapenem, ceftidoren 89 drugs approved, no antibacterial agents Daptomycin, gemifloxacin Agents

    WHONET HELPS US IN
    The understanding of the local epidemiology of microbial populations; the selection of antimicrobial agents; the identification of hospital and community outbreaks; and the recognition of quality assurance problems in laboratory testing.

    DR.T.V.RAO MD

    34

    CLINICIANS AND MICROBIOLOGIST CAN DO ANALYSIS OF THE DATA THEMSELVES


    WHONET has a user-friendly interface permitting many types of analysis. Options include isolate line-listings and summaries, such as organism frequencies over time, antimicrobial susceptibility test statistics, zone diameter antibiotic scatterplots and regression curves, and antibiotic resistance and MIC histograms, profile line listings and summaries. WHONET also has a number of alert features which permit the detection of unlikely or important results as well as possible community outbreaks of bacterial or non-bacterial species.
    DR.T.V.RAO MD

    35

    ALL THE DOCUMENTED RESULTS ARE ANALYZED IN WHONET


    The heart of WHONET is a software package designed to collect the results of antibiotic resistance tests. Researchers / Microbiologists feed the results into a computer and look for trends

    DR.T.V.RAO MD

    36

    CLINICIANS CAN ACCESS DATA OF THEIR PATIENTS ANYTIME IN THE COMPUTER JUST WITH CLICK OF THE MOUSE

    DR.T.V.RAO MD

    37

    OUR LABORATORY REPORTS ARE DOCUMENTED IN DIGITAL FORMAT WITH WHONET

    IMPLEMENTATION OF WHONET CAN HELP TO MONITOR RESISTANCE


    Legacy computer systems, quality improvement teams, and strategies for optimizing antibiotic use have the potential to stabilize resistance and reduce costs by encouraging heterogeneous prescribing patterns and use of local susceptibility patterns to inform empiric treatment.

    DR.T.V.RAO MD

    39

    ANTIBIOTICS SAVE LIVES SAVE ANTIBIOTICS FROM MISUSE

    DR.T.V.RAO MD

    40

    PHYSICIANS CAN IMPACT


    Patients
    Other clinicians

    Optimize patient evaluation Optimize consultations with Adopt judicious antibiotic other clinicians prescribing practices Use infection control measures Immunize patients Educate others about judicious use of antibiotics

    CONCLUSIONS
    Antibiotic resistance is a major problem world-wide
    Resistance is inevitable with use No new class of antibiotic introduced over the last two decades

    Appropriate use is the only way of prolonging the useful life of an antibiotic

    Programme Created by Dr.T.V.Rao MD for Medical, Paramedical and Health Care Workers in the Developing World
    Email
    [email protected]

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