Transcript History of antibiotic discovery and concomitant development

Brief reminder about global problem
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Antimicrobial resistance (AMR) threatens the
effective prevention and treatment of an everincreasing range of infections caused by bacteria,
parasites, viruses and fungi.
It is an increasingly serious threat to global public
health that requires action across all government
sectors and society.
AMR is present in all parts of the world. New
resistance mechanisms emerge and spread globally.
In 2012, there were about 450 000 new cases of
multidrug-resistant tuberculosis (MDR-TB).
Extensively drug-resistant tuberculosis (XDR-TB) has
been identified in 92 countries. MDR-TB requires
treatment courses that are much longer and less
effective than those for non-resistant TB.
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Resistance to earlier generation antimalarial drugs is
widespread in most malaria-endemic countries. Further
spread, or emergence in other regions, of artemisininresistant strains of malaria could jeopardize important
recent gains in control of the disease.
There are high proportions of antibiotic resistance (ABR) in
bacteria that cause common infections (e.g. urinary tract
infections, pneumonia, bloodstream infections) in all
regions of the world. A high percentage of hospitalacquired infections are caused by highly resistant bacteria
such as methicillin-resistant Staphylococcus aureus (MRSA)
or multidrug-resistant Gram-negative bacteria.
Patients with infections caused by drug-resistant bacteria
are generally at increased risk of worse clinical outcomes
and death, and consume more healthcare resources than
patients infected with the same bacteria that are not
resistant.
Without
urgent, coordinated action,
the world is heading towards a postantibiotic era, in which common
infections and minor injuries, which
have been treatable for decades,
can once again kill.
History of antibiotic discovery and concomitant development of antibiotic resistance.
Davies J , and Davies D Microbiol. Mol. Biol. Rev.
2010;74:417-433
 Antibiotic-associated
diarrhea (clostridium
difficile)
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Especially associated with wide spectrum cephalosporins
like ceftriaxon and fluoroquinolones
 Likelihood
of resistance also in the patient
treated increases, not just in population
 Increased likelihood of urinary track and
candida infections among women
 Importance of gut flora to health (for
example metabolic and immunity functions)
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Inappropiate use of antimicrobial drugs
Antimicrobial drugs used when not truly needed
 Use of wrong antibiotics or too short treatment
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Poor infection prevention
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Hand hygiene in hospitals!!!
Poor diagnostic facilities for communicable
diseases
 Use of antimicrobial drugs in animal husbandry
 Loose policy of sharing antimicrobial drug
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In many countries available without prescription
 Financial benefits and possible sanctions encouraging
doctors to overprescribe antimicrobial drugs
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Many working hours
spent convincing
patients that they
don’t need antibiotics
for common cold or
other minor
conditions
 Autoimmune diseases
partly due to too high
level of hygiene
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FINLAND
More fatal and bigger
variety of
communicable
diseases
 HIV and other
conditions decreasing
immunity
 More limited
diagnostic facilities
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TANZANIA
Despite presence of malaria, HIV, tuberculosis
etc. all the communicable illnesses are not fatal
 In bronchitis there is fewer, productive cough
and chest pain, but in many cases the causing
agent is virus and because of that antibiotics
don’t help
 Majority of diarrheas heal without antibiotics,
guidelines of treatment in Finland recommend
antibiotic just to Shigella, EIEC, typhoid fewer
and cholera (+more severe forms of bacterial
diarrhea)
 Follow up is also treatment option
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More cooperation with other staff
 Check the national treatment of guidelines and
internet resources (provide WLAN that functions)
 More consultation
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Nobody knows perfectly medicine immediately after
graduating, better to ask stupid questions than to give
obviously wrong treatment
 Medicine is not science of geniuses (Dr. House), but group
intelligence
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Consultation hours especially for the newly
graduated to discuss more difficult cases
 Guidelines of treatment for the hospital
 Radiological meetings
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Lectures given by local staff including
clinical officers to encourage studying
 Diagnostic facilities don’t improve fast, but
culture for consultation and learning can be
enhanced with less money
 More organized structure for meetings and
consultation would make the 6 week visit of
foreign doctors more beneficial
 Continuity in patient files to avoid many
identical cures for example suspected
helicobacter infection
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