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2000 B.C. – Here, eat this root
1000 A.D. – That root is heathen. Here, say this prayer.
1850 A.D. – That prayer is superstition. Here, drink this potion.
1920 A.D. – That potion is snake oil. Here, swallow this pill.
1945 A.D. – That pill is ineffective. Here, take this penicillin.
1955 A.D. – Oops....bugs mutated. Here, take this tetracycline.
1960‐1999 – 39 more "oops"...Here, take this more powerful antibiotic.
2000 A.D. – The bugs have won! Here, eat this root.
Source: World Health Organization http://www.who.int/infectious‐disease‐report/2000/
The Correct Drug
Administered by the Best Rout
In the Right Amount
At Optimum Intervals
For the Appropriate Period
After an Accurate Diagnosis
Source: World Health Organization http://www.who.int/infectious‐disease‐report/2000/
Natural Selection
Poverty and low access to medicine
Misdiagnosis
Counterfeit medicine
Pay‐offs by companies for broad spectrum antibiotics
Source: World Health Organization http://www.who.int/infectious‐disease‐report/2000/
Patient Pressure resulting from advertisements
Lack of education among health providers and public
Resistance in Hospitals (40 – 91% inappropriate use)
Use of Antibiotics in animals and food production
International travels
Source: World Health Organization http://www.who.int/infectious‐disease‐report/2000/
• Increased Morbidity • Prolonged Illnesses • Greater Risk of Complication
• Higher Mortality Rates
Health
• Loss of Productivity• Time spent by family • Increased Cost of diagnosis and treatment
Economic
• Pain • Change in Daily Activities
• Psychosocial Cost
Additional Human Burden
Malaria
Tuberculosis
HIV Infection
•Resistance to various Antimalarial including Artimisinin Derivatives
• Change of National anti malarial policy if reach over 10% Failure
• 290,000 MDR cases estimated in 2010 (only 18% notified)
• 3.4% of all new cases were MDR (2010)
• Extensively drug ‐ resistant seen in 77 countries
• Resistance rate in Anti‐HIV regimens 10‐20% Europe, USA
•Rate of transmission is low in LICs though
•HIV infection with comorbidity of AMR bacteria
Source: WHO, The Evolving Threat of Antimicrobial Resistance
25,000Extra deaths
(Per year)
1.5 billionExtra cost(Per year)
Less clear in
Community Acquired
Only 5 antibiotics (1.6%) produced by 15 companies producing (93%) between 1980 ‐ 2003
Source: WHO, The Evolving Threat of Antimicrobial Resistance
Reducing the disease burden and spread of infection
Improving access to appropriate Antimicrobials
Improving the use of Antimicrobials
Strengthening Health Systems and their surveillance capabilities
Enforcing regulation and legislation
Encouraging the development of appropriate new drugs and vaccines
Source: WHO, The Evolving Threat of Antimicrobial Resistance
Source: WHO, The Evolving Threat of Antimicrobial Resistance
Patient and General Community • Education
Prescribers and Dispensers • Education • Management Guidelines and Formulary
• Regulation
Hospitals• Management • Diagnostic Labs• Interaction with Pharma Companies
Health System and Government • Advocacy and Intersectoral Action • Regulation • Policy and Guidelines • Education • Surveillance