Oct-Dec, 2011 - Indian Journal of Pharmacy Practice

Daxesh M P - Combating Antimicrobial Resistance: 2011 is the year of “No action today, No cure tomorrow22Ÿ Infections from resistant bacteria are a serious problem in health care settings, causing life-threatening infections.Ÿ About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150 000 deaths1worldwide. XDR-TB has been reported in 64 countries to date. According to a study, the costs of first line and second line23medicines for the treatment of tuberculosis are US$20/course and US$3 500/course respectively and the average cost to treat24MDR-TB is $17 000.Ÿ Every year in the European Union alone, an estimated 25 000 patients die because of a serious resistant bacterial infection22acquired in hospitals. The costs associated with AMR among outpatients in the USA have been estimated to be between23,25US$400 million and US$18.6 billion and the corresponding costs among inpatients are likely to be several times higher. TheCanadian Committee on Antibiotic Resistance developed a model that suggested resistant infections add $14 to $26 million indirect hospitalization costs to health care cost in Canada – about $9 to $14 million more than those infections would have cost,had they been drug susceptible. Additional containment measures, such as patient screening and infection control, added23, 26another $26 million.Ÿ Primary resistance to at least one antiretroviral medicine is 0-25% for the treatment of HIV infection in recent years; surveys are1, 23under way to detect and monitor resistance. The first line and second line treatment costs to treat HIV/AIDS are estimated at23US$482/patient/year and US$6 700/patient/year respectively.Ÿ AMR has become a serious problem, with 5-98% penicillin resistance and 1-50% of fluoroquinolone resistance for the treatment1, 23of gonorrhoea, and is increasing worldwide. Untreatable gonococcal infections would result in increased rates of illness and1death. A Zimbabwean study reported that 90% of gonococci isolates were resistant to trimethoprim+sulphamethoxazole and23, 2716% were resistant to tetracycline.1Ÿ New resistance mechanisms such as the beta-lactamase NDM-1 have emerged among several gram-negative bacilli. A study in28ŸFig. 2: Facts and Figure on AMRIndia, Pakistan and UK found many isolates with NDM-1. This can render powerful antibiotics, which are often the last defence1against multi-resistant strains of bacteria, ineffective.23Chloroquine resistant malaria has affected 81 countries out of 92 countries worldwide. First line treatments are affordable at23, 29approximately US$0.10-0.20/adult course and Second line treatments cost approximately US$1.20-3.50/adult course.Ÿ ·The treatment of pneumonia and bacterial meningitis has been affected due to 0-70% penicillin resistance, 6-43% ampicillin23resistance and 11-72% Macrolide resistance in Streptococcus pneumoniae.Ÿ About 0-70% of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus1aureus (MRSA) and vancomycin-resistant enterococci. Studies have reported that the total cost of treating MRSA compared to30MSSA is up to three times more expensive.If AMR continues unchecked, many infectious diseases will become uncontrollable and could easily derail progress towards the1health-related United Nations Millennium Development Goals for 2015 and other development goals thereafter.AMR in Hospital and CommunityAntibiotic resistance has a negative impact on the outcome oftherapy and is associated with the increased risk of cross18, 31infections in the hospital and communities wheretransmission of bacteria is greatly amplified within a highlysusceptible population in a confined space. The elderly, veryyoung and chronically ill people are at greater risk of14developing drug resistance infections. With increasingantibiotic use in the community, the greatest concentration ofuse per patient is in hospitals, and hospital pathogens tend tobe the most resistant. Mortality rates and duration of hospitalstay are twice as high for patients infected with resistantbacteria as for those infected with susceptible strains of the31same species. The increase in the incidence of resistantorganisms in both hospitals and community settings is one ofthe reasons for the increase in the antimicrobial resistance32crisis.Consequences of AMRAntimicrobial resistance has been increasing at an alarmingmode in recent years and is expected to increase at a similar orgreater rate in future as antimicrobial agents continue to losetheir effectiveness. Resistant bacteria do not respect nationalor international borders; the development of resistance in themost remote locations can have an impact throughout theworld in a very short time.14 The tendency for antibiotic use topromote the emergence of resistant microorganisms is calledantibiotic pressure, and there are many reports of resistancerising during increased antibiotic use and falling after a31reduction in use.Antimicrobial resistance has struck at the core of infectious33, 34, 35disease control worldwide. Antimicrobial resistance isof particular concern in countries where prescription ofantimicrobial agents is unregulated and where antibiotics areIndian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 4