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Combating Drug Resistance

Syed Khalid Saeed Bukhari

World Health Day 2011The Regional theme is combating Drug

Resistance (DR) The slogan is

"COMBAT DRUG RESISTANCE, NO action today, NO cure tomorrow"

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Pakistan30% prescription lack a diagnosis/complaint.EDL was present in 19% health facilities.1 in 6 prescription do not contain any dosage

instructions. According to EDSP 2002 report prescription

contain 52% antibiotics.

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Percentage of Encounters with antibiotic

Provinces

NWFP 49.7%

Baluchistan 49.7%

Punjab 60.7%

Gender

Males 58.8%

Females 46.4%

Prescribers

Doctor 53.3%

LHV 21.4%

Dispenser 32.4%

AGE

Child (<15 Years)

65.8%

Adult (<15 Years)

44.8%

Countries Comparison of Percentage of Antibiotics

Pakistan 52%

Bangladesh 25%

Nigeria 48%

Nepal 43%

No action today, no cure tomorrow

DR kills human lives

Challenges care and control of infectious diseases

Greatly increases care costs

Threatens healthcare gains for individuals and society

Can take us back to the pre-antibiotic era

Threatens health security and damages trade and economy

Thomas McKeown

The role of Medicine: Dream, Mirage, or Nemesis. 1980

DECLINE OF RESPIRATORY TUBERCULOSIS

DECLINE IN CHILDHOOD MEASLES

DECLINE IN CHILDHOOD DIPTHERIA

Low relative impact of health care in other

diseases

See the trend in decline of the disease was there even before the advent of modern medicine

Modern medicine contributed only a portion of further decline

The main decline was due to improved hygiene, sanitation, living conditions, lifestyles, preventive approaches, and these are all important public health practices we teach and advice

WHD 2011: What will we achieve?

Goal: To save lives and protect health by keeping precious, life-saving medicines effective and useful to combat diseases

Aims:- To raise awareness on what drives DR- To build commitment for effective policies and practices and their implementation to combat DR

Objectives: To provide policy guidance to Member States on top

priority actions to combat DR To reach and engage key stakeholders through

innovative communications, advocacy and events To promote further collaboration across sectors and

among stakeholders

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What is DR?DR arises when

Patients do not take their medicine properly and rationally

Providers do not prescribe the medicine properly Patients and community do not know proper use of

medicine & problem of drug resistance Health authorities do not maintain quality of drugsHospitals do not adopt infection control measuresHealth policy makers do not prioritize drug resistance

containmentThere is limited research on new medicine

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What is DR?.........

TB: 440,000 new multidrug resistance (MDR) TB cases annually; extensively drug resistance (XDR) TB cases reported in 58 countries so far

Malaria: Emergence of Artemisin resistance linked to ongoing use of monotherapies

HIV: With expanded use of antiretrovirals (ARVs), resistance is a concern

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What is DR…….

Methicillin-resistant Staphylococcus aureus: lethal infections in hospital settings which are becoming increasingly frequent

Multi-drug resistant E. coli and K. pneumoniae: infections are on the rise

Neisseria gonorrheae and Shigella: are becoming increasingly resistant to drugs

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What drives DR?Policy

Drug resistance plans & resources are not comprehensive

Monitoring Surveillance system is weak

Quality assurance System to ensure quality and supply of

medicine is inadequate

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What drives DR?Awareness

Consumers and communities are not aware of drug resistance

Prevention Poor Infection prevention & control

R&D Research & development for diagnostics and

drugs is insufficient

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Six Steps to Stop DR

1. Political commitment Committing to a comprehensive, financed national plan with lines of accountability and civil society engagement

2. Monitoring Strengthening surveillance and laboratory capacity

3. Quality control & assurance Ensuring medicines of good quality and regular supply

4. Rational use of medicine Regulating and promoting rational use of medicines,

including in agricultural sector, and proper patient care

5. Prevention & stopping the spread Enhancing infection prevention & control

6. R&D Fostering innovations, research & development

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To address DR, we should know: DR is complex as

it involves different diseases, settingsand demands well coordinated actions across

different sectors

DR is also a behavioral issue

DR is EVERY BODY’ problem

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WHO Global strategy In September 2001, WHO launched the first

Global Strategy for Containment of Antimicrobial Resistance which aims to encourage the urgent actions needed to reverse or at least curtail trends which have major economic as well as health implications.

WHO Policy & strategy options Addressing antimicrobial resistance requires a comprehensive multisectoral approach

Target audience” Intervention areaGovernment (health systems)Patients and the general communityPharmacistsPrescribers and dispensersHospitalsPharmaceutical industryFood production

Advocacy and intersectoral actionIntersectoral task forceResources to promote the implementation of

interventionsIndicators to monitor and evaluate the impact

of resistanceRegulations

Prescription-only statusInternational quality, safety and efficacy

standards

Policies and guidelinesNational Drug Policy and Essential Drugs

List (EDL)Surveillance

Designate or develop reference microbiology laboratory facilities

Drug resistance surveillance

Health educationAppropriate use of antimicrobialsDisease prevention (immunization, vector control)Hygiene

Education (undergraduate an postgraduate)Appropriate use and containment Disease prevention and infection controlDiagnosis and management

Management, guidelines and formulariesPrescription audits / prescription limitsStandard treatment guidelines and prescription

limitsRegulation

Professional registration based on continuing education

Promotional activitiesControl and monitor promotion for medicines

(WHO ethical criteria)Quality

Good Manufacturing Practice (GMP) of pharmaceuticals and diagnostics

National intersectoral task force on antimicrobial resistance

Legislation and regulation:prescription-only use of antimicrobials

Hospital therapeutics committees and infection control programmes

Essential drugs concept in educational programmes

WHO's responsepolicy guidance, support for surveillance,

technical assistance, knowledge generation and partnerships, including through disease prevention and control programmes;

essential medicines quality, supply and rational use;

infection prevention and control; patient safety; laboratory quality assurance

Messages on DRPolicy makers Ministries of Health, other than Ministry

health policy influencers & makers: The threat of DR is real & enormous; needs vigorous response with allocation of

proper resources, public awareness campaigns, and the establishment and enforcing of clear

policies to prevent the onset and dissemination of DR

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Messages on DRThe public:

understand and adopt the appropriate use of, or alternatives to, antimicrobials

prevent from and get treatment for infectious diseases; and

learn & adopt measures to reduce transmission

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Messages on DRPractitioners & prescribers

understand and appropriately use antimicrobials against TB, malaria and HIV and other diseases

learn and adopt disease prevention and infection control measures

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Messages on DRMedia:

promote awareness of DR as a real, enormous public health threat

encourage actions at policy levels to address DR

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Messages on DRPharmaceutical industry

promote production of quality drugs foster proper branding, publicity, and

marketing measures that favor prevention and containment of DR

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THANK YOU

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