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Showing posts with label antibiotics. Show all posts
Showing posts with label antibiotics. Show all posts

Friday, 29 September 2017

Global threat of antibiotic resistance

The European Medicines agency, in partnership with the ECDC (European Centre for Disease Prevention and Control), is holding a workshop on global challenges from antimicrobial resistance (AMR). 

Loss of effectivenss of powerful classes of antimicrobial treatment is a serious issue both for less developed countries and for very developed healthcare systems. These are interdependent. Cultural and medical tourism leads to rapid transmission of resistant micro-organisms across continents.

There are 3 major current approaches to tackling AMR: 
1. reducing selection pressure on microbes to reduce the chance of their developing AMR. This needs strategies to reduce overuse of antimicrobial medicines. 
2. reducing human/human and animal/human transmission microbes. This needs effective infection control measures
3. increasing the availability of new antibiotics through more R & D combined with limiting their use within evidence-based guidelines - ie effective antibiotic stewardship.

There needs to be an integrated approach combining a pipeline of effective new antimicrobial and careful stewardship of existing antimicrobials through their effective use. However from a recent international survey, 20% of the public who took part were unaware that overuse of antibiotics leads to antimicrobial resistance to treatment. Furthermore 44% were unaware that antibiotics are ineffective against colds and 'flu'.

The WHO has estimated that, without major global action, by 2050 there may be ~400,000 preventable deaths annualy in the European region alone, as a result of lack of effective antiobiotics for serious infections (Figure).

Martial Plantady from the European Commission opened the day by discussing the EU Action plan launched in 2011 and running until 2016 against the threats from antimicrobial resistance. He noted that many solutions were described within the plan however there remain major challenges to effective implementation of the Plan, including:
- widespread and worldwide antibiotic use for growth promotion in livestock
- resulting need to push strategy to ban antibiotic use in livestock beyond the EU
- availability of animal and human data across member states
- effective surveillance on appropriate and prudent use of antimicrobials in humans
Some solutions include 
- effective dissemination of guidelines on prudent use of antibiotics in animals and humans
- Antibiotic Awareness Days
- more effective coordination of R & D across industry and academic sectors on new antimicrobials, alternatives, vaccines and rapid diagnostic tests
- engagement with key health professional and patient stakeholder organisations
The new EU Action Plan on antibiotic resistance was published in June 2017, with 3 pillars supported by strengthened measures for infection prevention and control:
- making the EU Region a best practice region on AMR
- improving research and innovation
- shaping the global agenda on AMR

At the 68th World Health Assembly in May 2015, the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance, including antibiotic resistance, the most urgent drug resistance trend. Carmen Pessoa da Silva from the WHO underlined the key point that if AMR remains unresolved, the global threat would be enormous both for human health as well as for the world economy. She summarised 5 key elements of WHO strategy against AMR.
1. improved awareness and understanding (annual WHO awareness week)
2. strengthen knowledge through surveillance and research 9WHO Global AMR Surveillance System - GLASS - further report due in Jan 2018 - 47 countries are fully enrolled - 25% of member states)
3. reduce incidence of infection
4. optimise use of anti-microbial medicines
5. ensure sustainable investment for R & D

The Pharmaceutical Group of the European Union represents the ~400,000 community pharmacists who dispense medicines for the ~500 million population of the European Union. Around 46 million people visit a community pharmacist every day in Europe.
James Wilkinson discussed efforts of the PGEU to educate community pharmacists and the public in rational use of antimicrobial medicines.

Tuesday, 8 November 2016

Antimicrobial resistance - a global public health threat

"Proper infection control practices and antimicrobial stewardship will be important to address this emerging threat" is the conclusion of a new publication from Sub-Saharan Africa on trends and reasons why resistance to antibiotics is becoming an increasing international problem.

The study, just published in the latest issue of the American Journal of Tropical Medicine and Hygiene, looked at data collected over a 5 year period on sensitivity of bacterial cultures to a wide range of WHO essential list as well as newer antibiotic medicines.

The data were collected in Kigali, Rwanda, at King Faisal Hospital, a major teaching and referral hospital for patients from throughout
Rwanda and from neighbouring countries.

The research team comprised international researchers from the USA (Yale AIDS Programme and the Department of Public Health, Philadelphia), the UK (Fellowship of Postgraduate Medicine, London) and SMBT Institute of Medical Science and Research Center in Nashik, India, in collaboration with clinicians from the King Faisal Hospital in Kigali, Rwanda.

"Differences in antimicrobial susceptibility between the first and fifth year of the study for each bacterial species was assessed using 2 test. Of 5,296 isolates collected, 46.7% were Escherichia coli, 18.4% were Klebsiella spp., 5.9% were Acinetobacter spp., 7.1% were Pseudomonas spp.,
11.7% were Staphylococcus aureus, and 10.3% were Enterococcus spp. Colistin and imipenem had greatest activity against gram-negative bacteria. 

Acinetobacter spp. showed the greatest resistance profile to antimicrobials tested, relative to other gram-negative bacteria. Vancomycin retained excellent activity against S. aureus and Enterococcus species (average susceptibility was 100% and 99.4%, respectively). 
Trend analysis determined that resistance to imipenem increased significantly among Klebsiella, E. coli, Pseudomonas, and Acinetobacter isolates; there was also rising resistance to colistin among E. coli and Pseudomonas species. 
Only E. coli demonstrated increased resistance to gentamicin. For gram-positive pathogens, vancomycin susceptibility increased over time for Enterococcus species, but was unchanged for S. aureus. Our data suggest that resistance to imipenem and colistin are rising among gram-negative bacteria in Rwanda."

Read the full article