1. Introduction to Antimicrobial Resistance
Dr Poonam Khetrapal Singh
Deputy Regional Director

2. Outline What is antimicrobial resistance (AMR) and its implications?
Why are we worried about AMR in SEA Region?
What are the possible solutions?
What is WHO doing?
What we all can do?

3. Outline What is antimicrobial resistance (AMR) and its implications
Why are we worried about AMR in SEA Region
What are the possible solutions
What is WHO doing
What we all can do

4. Antimicrobial (Antibiotics) resistance
Resistance is unresponsiveness to antimicrobial agents in standard doses
A natural biological unstoppable phenomenon which is driven by rampant misuse of antimicrobial agents
50% of antibiotics are prescribed inappropriately
50% of patients have poor compliance
50% of populations do not have access to essential antibiotics
50% of antibiotics in some countries are used for animal growth promotion

5. Resistance has huge negative impact on health
Longer duration of illness
Longer treatment
Higher mortality
Treatment with expensive drugs
Increased burden on health system
Negates technological advances in medical sector
Complex surgeries
Transplantations and other interventions
Patient acts as reservoir of resistant organisms which are passed to community and health-care workers
Huge economic impact on individual and society
Antimicrobial resistance has been recognized as an emerging public health problem because of its various serious implications. These include the longer duration of the illness and treatment which results into high mortality and morbidity associated with economic loss to the patients as well as to the community. Infections with micro-organism resistance to conventional antibiotic have to be treated with expensive nucleus drug which may be more toxic. All these bacteria produce extra burden on the health system and also increase the possibility of communication of resistance organisms to the community through the patients who is suffering from infections due to resistance organisms.

6. Outline What is antimicrobial resistance (AMR) and its implications
Why are we worried about AMR in SEA Region
What are the possible solutions
What is WHO doing
What we all can do

7. Resistance is negating “wonder drugs” in SEAR
Tuberculosis
MDR-TB < 3% : 130,000 cases annually, XDR-TB: Reported from 4 countries
Kala-azar
60% resistance in pentavalent antimony and 25% in pentamidine
Typhoid fever
MDR Salmonella Typhi prevalent all over Region
Causing 10% Case Fatality Rate (CFR) in children (preantibiotic era: 12.8%)
Hospital associated infections
Staphylococcus aureus: >50% isolates in hospitals are methicillin-resistant (MDR)
Acinetobacter baumannii: >50% of patients infected with resistant strains die
Pseudomonas, Klebsiella, Serratia: MDR persist in hospital settings, and cause huge mortality morbidity
Malaria
400 million people at risk of infection with resistant parasite

8. Superbugs* are visible manifestations of our prolonged failure to preserve antibiotics
Accumulation of resistance to multiple antibiotics
Self medication and poor compliance
Known but neglected.
Need immediate action
Inappropriate use of antibiotics
selection & multiplication of resistant strains
Weak surveillance & regulatory systems
Continuous natural evolution of resistance in bugs
Known but
inevitable
** Methicillin resistant Staph aureus, MDR-and XDR Mycobacteria, ESBL producing Gram negative bacteria and NDM-1 producing
enterobacteriaceae bacteria are few examples of superbugs because these fail to respond to large number of commonly used antibiotics

9. Outline What is antimicrobial resistance (AMR) and its implications
Why are we worried about AMR in SEA Region
What are the possible solutions
What is WHO doing
What we all can do

10. Possible solutions
Discover new drugs faster than emergence of resistance
Promote discovery, development and dissemination of new antimicrobial agents
Prevent emergence of resistance by reducing selection pressure by appropriate control measures
Rationalize the use of available antimicrobial agents

11. Antibiotics: Roadway
Since the discovery of penicillin in 1928, many new antibiotics have been introduced between 1940 and 1970, the golden era of antibiotic discovery (press spacebar for animation). During the late 1980s and early 1990s, two major groups of antibiotics became available & very commonly used, the third & fourth generation cephalosporins and the fluoroquinolones. Oxazolidinone is the last new antibiotic group introduced with the turn of the century. As is evident from the roadway, discovery of new agents has markedly slowed down in the last 2-3 decades. This has been coupled with emergence of multiple drug resistance in many bacteria, mainly in those common in serious infections in hospital practice. 11

12. Possible solutions
Discover new drugs faster than emergence of resistance
Rationalize the use of available antimicrobial agents
Prevent emergence of resistance by reducing selection pressure by appropriate control measures
Promote discovery, development and dissemination of new antimicrobial agents
Implementation requires a strategy with comprehensive national initiatives/plans

13. Regional Strategy on AMR and Resolution of RC63
Governance
Regulatory
Capacity building
Community education
Research

14. Outline What is antimicrobial resistance (AMR) and its implications
Why are we worried about AMR in SEA Region
What are the possible solutions
What is WHO doing
What we all can do

15. WHO material for technical support….
Available at

16. Outline What is antimicrobial resistance (AMR) and its implications
Why are we worried about AMR in SEA Region
What are the possible solutions
What is WHO doing
What we all can do

17. Antibiotics are a precious resource
“antimicrobial resistance is
possibly the single biggest
threat facing the world in
the area of infectious diseases”.
Antibiotics are
a precious resource
We need to preserve this resource by working together
Use Antibiotics rationally