Smanjena djelotvornost antibiotika jesmo li izgubili trku s bakterijama

Prof.dr.sc. Arjana Tambi Andraevi Klinika za infektivne bolesti Dr. F. Mihaljevi

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

Razvoj novih antibiotika

Quinolones, 1962 Streptogramins, 1962 Glycopeptide, 1958 Chephalosporine, 1953 Macrolide, 1952 Carbapenem, 1985 Fluoroquinolone, 1983

Glycycline, 2005 Lipopeptides, 2005 Ketolide, 2001 Oxazolidinone, 2000

Chloramphenicol, 1949 Tetracycline, 1948 Polymyxine, 1948

Aminoglycoside, 1944 Penicillin, 1943

Sulfonamide, 1936

Salvarsan,1910

1900

1910

1920

1930

1940

1950

1960

1970

1980

1990

2000

2010

ECMO

Modern Medicine Is Not Possible Without Effective Antimicrobials Hip replacement Organ transplants Cancer chemotherapy

Intensive care
Care of preterm babies

Kako zaustaviti rezistenciju na antibiotike?

Razumna uporaba antibiotika (samo kad su potrebni, tona doza i duljina primjene)

Razvoj novih antibiotika

Kontrola infekcija (higijena ruku, traenje kliconoa, izolacija)

New systemic antibacterial agents

ECDC / EMEA Technical Report 2009

Potronja antibiotika korelira sa stopama rezistencije na antibiotike

Antibiotic resistance (%Macrolide-R S. pneumoniae from community-acquired RTIs)
60

R2=0.66 P<0.001

40

20

0 0 2

R2=0.66 P<0.001 4
6 8

Antibiotic consumption (Outpatient consumption of macrolides and lincosamides, DDD per 1,000 inh days)

Outpatient antibiotic use in 25 European countries in 2003*

30

Others Sulfonamides (J01E) Tetracyclines (J01A) Quinolones (J01M) Macrolides (J01F) Cephalosporins (J01D) Penicillins (J01C)

DDD / 1000 inabitants / day

25

20 15

10

Luxembourg

Portugal

Finland

Hungary

Norway

France

Croatia

Poland

Germany

Czech Rep.

Sweden

Denmark

Belgium

Austria

Spain

Ireland

UK

* For Iceland total data are use; for Poland 2002 data are used.

Netherlands

Slovakia

Slovenia

Estonia

Iceland

Italy

Greece

Israel

Seasonal variation of outpatient antibiotic use in 11 European countries with quarterly data for 1997-2003

35

Greece Portugal

30 Belgium

DDD / 1000 inhabitants / day

25

Ireland Finland

20 Iceland 15 Slovenia UK 10 Sweden 5 Denmark Netherlands 0 1997 1998 1999 2000 2001 2002 2003

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

35

Slovakia Italy

30 Poland
DDD / 1000 inhabitants / day

25 Croatia 20 Spain Hungary 15 Czech Rep. 10 Austria Estonia Germany 0 1997 1998 1999 2000 2001 2002 2003

EARSS: MRSA in 2007

Tko utjee na potronju antibiotika?

Doctors major differences in antibiotic prescribing across Europe

Patients demanding antibiotics, especially parents for their children

Nurses also prescribing in some countries

Pharmacists sell over the counter in some countries (this practice is not legal in most cases)

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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

Samolijeenje antibioticima
Antibiotik = antipiretik = analgetik Antibiotici dostupni samo na recept Ostaci prethodnih terapija, kune 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 Im 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, Im Hungry!

Hang on, I need to wash my hands.

Dont bother. I never do and it hasnt 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 Im getting a cough.

Dont you have any antibiotics at home you can take?

Thats a good idea. We still have some from when my sister had an ear infection. Ill ask my mum.

When Amy got home, her mother decided to take her to the doctor. He said that she had a bad cold.
Go home and get some bed rest, take some painkillers for the headache if you need to. Im sorry, but theres no need.

But shes ill, you have to give her some antibiotics.

Harry didnt come to school the next day so Amy called around to see him on her way home from school.
You werent in school today, are you OK? Oh no, did he give you painkillers?

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.

No, he gave me antibiotics to help fight the infection but told me to take them until they were all finished.

Special medicine used to treat bacterial infecions

A drug used to take away pain

Very small microbe that can be helpful or harmful The smallest of the microbes usually harmful

A disease caused by a microbe

A sign of illness

e.g. headache, diarrhoea and fever A drug used to treat a disease or injury

The challenge of public awareness

Please indicate whether the following statement is true or false:Antibiotics kill viruses as well as bacteria
False 39.7% Do not know 19.0% True 41.3%

Source: Eurobarometer 55.2: Europeans, Science & Technology, May-June 2001

29

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 everyones responsibility !!!!

Banner on Passerelle Belliard, Brussels

European Antibiotics Awareness Day,

EAAD, 18 November

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