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PreventionandContainmentofAntimicrobialResistance USEANTIBIOTICSRATIONALLY Resistanceinmicrobesisanaturalphenomenon ResistanceisunresponsivenesstoantimicrobialagentsinstandarddosesAnaturalbiologicalunstoppablephenomenonResistanceisgenerallyslowtoreverseorirreversibleAllantimicrobialagentshavethepotentialtoselectdrug resistantsubpopulationsofmicroorganisms Resistanceisacceleratedthroughinappropriateuseofantimicrobials StandardtreatmentguidelinesnotprovidedtophysiciansorprovidedbutnotadheredtoDrugsavailablewithoutprescriptionAccessiblebutpoorqualityInadequatemonitoringIrrationalself administrationorprescriptionAntimicrobialresistance Resistanceisfalloutofinappropriateuseofantimicrobialsindifferentsettings Inanimalsandplants Therapeuticandnon therapeutic e g asgrowthpromoters IncommunityacquiredinfectionsInhospital associatedinfectionsIrrationaluseofantibioticsisthegreatestdriverofresistance50 ofantibioticsareprescribedinappropriately50 ofpatientshavepoorcompliance50 ofpopulationsdonothaveaccesstoessentialantibiotics Resistantorganismsalsomoverapidlyacrossbordersthroughhumansandthefood chain Twooutbreaksofmethicillin resistantStaph aureus MRSA inhospitalsinCanadaOrigininNorthIndiaMultidrug resistanttyphoidfeverinUSAOriginatedin6countries includingIndia MDRSalmonellaschwarzengrundImportedthroughThaifoodintoDenmarkandtheUSAMultidrugresistantMycobacteriaResistantmalariaatThai CambodiaborderResistanceinH1N1andHIVareglobalconcerns Resistanceisnegating wonder drugs StatusofresistanceinWHO sSouth EastAsiaRegion TuberculosisMDR TB 3 180000casesannuallyXDR TB ReportedfromBangladesh India Indonesia Thailand StatusofresistanceinWHO sSouth EastAsiaRegion 400millionpeopleatriskofinfectionwithresistantparasites Malaria StatusofresistanceinWHO sSouth EastAsiaRegion HIVandSTIs DataonHIVresistancebeinggeneratedSTIs Gonorrhoeawidelyresistanttopenicillin fluoroquinolones StatusofresistanceinWHO sSouth EastAsiaRegion Kala azar 60 resistanceinpentavalentantimonyand25 inpentamidine StatusofresistanceinSEAR 2epidemicpronediseases CholeraResistancetoNalidixicacid fluorazolidone cotrimoxazole IndiaTetracyclineresistance IndiaShigellosisMultidrugresistant causingextensiveoutbreaksTyphoidfeverMDRSalmonellatyphiprevalentalloverRegionCausing10 CaseFatalityRate CFR inchildren preantibioticera 12 8 Acuterespiratoryinfections pneumonias 69 ofStreptpneumoniaeresistanttopenicillininThailand StatusofresistanceinSEAR 3Hospital associatedinfections Staphylococcusaureus 50 isolatesinhospitalsaremethicillin resistant48 ofpatientswithbacteraemiadiedinThailandAcinetobacterbaumannii 50 ofpatientsinfectedwithresistantstrainsdiePseudomonas Klebsiella SerratiaMultidrug resistance persistinhospitalsettings andcausehugemortalitymorbidity Resistancehashugenegativeimpactonhealth LongerdurationofillnessLongertreatmentHighermortalityTreatmentwithexpensivedrugsIncreasedburdenonhealthsystemNegatestechnologicaladvancesinmedicalsectorComplexsurgeriesTransplantationsandotherinterventionsPatientactsasreservoirofresistantorganismswhicharepassedtocommunityandhealth careworkersHugeeconomicimpact Resistance Aglobalpublichealthissue ECDC antimicrobialresistanceispossiblythesinglebiggestthreatfacingtheworldintheareaofinfectiousdiseases IHR 2005 PHEICWorldAllianceonPatientSafetyChallengeIIIMDGs HIV TBandMalaria EssentialDrugsList usein120countries SeveralWHAResolutionsonrationaluseofdrugs antimicrobialresistancebutlittleprogressWHA37 33WHA51 17WHA54 11WHA58 27 Resistanceisamultifacetedproblem BiologicalBehaviouralTechnicalEconomicRegulatoryEducational Continuousnaturalevolutionofresistanceinbugs Weaksurveillance regulatorysystems Inappropriateuseofantibioticsselection multiplicationofresistantstrains Selfmedicationandpoorcompliance Accumulationofresistancetomultipleantibiotics Superbugs arevisiblemanifestationsofourprolongedfailuretopreserveantibiotics MethicillinresistantStaphaureus MDR andXDRMycobacteria ESBLproducingGramnegativebacteriaandNDM 1producingenterobacteriaceaebacteriaarefewexamplesofsuperbugsbecausethesefailtorespondtolargenumberofcommonlyusedantibiotics Superbugs Knownbutneglected Needimmediateaction Knownbutinevitable Possiblesolutions DiscovernewdrugsfasterthanemergenceofresistanceRationalizetheuseofavailableantimicrobialagentsPreventemergenceofresistancebyreducingselectionpressurebyappropriatecontrolmeasuresPromotediscovery developmentanddisseminationofnewantimicrobialagents Badbugsneednewdrugs Possiblesolutions DiscovernewdrugsfasterthanemergenceofresistanceRationalizetheuseofavailableantimicrobialagentsPreventemergenceofresistancebyreducingselectionpressurebyappropriatecontrolmeasuresPromotediscovery developmentanddisseminationofnewantimicrobialagentsImplementationrequiresastrategywithcomprehensivenationalinitiatives plans RegionalStrategyonAntimicrobialResistance Goal Tominimizethemorbidityandmortalityduetoantimicrobial resistantinfectionandtopreservetheeffectivenessofantimicrobialagentsinthetreatmentandpreventionofmicrobialinfections RationalUseofAntibiotics Majoractivities Willitwork TherearesuccessstoriesfromFinland FranceandsomehospitalsintheSEARegion Seppallaetal TheEffectofChangesin
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