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ANTIMICROBIAL RESISTANCE Flashcards

1
Q

WHAT ARE ANTIMICROBIALS?

A

MEDICINES USED TO PREVENT AND TREAT INFECTIONS CAUSED BY MICROORGANISMS IN HUMANS, ANIMALS AND PLANTS,
INCLUDE ANTIBIOTICS, ANTIVIRALS, ANTIFUNGALS AND ANTIPARASITICS
—> AN ANTIMICROBIAL DRUG WORKS AGAINST ONLY 1 TYPE OF ORGANISM

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2
Q

WHAT IS ANTIMICROBIAL RESISTANCE?

A

WHEN THE MICROORGANISMS CHANGE OR MUTATE OVER TIME AND GET TO A POINT WHERE THEY NO LONGER RESPOND TO MEDICINES PREVIOUSLY USED TO TREAT THEM

  • ENCOMPASSES ANTIBIOTIC, ANTIVIRAL, ANTIFUNGAL AND ANTIPARASITICS RESISTANCE
  • A NATURAL PROCESS/OCCURANCE (EVOLUTIONARY CHANGES, SURVIVAL OF THE FITTEST), BUT MASSIVELY ACCELERATED BECAUSE OF HUMAN ACTIONS
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3
Q

IS MALARIA CAUSED BY A VIRUS, BACTERIA, PARASITE OR FUNGI?

A

PARASITE

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4
Q

WHAT ARE USUAL TARGETS OF ANTIBIOTICS?

A
  • CELL WALL (GOOD TARGET BECAUSE HUMAN CELLS DO NOT HAVE A CELL WALL; E.G. BETA LACTAMS)
  • CELL MEMBRANE
  • FOLATE-PROTEIN SYNTHESIS
  • DNA/RNA SYNTHESIS
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5
Q

SOME MECHANISMS PF ACTION OF ANTIVIRAL MEDICINES?

A
  • INHIBITING ATTACHMENT/ENTRY OF VIRUS TO HOST CELL
  • INHIBITING REPRODUCTION
  • INHIBITING VIRUS LEAVING THE CELL
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6
Q

ANTIFUNGALS MECHANISM OF ACTION?

A
  • GENERALLY VIA IMPACT ON CELL MEMBRANE (VIA ERGOSTEROL: a sterol that resides on the cell membranes of fungi and acts to maintain cell membrane integrity)
  • SOME ALSO ACTING VIA CELL WALL (VIA BETA-GLUCAN INHIBITORS)
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7
Q

HOW DOES MICROBES RESISTANCE SPREAD? (E.G. BACTERIA)

A
  • BACTERIA IN HUMAN BODY ARE DIVERSE, AND SOME ARE DRUG RESISTANT
  • ANTIBIOTICS KILL BACTERIA BUT RESISTANT STRAINS REMAIN
  • ANTIBIOTIC RESISTANT BACTERIA MULTIPLY (ANTIBIOTICS HAVE KILLED OFF COMPETING BACTERIA, AIDING THIS PROCESS)
  • ANTIBIOTIC RESISTANCE SPREADS TO OTHER HUMANS/ANIMALS AND TO OTHER BACTERIA
  • SHARING OF RESISTANCE AMONG BACTERIA OCCURS VIA HORIZONTAL GENE TRANSFER; MEANING THAT GENETIC MATERIAL IS SHARED WITHOUT REPRODUCTION (E.G. VIA PLASMIDS)
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8
Q

DESCRIBE THE ROLE OF HORIZONTAL GENE TRANSFER IN SPREADING AND CO-SELECTION OF ANTIBIOTIC RESISTANCE?

A
  • HORIZONTAL GENE TRANSFER ENABLES ORGANISMS (E.G. BACTERIA) TO SHARE GENETIC MATERIAL WITHOUT REPRODUCING WITH EACH OTHER (the non-sexual movement of genetic information between genomes)
  • THIS IS SOMETIMES DONE VIA SHARING PLASMIDS
  • PLASMIDS CAN HAVE SEVERAL RESISTANCE GENES (TO DIFFERENT MOLECULES); THIS MEANS THAT WHEN ONE ANTIBIOTIC IS USED, IT NOT ONLY INCREASES THE PREVALENCE OF BACTERIA RESISTANT TO THAT ANTIBIOTIC, BUT ALSO THOSE RESISTANT TO OTHER ANTIBIOTICS –> CO-SELECTION (This means that a bacterium can become resistant to multiple antibiotics at once by picking up a single plasmid. They then become multidrug-resistant. Co-resistance occurs when the genes specifying resistant phenotypes are located together on the same genetic element such as a plasmid.)
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9
Q

SOME ANTIBIOTIC RESISTANCE MECHANISMS?

A
  • EFFLUX; ANTIBIOTICS PUMPED OUT OF CELL
  • TARGET MODIFICATION (SITE WHICH ANTIBIOTIC WAS TARGETING ALTERED)
  • IMMUNITY/BYPASS; STOP ANTIBIOTIC ACCESSING TARGET
  • ENZYMES; STOP ANTIBIOTICS FROM FUNCTIONING
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10
Q

DISK DIFFUSION?

A

The disk diffusion test (also known as the agar diffusion test, disc-diffusion antibiotic susceptibility test, disc-diffusion antibiotic sensitivity test) is a culture-based microbiology assay used in diagnostic and drug discovery laboratories. In diagnostic labs, the assay is used to determine the susceptibility of bacteria isolated from a patient’s infection to clinically approved antibiotics. This allows physicians to prescribe the most appropriate antibiotic treatment. In drug discovery labs, especially bioprospecting labs, the assay is used to screen biological material (e.g. plant extracts, bacterial fermentation broths) and drug candidates for antibacterial activity.

  • –> SHOWS HOW CLOSE MICROBES CAN GROW TO DISC IMPREGNATED WITH ANTIBIOTIC AGENTS (ZONE OF INHIBITION)
  • —> ANTIBIOTICS DIFFUSE FROM THE DISC SO HIGHER CENCENTRATION OF ANTIBIOTICS CLOSER TO DISC
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11
Q

WHAT IS MINIMUM INHIBITORY CONCENTRATION? (MIC)

A

the lowest effective concentration of an antimicrobial agent that inhibits visible growth of a bacterium of interest!!!!!!!!
- CAN BE DETERMINED BY PERFORMING A DISK DIFFUSION SYLE EXPERIMENT, A STRIP IS PLACED ONTO AN AGAR PLATE AND IT CONTAINS DIFFERENT CONCENTRATIONS OF AN ANTIBIOTIC ALONG IT (INDICATED BY NUMBER); EFFECT OF DIFFERENT CONCENTRATIONS CAN BE OBSERVED
(culture with a strip that has graduated levels of antibacterial agent in)

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12
Q

WHAT IS MINIMUM BACTERICIDAL CONCENTRATION (MBC)?

A
  • MINIMUM CONCENTRATION OF ANTIBIOTICS THAT CAN KILL BACTERIA
  • add liquid cultures mixed with increasing concentration of antibiotics to series of cultures
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13
Q

WHAT ARE THE DRIVERS OF ANTIMICROBIAL RESISTANCE?

A

MISUSE AND OVERUSE OF ANTIMICROBIAL AGENTS:

  • INAPPROPRIATELY PRESCRIBED
  • INAPPROPRIATELY USED
  • USE FOR GROWTH PROMOTION/PROPHYLAXIS IN ANIMALS
  • LOW UALITY DRUGS

(E.G. ANTIBIOTICS USED FRO NON-BACTERIAL INFECTIONS STILL HAVE AN IMPACT ON THE PERSON - KILL OFF THE NON-RESISTANT BACTERIA WITHIN THE ORGANISM WHICH ALLOWS THE RESISTANT ONES TO PROLIFERATE)

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14
Q

WHAT ARE SOME SOCIETAL FACTORS ENABLING RAPID SPREAD OF EMERGING ANTIMICROBIAL RESISTANCE?

A
  • LARGE, DENSE HUMAN/ANIMAL POPULATIONS

- RAPID TRAVEL

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15
Q

CHANGE IN ANTIBIOTIC USE IN FOOD-PRODUCING ANIMALS FROM 2015 TO 2019?

A

45% DROP

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16
Q

WHY IS ANTIMICROBIAL RESISTANE NOT ADDRESSED MORE IN THE DRUG DEVLOPMENT INDUSTRY?

A
  • MARKET FAILURE/WRONG INCENTIVES (MORE OPPORTUNITY TO RECOUP COSTS/PROFIT FROM DRUGS FOR CHRONIC CONDITIONS, HIGH COST CANCER DRUGS, FROM AMR PERSPECTIVE, WOULD WANT DRUGS TO BE USED AS INFREQUENTLY AS POSSIBLE RATHER THAN AS MUCH AS POSSIBLE)
  • ’ LOW HANGING FRUIT’ OPTIONS ARE GONE (EASIER CANDIDATES TO BE DEVELOPED INTO ANTIBIOTICS HAVE BEEN DONE)
  • INFECTIOUS DISEASE NOT SEEN AS A PRIORITY
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17
Q

THE DISCOVERY VOID?

A

“The discovery void” refers to the period from 1987 until today, as the last antibiotic class that has been successfully introduced as treatment was discovered in 1987.

Resistant infections occurred also in the early days of antibiotic use, but a steady flow of new antibiotics provided alternative treatments. It was possible to simply switch treatment once resistance against a specific antibiotic became a major problem. But then the antibiotics stopped coming. The latest discovery of a new antibiotic class that has reached the market was back in 1987. Since then there has been a lack of innovation in the field, and today there are few novel antibiotic classes in the drug pipeline. The consequences are seen worldwide as more and more bacterial infections are becoming hard to treat once again. Especially worrisome is the lack of antibiotics against Gram-negative bacteria.

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18
Q

CONSEQUENCES OF ANTIMICROBIAL RESISTANCE ON POPULATION HEALTH?

A
  • INFECTIONS HARDER TO TREAT (CAN BE ASSOCIATED WITH HIGHER RISK OF DEATH; E.G. MULTI DRUG RESISTANT S. AUERUS: 64% INCREASED RISK OF DEATH COMPARED TO METHIILIN SENSITIVE S. AUERUS)
  • LONGER TREATMENT (E.G. MULTI DRUG RESISTANT TUBERCULOSIS)
  • MORE EXPENSIVE TREATMENT
  • LENGTH OF STAY INCREASED
  • USE OF DURGS PREVIOUSLY AVOIDED DUE TO SIDE AFFECTS (E.G. COLISTIN)
  • COST TO INDIVIDUALS (AND THEIR FAMILIES AND THE WIDER SOCIETY) WHEN UNWELL FOR LONGER
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19
Q

CONSEQUENCES OF ANTIMICROBIAL RESISTANCE ON POPULATION HEALTH?

A
  • INFECTIONS HARDER TO TREAT (CAN BE ASSOCIATED WITH HIGHER RISK OF DEATH; E.G. MULTI DRUG RESISTANT S. AUERUS: 64% INCREASED RISK OF DEATH COMPARED TO METHIILIN SENSITIVE S. AUERUS)
  • LONGER TREATMENT (E.G. MULTI DRUG RESISTANT TUBERCULOSIS)
  • MORE EXPENSIVE TREATMENT
  • LENGTH OF STAY INCREASED
  • USE OF DURGS PREVIOUSLY AVOIDED DUE TO SIDE AFFECTS (E.G. COLISTIN)
  • COST TO INDIVIDUALS (AND THEIR FAMILIES AND THE WIDER SOCIETY) WHEN UNWELL FOR LONGER
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20
Q

TB DRUG RESISTANCE IN THE UK?

A

2020:

  1. 6% OF TB CASES WERE RESISTANT TO AT LEAST ONE FIRST LINE DRUG
  2. 7% WERE MULTI DRUG RESISTANT
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21
Q

MODELLED GLOBAL ESTIMATES OF DEATHS FROM ANTIMICROBIAL RESISTANCE? (2019)

A
  • 4.95 MILLION DEATHS ASSOCIATED WITH BACTERIAL AMR (ASSOCITED=RELATIVE TO NO INFECTION)
  • 1.27 MILLION DEATHS ATTRIBUTABLE TO BACTERIAL AMR (ATTRIBUTABLE=RELATIVE TO AN ANTIBIOTIC SENSITIVE INFECTION)
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22
Q

WHICH 6 BACTERIA ARE ATTRIBUTABLE TO 73% DEATHS FROM ANTIMICROBIAL RESISTANCE?

A
  • E. COLI
  • S. AUREUS
  • KLEBSIELLA PNEUMONIAE
  • STREPTOCOCCUS PNEUMONIAE
  • ACINOBACTER BAUMANNII
  • PSEDUMONAS AERUGINOSA
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23
Q

IN DEVELOPED COUNTRIES, MOST DEATHS FROM ANTIMICROBIAL RESISTANCE ARE ATRIBUTABLE TO WHICH 2 BACTERIA?

A

E. COLI AND S. AUREUS

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24
Q

O’NEILL REPORT (2016) ESTIMATES THAT THER EOCULD BE HOW MANY AMR DEATHS PER YEAR BY 2050?

A

10 MILLION

25
Q

FUTURE HEALTH ISSUES AS A CONSEQUENCE OF AMR?

A
  • INCREASE IN ILL HEALTH/DEATH FROM INFECTIOUS DISEASE
  • SURGERY RISK (E.G. ORGAN TRANSPLANT; DRUGS GIVEN TO PEOPLE TO PREVENT IMMUNE RESPONSE, MAKING THEM ESP SUSCEPTIBLE TO INFECTION)
  • HEIGHTENED RISK FOR THOSE WITH SUPPRESSED IMMUNE SYSTEM (CHANGE TO RISK/BENEFIT BALANCE FROM CHEMOTHERAPY AND ORGAN TRANSPLANTS?)
26
Q

GONORRHOEA; CAUSATIVE PATHOGEN AND ITS SHAPE?

A

CAUSED BY N. GONORRHOEAE, DIPLOCOCCAL SHAPE

27
Q

ENGLAND ANNUAL CASES OF GONORRHOEA?

A

CCA 70 000 (2019)

28
Q

HOW OFTEN IS GONORRHOEA ASYMPTOMATIC? (MEN VS WOMEN)

A

1/10 MEN

ALMOST 1/2 WOMEN

29
Q

ACCORDING TO CURRENT GUIDANCE AND PROBLEMS WITH EXTENSIVE RESISTANCE, WHAT IS THE FIRST LINE TREATMENT FOR GONORRHOEA?

A

CEFTRIAXONE

30
Q

WHAT IS GRASP SENTINEL SURVEILLANCE SYSTEM?

A

Gonorrhoea, caused by the bacterium Neisseria gonorrhoeae, is the second-most common sexually transmitted infection (STI) diagnosed in the UK.
Established in 2000, the gonococcal resistance to antimicrobials surveillance programme (GRASP) includes a suite of testing and surveillance systems to detect and monitor AMR in N. gonorrhoeae and potential treatment failures.

The cornerstone of GRASP is a national sentinel surveillance system. The GRASP sentinel surveillance system involves the collection of N. gonorrhoeae isolates from consecutive individuals attending a network of 27 sexual health clinics (SHCs) across England and Wales and their 21 associated laboratories, typically between July and September annually.

Since 2000, GRASP data have revealed important antimicrobial susceptibility trends and provided evidence to revise national treatment guidelines in 2005, 2011 and 2019.

31
Q

SENTINEL SURVEILLANCE?

A

Sentinel surveillance is conducted at specific sites or in specific populations and may be passive or active. Instead of reports on a specific condition provided in traditional active or passive surveillance, with sentinel surveillance only specific hospitals or providers report on the condition. Sentinel sites can be spread across the world, or located within a single region, country, or community, depending on the population of interest.

Sentinel surveillance is the “monitoring of rate of occurrence of specific diseases/conditions through a voluntary network of doctors, laboratories and public health departments with a view to assess the stability or change in health levels of a population”.

Instead of attempting to gather surveillance data from all health care workers, a sentinel surveillance system selects, either randomly or intentionally, a small group of health workers from whom to gather data.

32
Q

CARBAPANEMS?

A

The carbapenems are beta-lactam antibacterials with a broad-spectrum of activity which includes many Gram-positive and Gram-negative bacteria, and anaerobes. The carbapenems are not active against meticillin-resistant Staphylococcus aureus.

Carbapenems are a class of highly effective antibiotic agents commonly used for the treatment of severe or high-risk bacterial infections. This class of antibiotics is usually reserved for known or suspected multidrug-resistant (MDR) bacterial infections.

33
Q

COLISTIN?

A

Colistin is an antibiotic medication used as a last-resort treatment for multidrug-resistant Gram-negative infections including pneumonia. These may involve bacteria such as Pseudomonas aeruginosa, Klebsiella pneumoniae, or Acinetobacter.

34
Q

HOW MIGHT THE COVID PANDEMIC HAVE AFFECTED AMR?

A
  • INITIALLY UNKNOWN DISEAE, DIFFRENT TREATMENTS GIVEN, INCLUDING ANTIMICROBIALS
  • MORE PEOPLE GOING INTO HOSPITAL; OPPORTUNITY TO PICK UP CO-INFECTIONS
  • IMPACT OF ELEMEDICINE (HCPs MORE CAUTIOUS/RELUCTANT TO PRESCRIBE ANTIBIOTICS IF NOT SEEING PATIENTS FACE 2 FACE?)
  • POTENTIALLY DISRUPTION OF HEALTHCARE (DISRUPTION OF ‘BUSINESS AS USUAL’ ANTIBIOTIC STEWARDSHIP?)
  • SYSTEM CAPACITY/PRIORITY TO TACKLING AMR? (INCREASING RESOURCES BEING POURED INTO COVID)
  • OPPORTUNITIES (COVID INCREASED THE USE OF GENOME SEQUENCING, WHICH COULD BECOME MORE COMMONLY USED FOR OTHER PATHOGENS, COVID ALSO SHOWED THAT INFECTIOUS DISEASE ISN’T A THING OF THE PAST)
35
Q

THE ‘ONE HEALTH’ APPROACH?

A

AN APPROACH THAT RECOGNISES THE INTERCONNECTIONS BETWEEN HUMAN, ANIMAL AND ENVIRONMENTAOL HEALTH
(IMPORTANT FOR AMR AS IT SHOULDN’T BE LOOKED SOLELY FROM ‘HUMAN HEALTH’ PERSPECTIVE)

What is ‘One Health’?
‘One Health’ is an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes.

The areas of work in which a One Health approach is particularly relevant include food safety, the control of zoonoses (diseases that can spread between animals and humans, such as flu, rabies and Rift Valley Fever), and combatting antibiotic resistance (when bacteria change after being exposed to antibiotics and become more difficult to treat).

36
Q

4 Cs FOR CONTROLLING INFECTIONS (ESP GI)?

A
  • CLEANING
  • COOKING
  • CHILLING
  • AVOIDING CROSS CONTAMINATION
37
Q

EXAMPLES OF HOW WE CAN ADDRESS AMR?

A
  • REDUCING INFECTIONS (IT WOULD REDUCE NEED FOR ANTIMICROBIALS AND THEREFORE SPREAD OF DRUG RESISTANT INFECTIONS) –> DONE THROUGH VACCINATION, WASH, SAFER SEX, FARMING METHODS
  • PRESCRIBING APPROPRIATELY (IT WOULD HELP AVOID ANTIMICROBIALS WHERE NOT NEEDED) –> DONE THROUGH EDUCATING PUBLIC TO REDUCE DEMAND, RESEARCH/GUIDELINES AROUND PRESCRIBING, SUPPORT FOR PRESCRIBERS, REDUCING AM USE IN ANIMALS, RAPID DIAGNOSTIC TO ENSURE CORRECT TREATMENT ETC)
  • CONSUMING APPROPRIATELY (IT WOULD SLOW DOWN THE PROCESS OF RESISTANCE) –> DONE THROUGH FINISHING COURSES OF ANTIBIOTICS, APPROPRIATE COURSE LENGTH/TYPE, APPROPRIATE USE BY TYPE..)
  • DEVELOPING ALTERNATIVES (PROVIDING ALTERNATIVE TRETAMENT OPTIONS) –> DONE THROUGH INCENTIVES/DISINCENTIVES FOR RESEARCH AND DEVELOPMENT INTO NEW ANTIMICROBIALS, REPURPOSING OLDER DRUGS, DIFFERENT COMBINATIONS, ALTERNATIVES..)

+ ALL SHOULD BE SUPPORTED BY SURVEILLANCE (MONITOR ANTIMICROBIAL USE AND DRUG-RESISTANT INFECTIONS)

38
Q

WORLD HEALTH ORGANISTAION; GLOBAL ACTION PLAN ON ANTIMICROBIAL RESISTANCE (2015) - 5 OBJECTIVES?

A
  • TO IMPROVE AWARENESS AND UNDERSTANDING OF AMR
  • TO STRENGTHEN SURVEILLANCE AND RESEARCH
  • TO REDUCE THE INCIDENCE OF INFECTION
  • TO OPTIMIZE THE USE OF ANTIMICROBIAL MEDICINES
  • TO ENSURE SUSTAINABLE INVESTMENT IN COUNTERING AMR
39
Q

AWaRe CLASSIFICATION OF ANTIBIOTICS?

A

ACCESS GROUP ANTIBIOTICS (first-line, low resistance potential)
WATCH GROUP ANTIBIOTICS (critically important antibiotics, high resistance potential)
RESERVE GROUP ANTIBIOTIC (antibiotics for MDR organisms, ‘last resort’)

40
Q

‘GLASS’ SURVEILLANCE?

A

On 22 October 2015, WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS), the first global collaborative effort to standardize AMR surveillance.
- HELPS UNIFY/HARMONISE WAYS OF DATA COLLECTION (MAKE SURE SAME TESTS, INDICATORS ETC ARE USED)

41
Q

EXAMPLES OF HOW GOVERNMENTS CAN HELP ADDRESS AMR THROUGH INCENTIVES/DISINCETINVES FOR DRUG COMPANIES?

A
  • MARKET ENTRY REWARDS POTENTIALLY FUNDED BY ‘PAY OR PLAY’ LEVY (COMPANIES SHOULD RE AMR RESEARCH OR PAY A CERTAIN AMOUNT, O’NEILL REPORT, 2016)
  • ‘NETLFIX MODEL’ (NICE, SUBSCRIPTION MODEL; PAYING FOR THE DRUG/SUBSCRIBING TO THE DRUG BASED ON ITS OVERALL VALUE TO SOCIETY RATHER THAN UNIT SOLD)

‘UK tests ‘Netflix Subscription Model’ for new antibiotic drugs
03 Jul 2020

The UK Department of Health and Social Care (DHSC) recently announced a new approach for the procurement and provision of new antibiotics in the NHS, through a subscription-style’ payment model. The news represents a total re-think of how antibiotics are valued in public health.

The proposed payment model is the first time that antibiotics are being sold under contracts that are based on the population covered as opposed to the number of pills sold. Not only does this demonstrate a recognition of the need for new antibiotics but simultaneously signifies the creation of a new system which uses them sparingly. It incentivises antibiotic innovation, at the same time decoupling its financial viability from the number of doses prescribed, promoting stewardship over volume.’

42
Q

EXAMPLE OF UK GOVERNMENT WORKING WITH OTHER COUNTRIES TO ADDRESS AMR; FLEMING FUND?

A

‘The Fleming Fund brings evidence and people together to encourage action against drug resistance for a healthier world.

We support low- and middle-income countries to generate, share and use data to improve antimicrobial use and encourage investment in AMR.’

43
Q

UK GOV TACKLING ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN?

A
  • 2019-2024

9 AMBITIONS

44
Q

UK’s 20 YEAR VISION FOR AMR?

A
  • A LOWER BURDEN OF INFECTION, BETTER TREATMENT OF RESISTANT INFECTIONS, MINIMISED TRANSMISION
  • OPTIMAL USE OF ANTIMICROBIALS AND GOOD STWEARDSHIP ACROSS ALL SECTORS
  • NEW DIAGNOSTICS, THERAPIES, VACCINES AND INTERVENTIONS
45
Q

HOW CAN PHARMACEUTICAL COMPANIES ADDRESS AMR?

A
  • DEVELOPING PIPELINE FOR NEW ANTIMICROBIALS
  • REPOURPOSING OLDER DRUGS/TESTING COMBINATIONS (TO EXTEND DRUG ‘LIFESPAN’)
  • DEVELOPMENT OF RAPID DIAGNOSTICS
  • RESEARCH ON CORRECT DOSES
  • O’NEILL REPORT 2019; REGULATORY BODIES SHOULD BE MORE HARMONISED AND FLEXIBLE (DIFFERENT BODIES FOR DIFFERENT MARKETS NOW) –> SHOULD BE MADE EASIER FOR DRUG COMPANIES TO DEVELOP DRUGS
46
Q

PHE FINGERTIPS TOOL?

A

PHE FINGERTIPS TOOL: AN INTERACTIVE DATA RESOURCE
These interactive, localised profiles are a rich source of indicators across a range of health and well-being themes, helping to reduce inequalities.

47
Q

IN SURVEILLANCE, TOTAL NUMBER ‘PER STAR-PU’ MEANS?

A

SPECIFIC THERAPEUTIC GROUP AGE-SEX RELTED PRESCRIBING UNIT

48
Q

ANTIBIOTICS ARE VERY COMMONLY PRESCRIBED FOR CHILDREN PRESENTING WITH UNCOMPLICATED LOWER RESPIRATORY TRACT INFECTIONS (LRTIs)? EVIDENCE FROM RCTs SHOW THAT EFFECTIVENESS OF THIS IS?

A

LOW
–> UNLESS PNEUMONIA IS SUSPECTED, CLINICIANS SHOULD PROVIDE SAFETY NETTING ADVICE BUT NOT PRESCRIBE ANTIBIOTICS FOR MOST CHILDREN PRESENTING WITH CHEST INFECTIONS)

49
Q

WHAT ARE ‘BACK UP’ PRESCRIPTIONS?

A

WHERE PRESCRIPTION IS GIVEN BUT A PATIENT ADVISED NOT TO USE UNLESS SYMPTOMS GET WORSE

50
Q

WHAT MIGHT BE USES OF ‘GUIDANCE ON PRESCRIBING’ GRAPHS FOR PRESCRIBERS?

A
  • CAN HELP THEM WHEN THEY AREN’T SURE
  • CAN EMPOWER THEM NOT TO PRESCRIBE UNNECCESSARY ANTIMICROBIALS
  • THEY CAN SHOW THEM TO PTIENTS SO THEY HELP UNDERSTAND DECISIONS AND ALTER DEMAND OF ANTIMICROBIALS
51
Q

‘START SMART - THEN FOCUS’ TOOLKIT?

A

Antimicrobial stewardship: Start smart - then focus
This toolkit provides an outline of evidence-based antimicrobial stewardship in the secondary healthcare setting.
for hospitals!!!!!, noticed that the reasons for antibiotics prescribing aren’t recorded/justified clearly–> important to document well and regularly reassess need for antibiotics (e.g. could antibiotics be stopped, or maybe moved from broad spectrum to specific ones etc etc)

52
Q

CASE EXAMPLE FOR REDUCING ANTIBIOTIC USE IN FOOD-PRODUCING ANIMALS

A
  • 2015, TARGETED MEDICATION TECHNIQUE USED IN WILTSHIRE TO SUCCESSFULLY ELIMINATE THE COMMON RESPIRATORY DISEASE ENZOONOTIC PNEUMONIA (EP) FROM SIX LARGE OUTDOOR PIG HERDS TOTALLING 5 000 SOWS
  • EACH SOW PRESCRIBED 31g OF ACTIVE ANTIBIOTIC, ADMINISTERED OVER A SIX WEEK PERIOD
  • BY THE END OF INTERVENTION, EP COMPLETELY VANISHED FROM ALL 6 HERDS
  • THIS HAS REDUCED THE AVERAGE ANTIBIOTIC USE FROM 120mg/kg TO LESS THAN 30mg/kg
53
Q

TARGET TOOLKIT?

A

TARGET stands for Treat Antibiotics Responsibly, Guidance, Education and Tools. It is a toolkit designed to support primary care clinicians!!!! to champion and implement antimicrobial stewardship activities. The resources can also be used to support CPD and revalidation requirements.

54
Q

WHO IN THE UK DOES THE MAJORITY OF ANTIBIOTIC PRESCRIBING?

A

GPs (73%)

55
Q

HOSPITAL INPATIENT ACCOUNT FOR WHAT % OF ANTIBIOTICS PRESCRIBED?

A

12%

56
Q

HOW CAN THE PUBLIC ADDRESS AMR?

A

Preventing infections e.g. vaccinations, handwashing, food hygiene, safer sex

Awareness of AMR; expectations (around whether being prescribed antibiotics is always desireable)

Awareness around need to finishing courses of antibiotics, taking only antibiotics prescribed to you for that illness/condition, not sharing with others

As consumer using buying power to influence decisions e.g. choosing to not buy meat where antibiotics are used (see O’Neill, 2016)

57
Q

THE TRAGEDY OF THE COMMONS?

A

WHEN SHORT-TERM SELF-INTEREST LEADS TO TRAGEDY FOR ALL
(can be applied to the drivers of AMR):
On dealing with problems before they reach ‘acute phase’ (O’Neill report 2016, p.14; note: estimates cost of tackling AMR over 10-year period at $40bn):
Governments always have to make very difficult financial allocation choices. Understandably, they often find it easier to react to visible and immediate threats rather than longer term and less visible problems even if the latter are very large, such as AMR.
When threats such as SARS, Swine Flu and Ebola arise, governments spend vast sums, often in haste and with vision clouded by the imperative to respond to an acute global health crisis.
[…]
These crises were of course impossible to predict and required a quick response with large sums of money, from a position of relative weakness – but the vast sums involved illustrate the almost uncontainable cost of responding to a major health crisis once it reaches an acute phase. In contrast, the unfolding global threat of rising drug resistance is essentially predictable, and the costs that we present here for mounting an effective pre-emptive response to it are substantially lower than the expense of responding once it becomes a true public health emergency.

58
Q

CHALLENGES OF ADDRESSING AMR?

A

Global issue – can’t be solved by one country alone

Multidisciplinary – can’t be solved by one sector alone – not just a ‘health’ issue

Approach needs to be tailored to different settings – need to ensure that don’t restrict access when needed

Short-/medium-term need/interests vs collective good (or prevent a collective ‘bad’)

Mismatch between free market ideology and antibiotic development, given ‘market failure’? (market isn’t regulating itself and producing what’s needed)

Ethical issues – who gets benefits/risks? What do we owe to future generations?

Prevention paradox (Geoffrey Rose) – individuals may not see benefit but might be expected to bear ‘cost’ e.g. not getting antibiotics when they want them; they might never get a drug resistance infection so avoiding antibiotics won’t directly help them (everyone implementing the preventative measures, but only the small proportion directly benefit from it)

INF (40 decks)

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