Smanjena djelotvornost antibiotika – jesmo li izgubili trku s bakterijama? – prof.dr.sc. Arjana...
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Transcript of Smanjena djelotvornost antibiotika – jesmo li izgubili trku s bakterijama? – prof.dr.sc. Arjana...
Smanjena djelotvornost Smanjena djelotvornost antibiotika – jesmo li izgubili antibiotika – jesmo li izgubili
trku s bakterijamatrku s bakterijama
Prof.dr.sc. Arjana Tambić AndraševićKlinika za infektivne bolesti
“Dr. F. Mihaljević”
“But I would like to sound one note of warning.... It is not difficult to make microbes resistant to penicillin in the
laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionaly happened
in the body ...”
Fleming A. Penicillin. Nobel lecture. December 11, 1945
“ Antibiotic therapy: use it and lose it”
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
Salvarsan,1910
Sulfonamide, 1936
Penicillin, 1943
Aminoglycoside, 1944
Polymyxine, 1948
Tetracycline, 1948
Chloramphenicol, 1949
Macrolide, 1952
Chephalosporine, 1953
Glycopeptide, 1958
Fluoroquinolone, 1983
Carbapenem, 1985
Glycycline, 2005
Lipopeptides, 2005
Ketolide, 2001
Oxazolidinone, 2000
Quinolones, 1962Streptogramins, 1962
Razvoj novih antibiotika
ECMO
Hip replacement
Organ transplants
Cancer chemotherapy
Intensive care
Care of preterm babies
Modern Medicine Is Not Possible Without Effective Antimicrobials
Kako zaustaviti rezistenciju na antibiotikeKako zaustaviti rezistenciju na antibiotike??
7
Razvoj novih antibiotika
Razumna uporaba antibiotika (samo kad su potrebni,
točna doza i duljina primjene)
Kontrola infekcija (higijena ruku,
traženje kliconoša, izolacija)
New systemic antibacterial agentsECDC / EMEA Technical Report 2009
Potrošnja antibiotika korelira sa stopama rezistencije na antibiotike
9
R2=0.66
P<0.001
R2=0.66P<0.001
0
20
40
60
0 2 4 6 8
Antibiotic consumption(Outpatient consumption of macrolides and lincosamides, DDD per 1,000 inh days)
An
tib
ioti
c r
es
ista
nc
e
(%
Ma
cro
lide
-R S
. p
ne
um
on
iae
fro
m c
om
mu
nity
-acq
uire
d R
TIs
)
Outpatient antibiotic use in 25 European countries in 2003*
* For Iceland total data are use; for Poland 2002 data are used.
0
5
10
15
20
25
30
Gre
ece
Fra
nce
Lu
xem
bou
rg
Por
tuga
l
Slo
vak
ia
Ital
y
Bel
giu
m
Cro
atia
Pol
and
Sp
ain
Irel
and
Icel
and
Isra
el
Fin
lan
d
Slo
ven
ia
Hu
nga
ry
Cze
ch R
ep.
Nor
way
UK
Sw
eden
Ger
man
y
Den
mar
k
Au
stri
a
Est
onia
Net
her
lan
ds
DD
D /
1000
inab
itan
ts /
day
Others
Sulfonamides (J01E)
Tetracyclines (J01A)
Quinolones (J01M)
Macrolides (J01F)
Cephalosporins (J01D)
Penicillins (J01C)
↓
Seasonal variation of outpatient antibiotic use in 11 European countries with quarterly data for 1997-2003
0
5
10
15
20
25
30
35
1997 1998 1999 2000 2001 2002 2003
DD
D /
1000
inh
abit
ants
/ d
ay
Greece
Portugal
Belgium
Ireland
Finland
Iceland
Slovenia
UK
Sweden
Denmark
Netherlands
Seasonal variation of outpatient antibiotic use in 10 European countries not able to deliver quarterly data for 1997 - 2003,
but at least for one year in this period
0
5
10
15
20
25
30
35
1997 1998 1999 2000 2001 2002 2003
DD
D /
1000
inh
abit
ants
/ d
ay
Slovakia
Italy
Poland
Croatia
Spain
Hungary
CzechRep.
Austria
Estonia
Germany
EARSS: EARSS: MRSA in 2007MRSA in 2007
Tko utječe na potrošnju antibiotikaTko utječe na potrošnju antibiotika??
14
Doctors – major differences in
antibiotic prescribing
across Europe
Nurses – also prescribing in
some countries
Pharmacists – sell over the
counter in some countries (this practice is not legal in most
cases)
Patients – demanding antibiotics, especially
parents for their children
WHO global strategy for containment of antimicrobial resistance, 2001
1. Patients and the general community education On the appropriate use of antibiotics On the importance of measures to prevent infection
2. Prescribers and dispensers education Diagnostic and treatment guidelines Disease prevention (immunization), infection control Link professional registration requirements to CME
3. Hospitals Infection control programmes Hospital therapeutics committees Hospital antimicrobial formularies Asure access to microbiology laboratories Control pharmaceutical company promotional activities
WHO global strategy for containment of antimicrobial resistance, 2001
4. Use of antimicrobials in food producing animals
5. National government and health systems- make the containment of antimicrobial resistance a national priority- create a national intersectoral task force- allocate resources to promote the implementation of interventions to contain resistance- develop indicators to monitor and evaluate the impact of the antimicrobial resistance containment strategy
6. Drug and vaccine development
7. Pharmaceutical promotion
8. International aspects of containing antimicrobial resistance
Samoliječenje antibioticima
• Antibiotik = antipiretik = analgetik
• Antibiotici dostupni samo na recept
• Ostaci prethodnih terapija, “kućne apoteke”
Miracle Cure?Antibiotics resistance
– Many bacteria have developed the ability to become resistant to antibiotics.
– These bacteria are now a major threat in our hospitals.
– Antibiotic resistant bacteria include Methicillin Resistant Staphylococcus aureus (MRSA)
Antibiotic Resistance The Causes
– Overuse
• Antibiotics used to treat infections when they are not needed or not effective i.e. for the flu
– Misuse
• Not completing a prescribed course
• Using antibiotics not prescribed for you
How antibiotic resistance can be
prevented– Antibiotics should be the last line of defence NOT the
first
• Most common infections will get better by themselves through time, bed rest, liquid intake and healthy living.
– Only take antibiotics prescribed by a doctor
– If prescribed antibiotics, finish the course.
– Do not use other peoples or leftover antibiotics
• they be specific for some other infection
Amy went to school not feeling very well. She had a headache and a runny nose. She soon realised that Natasha was also not well.
Are you OK Natasha?
Not really but my mum said that I have to come to
school *cough* *cough*Mine too. But I’m not
coughing. You really should cover your mouth you
know.
At lunch time, Amy and Natasha went to the toilet. Natasha was hungry and in a hurry to have her lunch.
Come on Amy, I’m Hungry!
Hang on, I need to wash my
hands.
Don’t bother. I never do and it hasn’t done me
any harm.
During lunch Amy was talking to her friend Harry about her headache and runny nose.It really hurts and I think I’m getting a
cough.
Don’t you have any antibiotics at home you can
take?
That’s a good idea. We still have some from when my sister had an ear infection.
I’ll ask my mum.
Go home and get some bed rest, take some painkillers for the
headache if you need to.
But she’s ill, you have to give her some
antibiotics.
I’m sorry, but there’s no need.
When Amy got home, her mother decided to take her to the doctor. He said that she had a bad cold.
You weren’t in school today, are you OK?
No, my knee started to get really painful in the night so my Mum
took me to see the doctor. He said that my cut got infected.
Oh no, did he give you painkillers?
No, he gave me antibiotics to help fight the infection but told me to
take them until they were all finished.
Harry didn’t come to school the next day so Amy called around to see him on her way home from school.
A drug used to take away pain
Very small microbe that can be helpful or harmful
A disease caused by a microbe
Special medicine used to treat bacterial infecions
A sign of illness e.g. headache, diarrhoea and fever
The smallest of the microbes - usually harmful
A drug used to treat a disease or injury
The challenge of public awareness
29
Please indicate whether the following statement is trueor false:”Antibiotics kill viruses as well as bacteria”
False
39.7%
True
41.3%
Do not know
19.0%
Source: Eurobarometer 55.2: Europeans, Science & Technology, May-June 2001
A little learning is a dangerous thing.
Drink deep, or taste not the Pierian spring;
There shallow draughts intoxicate the brain;
And drinking largely sobers us again
Alexander Pope (1688-1744)
Keeping antibiotics effective is everyone’s responsibility !!!!
Banner on Passerelle Belliard, Brussels
European Antibiotics Awareness Day,EAAD, 18 November
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