Introduction to
Antimicrobial Resistance
Dr Poonam Khetrapal Singh
Deputy Regional Director
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Prevention and control of antimicrobial resistance: WHD2011
Outline
 What is antimicrobial resistance (AMR) and its
implications?
 Why are we worried about AMR in SEA Region?
 What are the possible solutions?
 What is WHO doing?
 What we all can do?
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Prevention and control of antimicrobial resistance: WHD2011
Outline
 What is antimicrobial resistance (AMR) and its implications
 Why are we worried about AMR in SEA Region
 What are the possible solutions
 What is WHO doing
 What we all can do
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Prevention and control of antimicrobial resistance: WHD2011
Antimicrobial (Antibiotics) resistance
 Resistance is unresponsiveness to antimicrobial agents in
standard doses
 A natural biological unstoppable phenomenon which is driven
by rampant misuse of antimicrobial agents
– 50% of antibiotics are prescribed inappropriately
– 50% of patients have poor compliance
– 50% of populations do not have access to essential antibiotics
– 50% of antibiotics in some countries are used for animal growth promotion
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Prevention and control of antimicrobial resistance: WHD2011
Resistance has huge negative impact on health
 Longer duration of illness
 Longer treatment
 Higher mortality
 Treatment with expensive drugs
 Increased burden on health system
 Negates technological advances in medical sector
– Complex surgeries
– Transplantations and other interventions
 Patient acts as reservoir of resistant organisms which are
passed to community and health-care workers
 Huge economic impact on individual and society
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Prevention and control of antimicrobial resistance: WHD2011
Outline
 What is antimicrobial resistance (AMR) and its implications
 Why are we worried about AMR in SEA Region
 What are the possible solutions
 What is WHO doing
 What we all can do
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Prevention and control of antimicrobial resistance: WHD2011
Resistance is negating “wonder drugs” in SEAR
 Tuberculosis
– MDR-TB < 3% : 130,000 cases annually, XDR-TB: Reported from 4 countries
 Kala-azar
– 60% resistance in pentavalent antimony and 25% in pentamidine
 Typhoid fever
– MDR Salmonella Typhi prevalent all over Region
– Causing 10% Case Fatality Rate (CFR) in children (preantibiotic era: 12.8%)
 Hospital associated infections
– Staphylococcus aureus: >50% isolates in hospitals are methicillin-resistant (MDR)
– Acinetobacter baumannii: >50% of patients infected with resistant strains die
– Pseudomonas, Klebsiella, Serratia: MDR persist in hospital settings, and cause huge mortality
morbidity
 Malaria
– 400 million people at risk of infection with resistant parasite
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Prevention and control of antimicrobial resistance: WHD2011
Superbugs* are visible manifestations of our prolonged failure to preserve antibiotics
Known but neglected.
Need immediate action
Known but
inevitable
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** 8
Methicillin
resistant
Staph aureus,
Mycobacteria, ESBL
producing Gram
negative bacteria and NDM-1 producing
Prevention
and MDR-and
controlXDR
of antimicrobial
resistance:
WHD2011
enterobacteriaceae bacteria are few examples of superbugs because these fail to respond to large number of commonly used antibiotics
Outline
 What is antimicrobial resistance (AMR) and its implications
 Why are we worried about AMR in SEA Region
 What are the possible solutions
 What is WHO doing
 What we all can do
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Prevention and control of antimicrobial resistance: WHD2011
Possible solutions
 Discover new drugs faster than emergence of resistance
 Promote discovery, development and dissemination of new
antimicrobial agents
 Prevent emergence of resistance by reducing selection
pressure by appropriate control measures
 Rationalize the use of available antimicrobial agents
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Prevention and control of antimicrobial resistance: WHD2011
Antibiotics: Roadway
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Prevention and control of antimicrobial resistance: WHD2011
Possible solutions
 Discover new drugs faster than emergence of resistance
 Rationalize the use of available antimicrobial agents
 Prevent emergence of resistance by reducing selection
pressure by appropriate control measures
 Promote discovery, development and dissemination of new
antimicrobial agents
Implementation requires a strategy with comprehensive
national initiatives/plans
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Prevention and control of antimicrobial resistance: WHD2011
Regional Strategy on AMR and Resolution of RC63




Governance
Regulatory
Capacity building
Community
education
 Research
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Prevention and control of antimicrobial resistance: WHD2011
Outline
 What is antimicrobial resistance (AMR) and its implications
 Why are we worried about AMR in SEA Region
 What are the possible solutions
 What is WHO doing
 What we all can do
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Prevention and control of antimicrobial resistance: WHD2011
WHO material for technical support….
Available at www.searo.who.int/AMR
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Prevention and control of antimicrobial resistance: WHD2011
Outline
 What is antimicrobial resistance (AMR) and its implications
 Why are we worried about AMR in SEA Region
 What are the possible solutions
 What is WHO doing
 What we all can do
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Prevention and control of antimicrobial resistance: WHD2011
“antimicrobial resistance is
possibly the single biggest
threat facing the world in
the area of infectious diseases”.
Antibiotics are
a precious resource
We need to preserve this
resource by working
together
Use Antibiotics rationally
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Prevention and control of antimicrobial resistance: WHD2011