Antimicrobial resistance

Public Health Seminar

1. Seminar on Antimicrobial resistance: Current scenario, future challenges and mitigating strategies in Nepalese context Theme: Issue in public health Under cardinal guidance of Dr. Hari Prasad Kaphle Assistant Professor SHAS, PU By Ashrita Subedi 2015-1-37-0007 At School of health and allied Science Pokhara University, Dhungepatan , Pokhara 2019 9/28/2019 1

2. Introduction Antimicrobial resistance (AMR) is the ability of a microorganism (bacteria, viruses and some parasites) to stop an antimicrobial (antibiotics, antivirals,antimalarials) from working agents it. Standard treatment become ineffective, infections persist and may spread to others. 9/28/2019 2

3. Cond…. This is responsible for millions of death worldwide and is considered as a major public health concern nowadays. Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever increasing range of infections caused by the microbes The cost of health care for patients with resistant infections is higher 9/28/2019 3

4. Examples of AMR Bacteria that are resistance to antibiotic include methicillin-resistance, Staphylococcus aureus (MRSA), Penicillin-resistance Enterococcus, and multidrug-resistance Mycobacterium tuberculosis (MDR-TB), which is resistance to tuberculosis drugs, Isoniazid and rifampicin 9/28/2019 4

5. Why resistance is a concern Resistant organisms lead to treatment failure Increased mortality Resistance bacteria may spread in community Low level resistance can go undetected Added burden of health care costs Threatens to return to pre-antibiotic era 9/28/2019 5

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7. Factors of antibiotic resistance Drug related factors Environmental factors Prescriber r elated factors Patient related factors 9/28/2019 7

8. Drug Related Over the counter availability of antimicrobials Irrational fixed dose combination of antimicrobials Soaring use of antibiotics 9/28/2019 8

9. Environmental factors Huge populations and overcrowding Rapid spread by better transport facility Poor sanitation Increased community acquired resistance Ineffective infection control program Widespread use of antibiotics in animal husbandry and agriculture and as medication cleansing products 9/28/2019 9

10. Patient Related Poor knowledge of dosage regimens Poverty Lack of sanitation concept Self- medication Misconception 9/28/2019 10

11. Prescriber Related Inappropriate use of available drugs Increased empiric poly-antimicrobial use Overuse of antimicrobials Inadequate dosing Lack of current Knowledge and training 9/28/2019 11

12. Antimicrobial resistance Scenario

13. Source: frontiersin.org

14. Challenges of Antimicrobial resistance emergence of newer MDR organisms pose newer diagnostic and therapeutic challenges poverty, illiteracy, overcrowding and malnutrition further compound the situation Lack of awareness about infectious diseases  self-prescription of antimicrobial agents Low doctor to patient and nurse to patient ratios 9/28/2019 14

15. Contd … rise in the pharmaceutical sector increase waste from companies lack of strict supervisory and legal actions U se of antimicrobial agents as pesticides and insecticides in the agriculture industry Uncontrolled sale in many low or middle income countries 9/28/2019 15

16. Condt … 36% of individuals with cold or an upper respiratory infections were given prescription for antibiotic 9/28/2019 16

17. Mitigation strategies WHO recommended that farmers and food industry stop using antibiotics Preserve the effectiveness of antibiotics by reducing their unnecessary use in animals Strong sustained action across all sectors is vital if we are to turn back the tide of antimicrobial resistance. Consumers and supliers drive the major food chains adopting antibiotic-free policies. 9/28/2019 17

18. Condt … Alternative options to using antibiotics for disease prevention in animals Preserve the effectiveness of the most critical antibiotics for medicine Use of antibiotics only when prescribed by a doctors No sharing of antibiotic with others or using lefeover prescriptions 9/28/2019 18

19. Condt … Nepal has made important advances in reducing mortality and morbidity and increase health coverage, but has not yet taken steps to address antibiotic resistance. 9/28/2019 19

20. References Adhikari s., saud b, Paudel G. Emergence of Antimicrobial Drug Resistance Bacteria in Nepal: A current Scenario February 2019;10(8). World Health Organization: Antimicrobial resistance,2016-Geneva,swizerland. Acharya KR. Antimicrobial residue and Prevalence of Indicators bacteria Having Antimicrobial Resistance Isolated from Marked poultry in Kathmandu, Nepal.(2011) 9/28/2019 20

21. Condt … Shrestha k. Potential Antimicrobial Resistance Threat- Nepal.(Accessed july 22, 2018) VSDAO 2067/68 B.s. Annual Technical Report. (2016)(accessed january19,2018) 9/28/2019 21

22. Thank You!!! 9/28/2019 22