Transcript Slide 1

Combatting Antimicrobial
Drug Resistance
Dr Charles Penn
Pandemic and Epidemic Diseases
Health Security and Environment
Antimicrobial Resistance
 Impact
 Challenges
 Research perspectives
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We are facing a public health crisis
Increasing
incidence of
resistance to
antimicrobial
medicines
Few new
medicines in
the pipeline
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Rising
Mortality,
Costs
Patients with
pneumonia
and bacteria
in the blood
Penicillin
increased the
chance of survival
from 10% to 90%
Adapted from Austrian et al.
Ann.
Med
1964; 2013
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4 | Int.
% survivors
Penicillin
Untreated
Days
Proportion of MDR among
previously treated TB cases, 1994-2010
0-<6
6-<12
12-<30
30-<50
>50
No data available
Subnational data only
Combining data from all countries and territories:
• MDR in previously treated TB cases: 19.8% (95%CI: 14.4-25.1)
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4 neonatal deaths in a rural hospital, India
 November 2009 West Bengal
 E coli septicaemia
 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
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Death of two liver transplant patients
USA
 Both had been treated
meropenem
 Carbapenemase producing
K pneumoniae
Mathers et al. Transpl. Inf. Dis. 2009 11: 257
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Some diseases becoming untreatable
(gonorrhea)
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
 Resistant to ceftriaxone
– Ohnishi et al Emerging Inf Dis 2011 17:148
– MIC 2 ug/ml
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Impact on multiple sectors of health care
Infectious Disease
Medical Procedures
Health Security
 Pneumonia
 Neonatal care
 Travel
 Gonorrhea
 Transplantation
 Deployment
 TB
 Cancer treatment
 Malaria
 Surgery
 Conflict &
emergencies
 HIV
 Etc.
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 Etc.
 Refugees
 IHR
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
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From Albrich et al EID 2004
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WHO Goal: combat AMR
 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
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WHO programmes that include AMR
 Foodborne AMR
 Malaria
 Patient Safety
 TB
 Infection Control
 HIV
 Environmental health
 STI
 Laboratory capacity &
capability
 Cholera
 Medicines
– Critically Important Antimicrobials
– Regulations, Rational use
– Quality and standards
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 Hepatitis
 Influenza
Carmem Pessoa da Silva
Johan Struwe
Un-Yeong Go
Paul Rogers
Keiji Fukuda
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
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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
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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?
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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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