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Combatting Antimicrobial Drug Resistance Dr Charles Penn Pandemic and Epidemic Diseases Health Security and Environment

Combatting Antimicrobial Drug Resistance Dr Charles Penn Pandemic and Epidemic Diseases Health Security and Environment. Antimicrobial Resistance. Impact Challenges Research perspectives. We are facing a public health crisis. Increasing incidence of resistance to antimicrobial medicines.

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Combatting Antimicrobial Drug Resistance Dr Charles Penn Pandemic and Epidemic Diseases Health Security and Environment

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  1. Combatting Antimicrobial Drug ResistanceDr Charles PennPandemic and Epidemic DiseasesHealth Security and Environment

  2. Antimicrobial Resistance • Impact • Challenges • Research perspectives

  3. We are facing a public health crisis Increasing incidence of resistance to antimicrobial medicines Rising Mortality, Costs Few new medicines in the pipeline

  4. Patients withpneumonia and bacteria in the blood Penicillin Penicillin increased the chance of survival from 10% to 90% % survivors Untreated Adapted from Austrian et al. Ann. Int. Med 1964; 60, 759 Days

  5. Proportion of MDR among previously treated TB cases, 1994-2010

  6. 4 neonatal deaths in a rural hospital, India • November 2009 West Bengal • E colisepticaemia • Treated cefotaxime and amikacin • BUT E coli carried NDM-1 gene • Imipenem resistant • Infections likely hospital acquired Roy et al. J Antimicrob. Chemother. 2011 v66: 2773

  7. Death of two liver transplant patientsUSA • Both had been treated meropenem • Carbapenemase producing K pneumoniae Mathers et al. Transpl. Inf. Dis. 2009 11: 257

  8. Some diseases becoming untreatable(gonorrhea) • Resistant to ceftriaxone • Ohnishi et al Emerging Inf Dis 2011 17:148 • MIC 2 ug/ml Resistant gonorrhea strain found in Japan CBC News Posted: Jul 11, 2011 1:38 PM ET Last Updated: Jul 11, 2011 10:17 PM ET External Links Antibiotic susceptibility of gonorrhea, CDC Morbidity and Mortality Weekly Report A strain of gonorrhea is that is resistant to all currently available antibiotics has been identified in Japan. Gonorrhea is a bacterial infection that can be transmitted through oral, genital or anal sex with an infected person. If left untreated, the disease can cause other problems, including sterility and a greater susceptibility to HIV. The newly identified strain of the sexually transmitted infection, called H041, is resistant to the last remaining drugs that treat gonorrhea, known as cephalosporin-class antibiotics, • http://www.cbc.ca/news/health/story/2011/07/11/gonorrhea-resistant.html

  9. Impact on multiple sectors of health care Health Security Infectious Disease Medical Procedures Neonatal care Transplantation Cancer treatment Surgery Etc. • Travel • Deployment • Conflict & emergencies • Refugees • IHR • Pneumonia • Gonorrhea • TB • Malaria • HIV • Etc.

  10. Antimicrobial Resistance: Global Challenges • Lack of adequate awareness and understanding • Lack of global cohesion and plans • Insufficient surveillance information • No cohesion, no reporting standards • Inappropriate use of antimicrobial medicines • Human and animal health ("CIA") • Lack of equitable access • No new products From Albrich et al EID 2004

  11. WHO Goal: combatAMR • Comprehensive national plans, accountability, civil society engagement • Strengthen surveillance and laboratory capacity • Access to essential medicines of assured quality • Rational use of medicines • Enhance infection prevention and control • Foster innovation and R&D for new tools

  12. WHO programmes that include AMR • Foodborne AMR • Patient Safety • Infection Control • Environmental health • Laboratory capacity & capability • Medicines • Critically Important Antimicrobials • Regulations, Rational use • Quality and standards • Malaria • TB • HIV • STI • Cholera • Hepatitis • Influenza Carmem Pessoa da Silva Johan Struwe Un-Yeong Go Paul Rogers Keiji Fukuda

  13. Research needs: surveillance and burden of disease • Global surveillance data • Networks of networks • Common standards for data and reporting • Burden of disease • Health • Economic • In "real time" • Evidence to support policy • Monitor effectiveness of action

  14. Research needs: evidence to support policy • Use of antibiotics in agriculture and animal health, aquaculture • Growth promotion,Prophylaxis • Balancing human health, food supply, economic interests • Reviews of existing evidence • Molecular epidemiology and forensics • Economics and burden of disease • Differential products • Public and prescriber behaviour

  15. Research needs: innovation, new tools • Smarter diagnostic tools • From POC to "molecular forensics" • Alternatives • Vaccines, other interventions • How to encourage and reward development of new antimicrobial medicines while maintaining controlled and rational use? • New business models?

  16. Prime objective: to continue to treat and cure life threatening infections, everywhere • Thailand – SMART antibiotic use • Bedaquiline – treatment of MDR-TB

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