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AMRandRationalUseof

AMR
and Rational Use of
AntibioticsWorkshop
p
Dr.MaryMurray
Dr.
Mary Murray
GlobalNetworkCoordinator
ReAct ActiononAntibioticresistance
i
ibi i
i

Antimicrobial resistance what are we talking about?

Antimicrobialresistance(AMR)

ABR

Antiviral
agents
t

Antiparasitiic
agents

(e.g drugsfor
HIV))

(e.g drugsfor
malaria)

Antibacterialagents
Antibacterial
agents
=Antibiotics
(e.g.drugsfor
t b
tuberculosis)
l i)
and

otherbacterial
other
bacterial
diseases

Antibiotic resistance isthe


is the
main focusof theworkshop
Compared
p
toother health p
problems,
we arenot talking about aspecific disease
Instead, we are talking about a medical
product thatisnolonger working against
bacteria causing many common infectious
diseases

Common diseases becoming nontreatable


Blood
infections

Surgical
infections

Antibiotic
Resistance

Pneumonia

Gonorrhea

Typhoid
fever

Inaddition,many medical procedures


areaffected andthreatened byABR
y
Careof
preterm
children
Trans
plantations
Major
surgical
procedures

Antibiotic
Resistance
Cancer
Cancer
treatment

Safe child
deliveries

Whoisaffected byABR?
Everyone
y
!
However
vulnerablepopulationswiththehighest
p p
g
infectiousdiseaseburdenpaysthehighestprice
thesepopulationsarealsotheonesthathave
leastaccesstocurrentandfutureinterventions
tomanageantibioticresistance

Some parts of the world have already


r no
run
outt of effecti
effective
e antibiotics

Muhimbili hospital, Dar es Salaam Tanzania

ThemortalityratefromGramnegative
bloodstreaminfectioninchildren(43,5%)
was more than double that of malaria.
wasmorethandoublethatofmalaria.
Blomberg etal.BMCInfectDis.2007

About70%ofneonatalsystemic
infectionscannotbetreatedwiththe
infections
cannotbetreatedwiththe
antibioticsrecommendedbyWHO.
antibiotics recommended by WHO.
antibioticsrecommendedbyWHO
WHO.
Lancet2005;365:117588

CostImplicationsofgrowingantibioticresistanceARE
HUGE
Typhoidfever
Cost of antibiotics for non-resistant cases

$3-5

Cost of antibiotics for resistant cases


Azithromycin

$35-42

O l cephalosporins
Oral
h l
i (cefixime)
( fi i )

$37 42
$37-42

Parenteral cephalosporins (ceftriaxone)


AverageTreatmentCostsforTyphoid(US$)
Childweighing20kgusingstandardtreatmentguidelines
Source:AKUPharmindex 2004&WHOguidelines2003

$84-104

Wearebeginningtosensethatthehiddenproblemismuchlargerthanweimagined

How did we end up here?


Howdidweenduphere?
The indiscriminate use of antibiotics
The rapid dynamics of gene transfer between
bacteria and the global spread of resistance
Poor sanitation and hygiene
Alarming decline in antibiotics development

A Global Problem
Worldwide spread of the 23F clone of penicillin
resistant pneumococci

U.K
France
Korea

USA
Thailand
Mexico

Taiwan
Singapore

Colombia
Argentina

Japan

Brazil

S.Africa

ESBL (CTX-M) producing Enterobacteriaceae


2001-2002

Endemicity

Sporadic reports

2007

Endemicity

Sporadic reports

2005

Thedrugdevelopmentpipelinefor
antibioticshasgonedry
Thelastantibiotic
h l
ibi i class
l was discovered
di
d in
i
1987! No new drugs for:

- Typhoid fever
g
Shigella
The older-antibiotics
Theolder
are rapidly becoming
arerapidly
- Gonorrhoea
ineffective- Urinary
due toantibiotic
resistance
tract infections
- Blood
Bl d infections
i f ti
- ..........
Thepharmaceutical
industry
hasneither
the
- ........

innovativecapacity northecommercial
interest todevelop novel antibiotics

Strategiestostopmanageantibiotic
resistance
i
Prolong the lifespan of existing drugs
Rational Use
B tt diagnostics
Better
di
ti

Prevent the spread of resistant bacteria


Improved hygiene
Infection control

Development of new antibiotics


New collaborative models

Controlled distribution and use of new future antibiotic


A new global system to preserve the effectiveness of antibiotics

AntibioticResistance
Causedbyhumanactivityandbyover consumption
ofagobal
g
resource
Afailureofpublicpolicy&globalgovernance,research
prioritizationandthecurrentmarketsystem
Itisacollectiveresponsibilitybygovernments,supranational
It
is a collective responsibility by governments supranational
organizationsandindividualstotakeaction
Throughouractivism,needtoinspirepeopletoholdusall
collectivelyaccountable

Nasa 1969:EarthriseoverthemoonfromApolloII

Encouraging Multisectoral Regional Networks

China
Af i
Africa
Latin
Latin
America

India

South
East
Asia

Australia