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Consequences of excessive use and misuse of antibiotics . Dina Apele-Freimane PhD Student Walden University PUBH 8165-1 Instructor: Dr Robert Marino Fall term 2011. Stakeholders. After this presentation you will. Understand the role of antibiotics in the world of today

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Consequences of excessive use and misuse of antibiotics


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    1. Consequences of excessive use and misuse of antibiotics Dina Apele-Freimane PhD Student Walden University PUBH 8165-1 Instructor: Dr Robert Marino Fall term 2011

    2. Stakeholders

    3. After this presentation you will • Understand the role of antibiotics in the world of today • Recognize different ways and different areas were antibiotics are used • Recognize the ways how antibiotics can be misused or overused • Understand the public health and environmental impact of misuse and overuse of antibiotics • Define the milestones for the rational use of antibiotic • Facilitate implementation of local and global measures in order to limit misuse and overuse of antibiotics

    4. Objectives

    5. History of antibiotics • Antagonistic activities by fungi against bacteria were first described in England by John Tyndall in 1875 • Synthetic antibiotic chemotherapy as a science begun in Germany with Paul Erlich in the late 1880s • in 1928 Alexander Fleming observed antibiosis against bacteria by a fungus of the genus Penicilliumandpostulated that the effect was mediated by an antibacterial compound named penicillin, and its antibacterial properties could be exploited for chemotherapy Calderon, C.B., Sabundayo, B.P. (2007) Antimicrobial classifications: Drugs for Bugs. CRC Press. Taylor & Frances group. ISBN 978-0-8247-4100-6 Waksman, S.A. (1947) What is an antibiotic ar an antibiotic substance. Mycologia. 39(5) 565-569 doi:10.2307/3755196

    6. Antibiotics today • Antibiotics are among the most frequently prescribed medications in modern medicine • Over 10 000 different antibiotic substances have been reported until today • Over 100 products are available to doctors to cure minor discomforts as well as life-threatening infections • Research and innovation on new antibiotics • Improved infection control World Health Organization. Antibiotic Resistance. Retrieved on 20. October 2011 from: http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/antimicrobial-resistance/antibiotic-resistance

    7. Antibiotic resistance Jakab, Z. (2011) Towards a strategy on the containment of antibiotic resistance in the WHO European Region. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    8. Overuse and misuse of antimicrobial drugsin The main causes of antibiotic resistance Drug resistant bacteria

    9. Antibiotics in human medicine • Overuse: - Practice of prescribing antibiotics for common cold and flu - Prophylactic use of antibiotics in cases were it is not necessary • Misuse: - Non-causal prescription were antibiotics are prescribed without determining the bacterial agent and its sensitivity - Initiation of the antibacterial treatment with stronger new generation antibiotics instead of staggered approach

    10. Antibiotics in human medicine • Underuse: - Insufficient doses - Insufficient duration of antibacterial treatment → Emergence of serious bacteria which are resistant to antibiotics→Antibiotic resistance is becoming a public health emergency of yetunknown proportions!

    11. Global view on antimicrobial resistance Joncheere, K. (2011) Towards a strategy on the containment of antibiotic resistance in WHO. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    12. Global view on antimicrobial resistance

    13. Non-Human use of antibiotics

    14. Antibiotic use in livestock • For therapeutic purposes • For prophylaxis - Common source of antibiotics overuse in animals - Performed by adding antibiotics in animal food - Very complicated to control • For growth promotion - Banned in the European Union since 2006 - Allowed in other countries Kruse, H. (2011) Tackling antibiotic resistance from a food safety perspective at a national level. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    15. Antibiotic use in livestock • Same antibiotic classes as in human medicine • May outweigh use in humans in some countries Antibiotics→→Farm dwellers contacting with animals →Meat and dairy products →Contamination: faces and manure ↓ ↓ ↓ ↓ Wildlife Soil Fruits Wells Vegetables Rivers

    16. Consequences • Increasingly developing antimicrobial resistance • Increase of allergic diseasesdue to daily use of products containing antibiotics • Aquatic and soil environment pollution • Infectious disease outbreaks The vast overuse of antibiotics wasreported as one of possible causes of the recent E. Coli outbreak in Europe. Guardian, UK, June 6, 2011, London

    17. What we can do? Factors influencing use of antibiotics

    18. Factors influencing use of antibiotics

    19. National coordination • Develop plan of action • Intersectional collaboration: clinicians, epidemiologists, pharmacists, veterinarians and microbiologists • Legislation: guidance on antibiotic stewardship, regulations, information, awareness, training etc. • Involvement of scientific and academic recourses: universities and academic staff, ensure that the curriculum includes the prudent use of antibiotics Jakab, Z. (2011) Towards a strategy on the containment of antibiotic resistance in the WHO European Region. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int Joncheere, K. (2011) Towards a strategy on the containment of antibiotic resistance in WHO. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    20. Good clinical practice • Provide regular analysis on antibiotic resistance • Provide local guidelines on antibiotic use • Use of well‐established surveillance networks (e.g. EARS‐NET (European Antimicrobial Resistance Surveillance Network) managed by the ECDC) • For many interventions, prophylaxis can be as brief as 24 hours • Promote hand hygiene and compliance - Prevents cross‐infection in hospitals - Decreases hospital‐acquired infections, including infections caused by resistant bacteria Jakab, Z. (2011) Towards a strategy on the containment of antibiotic resistance in the WHO European Region. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int Joncheere, K. (2011) Towards a strategy on the containment of antibiotic resistance in WHO. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    21. Facilitating the rational use of antibiotics, including surveillance of antibiotic consumption • Establish surveillance of the resistance to selected antibiotics in priority invasive bacteria • Includes antibiotic resistance testing for seven major invasive pathogens: – Streptococcus pneumoniae – Staphylococcus aureus – Escherichia coli – Enterococcusfaecalis – Enterococcusfaecium – Klebsiellapneumoniae – Pseudomonas aeruginosa Jakab, Z. (2011) Towards a strategy on the containment of antibiotic resistance in the WHO European Region. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int Joncheere, K. (2011) Towards a strategy on the containment of antibiotic resistance in WHO. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    22. Ban over‐the‐counter sales • Promote and change prescribing habits (e.g. going back to Penicilin) • Improve the review of hospital infections and antibiotic use Jakab, Z. (2011) Towards a strategy on the containment of antibiotic resistance in the WHO European Region. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int Joncheere, K. (2011) Towards a strategy on the containment of antibiotic resistance in WHO. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    23. Improve infection control and the stewardship ofantibiotics use • Multidisciplinary committeestoimprove the surveillance of hospital‐acquired infections andguide antibiotic therapy or prophylaxis • Need to involve the private and public sectors • Promote research and innovation of new drugs • Rewards policy • Government support Jakab, Z. (2011) Towards a strategy on the containment of antibiotic resistance in the WHO European Region. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int Joncheere, K. (2011) Towards a strategy on the containment of antibiotic resistance in WHO. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    24. Improve awareness of antimicrobial use and resistance • Collaboration and involvement with patient safety groups • Public health campaigns aimed to rising people awareness about prudent use of antibiotics • Campaigns aimed to policy guidance and regulations • Promote hand hygiene and information on infections at schools and public places Jakab, Z. (2011) Towards a strategy on the containment of antibiotic resistance in the WHO European Region. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int Joncheere, K. (2011) Towards a strategy on the containment of antibiotic resistance in WHO. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    25. Promote the surveillance, prevention and controlof antibiotic resistance in the food chain • Antibiotics in animals should be used only under the strong control of veterinarian • Avoid to use in animals antibiotics critically important for human medicine • Surveillance and monitoring of antibiotics use in livestock • Food safety regulations • Maintain animal health through improvement of animal welfare, vaccination and biosecurity • Eliminate the use of antibiotics as a growth promoter Kruse, H. (2011) Trackling antibiotic resistance from a food safety perspective at a national level. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int

    26. Conclusions • Overuse and misuse of antibiotics can cause harmful public health and environmental consequences: - Antibiotic resistance - Increase of frequency of allergic reactions - Foodborne diseases - Soil and water contamination • Problem requires multifaceted intersectional response, nationally and internationally • Collaboration between public health professionals, healthcare practitioners, government, academic and scientific staff, pharmaceutical industry, veterinarians, farmers and society is the background of public health protection against overuse and misuse of antibiotics

    27. The first rule of antibiotics is try not to use them, and the second rule is try not to use too many of them. Paul L. Marino, The ICU Book Thankyou!

    28. References Centers for Disease Control and Prevention. Antimicrobial resistance. Retrieved on 20. October 2011 from: http://www.cdc.gov/drugresistance/index.html D’Costa, V., King, C., Kalan, L., Morar, M., Sung, W., Schwartz, C., Froese, D., Zazula, G. (2011). Antibiotic resistance is ancient. Nature. 7365, 457-461. doi: 10.1038/nature10388 Jakab, Z. (2011) Towards a strategy on the containment of antibiotic resistance in the WHO European Region. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int Joncheere, K. (2011) Towards a strategy on the containment of antibiotic resistance in WHO. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int Kruse, H. (2011) Tackling antibiotic resistance from a food safety perspective at a national level. World health organization. Retrieved on 20. October 2011 from: http://www.euro.who.int Newman, R. (2008).Antibiotics and the aquatic environment. The University of Sheffield. Waksman, S.A. (1947) What is an antibiotic ar an antibiotic substance. Mycologia. 39(5) 565-569 doi:10.2307/3755196 World Health Organization. Antibiotic Resistance. Retrieved on 20. October 2011 from: http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/antimicrobial-resistance/antibiotic-resistance

    29. Recourses for further reading American College of Physicians. Antibiotic Resistance. Retrieved on 1st November 2011 from: http://www.acponline.org/patients_families/diseases_conditions/antibiotic_resistance/ Bugs & Drugs on the Web. NeLi antimicrobial resistance website. Retrieved on 1st Novembers 2011 from: http://www.antibioticresistance.org.uk/ Centers for Disease Control and Prevention. Antimicrobial resistance. Retrieved on 20. October 2011 from: http://www.cdc.gov/drugresistance/index.html European Center for Disease Prevention and Control. European Antimicrobial Resistance Surveillance Network (EARS-net). Retrieved on 1st November 2011 from: http://www.ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/index.aspx

    30. Recourses for further reading European Medicines Agency. Antimicrobial resistance. Retrieved on 1st November 2011 from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000186.jsp&mid=WC0b01ac058002d8a0&jsenabled=true U.S. Food and Drug Administration. Animal and Veterinary. Antimicrobial resistance. Retrieved on 1st November 2011 from: http://www.fda.gov/animalveterinary/safetyhealth/antimicrobialresistance/default.htm World Health Organization. Antibiotic Resistance. Retrieved on 20. October 2011 from: http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/antimicrobial-resistance/antibiotic-resistance