CLINICAL WORKSHOPON

EMERGING TRENDS IN HEALTHCARE

MEENAKSHI SHARMAPharm .d ( 2nd yr)CHITKARA COLLEGE OF PHARMACY

ANTIBIOTIC RESISTANCE

It is when microbes are less treatable with one or more antimicrobial medications used to treat or prevent Infection.

First discovered by A. Fleming . Brought into widespread use in 1940s.He himself warned about the dangers of the resistance in his NOBEL PRIZE LECTURE in 1945.

HISTORY “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 occasionally happened in the body …….and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

TIMELINE OF ANTIBIOTIC RESISTANCE

• Resistant organisms lead to treatment failure.• Increased mortality.• Resistant bacteria may spread in community.• Low level resistance can go undetected.• Added burden on healthcare costs .• Threats to return to pre – antibiotic era.• Selection pressure.

WHY RESISTANCE IS CONCERN ?

http://www.tufts.edu/med/apua/about_issue/about_antibioticres.shtmlhttp://www.smallworldinitiative.org/

RESISTANCE TO ANTOBIOTICS

• DENIED ACCESS : Membranes become impermeable to antibiotic • ANTIBIOTIC MODIFICATION : Some bacteria have enzymes that cleave or modify antibiotics.• ALTERED TARGET SITE: Antibiotic cannot bind to its intended target because the target itself is modified.• PUMPING OUT the antibiotic faster than it gets in.• ALTERNATIVE TARGETS (typically enzyme) : eg alternative penicillin binding protein .

SUPERINFECTION

THE USE OF BROAD SPECTRUM ANTIBIOTICS RATHER THAN NARROW SPECTRUM DRUGS IS KNOWN TO FAVOR THE EMERGENCE OF RESISTANCE BY BROADLY ELIMINATING COMPETING SUSCEPTIBLE FLORA LEADING TO THE RISE IN RESISTANCE

GENETIC BASIS OF RESISTANCE

They either change the target of the drug so that the drug doesn’t bind or change the membrane so that drug don’t penetrate wellOccurs at low frequency Usually affect one drug or one family of drugs. CHROMOSAL

MUTATION

PLASMID

• Plasmid cause drug resistance by encoding enzymes that degrade or modify drugs. • Occurs at high frequency. • Affect multiple drugs or family of drugs

Resistant plasmids usually two sets of genes. One set encodes the enzymes that degrades or modify the drugs and other encodes the proteins that mediate conjugation,the main process by which resistance genes are transferred from one bacterium to another. RESISTANT PLASMIDS

• Transposons are small pieces of DNA that move from one site on bacterial chromosome to another or from the bacterial chromosome to plasmid DNA.• Transposons often carry drug resistant genes.• Many R chromosomes carry one or more transposons. TRANSPOS

ONS

PrescriberRelated

DRUG RELATED

ENVIRONMENTAL

FACTORS

PATIENT RELATED

FACTORS CONTRIBUTINGTO RESISTANCE

• Huge population and overcrowding.• Rapid spread by better transport facility.• Poor sanitation.• Increases community required resistance.• Ineffective infection control program.• Widespread use in animal husbandry and agriculture. ENVIRONMENTAL

FACTORS

• Over the counter availability of antimicrobials.• Counterfeit and substandard drug causing sub optimal blood concentration.• Irrational fixed dose combination of antimicrobials.• Soaring use of antibiotics. DRUG RELATED

• Poor adherence of dosage regimes

• Poverty • Lack of santation• Lack of education• Self-medication• misconception PATIENT RELATED

• Inappropriate use of available drugs.• Increased empiric poly – antimicrobial use.• Overuse of anti – microbials• Inadequate dosage• Lack of current knowledge and training

PRESCRIBER RELATED

PHAGE THERAPY MOBILISATION OF HOST DEFENSE MECHANISMS

USE OF NORMAL BACTERIAL FLORA

DEVELOPMENT OF NEW ANTIBIOTICS

MANAGING DRUG RESISTANT PROBLEM

REFERENCE

• http://www.who.int/mediacentre/factsheets/fs194/en/

• http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm092810.htm

• http://www.cdc.gov/drugresistance/