Dr. Ertan Beyatlı

Simple solution for Antibiotic Resistance

(Update: ) - general subjects

The condition known as antibiotic resistance in the community is its medical name in the literature. "Antimicrobial Resistance" Known as AMD. As of 2019, I prepared this article with the thought that there may be a serious increase in this situation worldwide and in our country.

Main elements

  • Antimicrobial resistance (AMD) caused by bacteria, parasites, viruses and fungi the increasing spectrum of infections threatens its effective prevention and treatment.
  • AMD is in all government sectors and requiring action in society It is an increasingly serious threat to global public health.
  • Without effective antibiotics, the success of major surgery and cancer chemotherapy is jeopardized.
  • For patients with resistant infections health care costis higher in care for patients with non-resistant infections due to the longer disease duration, additional tests, and the use of more expensive drugs.
  • In 2016, 490.000 people developed multidrug-resistant TB (Tuberculosis, Tuberculosis) globally, and drug resistance began to make the fight against HIV and malaria difficult.

What is antimicrobial resistance?

In the case of random drug use, the microbes develop resistance to the drug and the drugs become ineffective. Microbes continue to multiply.

What is known as antibiotic resistance

Antimicrobial resistanceoccurs when microorganisms (such as bacteria, fungi, viruses, and parasites) change when exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimails, and anthelmintics).

Microorganisms that develop antimicrobial resistance are sometimes called "super bugs". As a result, medications become ineffective and infections remain in the body and increase the risk of spreading to others.

Antimicrobial resistance is a global concern

New mechanisms of resistance are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in long-term illness, disability, and death.

Without effective antimicrobials for the prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (eg cesarean or hip replacement) become very high risk.

Antimicrobial resistance increases the cost of healthcare with longer hospital stays and more intensive care.

Antimicrobial resistance puts the achievements of the Millennium Development Goals at risk and jeopardizes the success of the Sustainable Development Goals.

What accelerates the emergence and spread of Antibiotic Resistance?

Antimicrobial resistance occurs naturally over time, usually through genetic changes. However, the abuse and overuse of antimicrobials accelerates this process. In many places, antibiotics are overused and abused in humans and animals and are often given without professional supervision.

Examples of abuse include when taken by people with viral infections such as the common cold and flu and given as growth promoters in animals or used to prevent disease in healthy animals.

Antimicrobial resistant microbes are found in humans, animals, food and the environment (water, soil and air). They can spread between people and animals, and from person to person, including food of animal origin. Poor infection control, poor health conditions, and the use of inappropriate food encourage the spread of Antibiotic Resistance.

What is the current situation?

Bacteria resistance

Antibiotic resistance is present in every country.

Patients with infections caused by drug-resistant bacteria are at risk of worse clinical outcomes and death, and consume more health resources than patients infected with non-resistant strains of the same bacteria.

Klebsiella pneumoniaeResistance in - common intestinal bacteria that can cause life-threatening infections - to last resort treatment (carbapenem antibiotics) has spread to all parts of the world. K. pneumoniae is a major cause of nosocomial infections such as pneumonia, bloodstream infections and infections in neonatal and intensive care unit patients. In some countries, due to resistance, carbapenem antibiotics do not work in more than half of people treated for K. pneumoniae infections.

CarbapenemsIt is one of the antibiotics with a very broad spectrum, constituting the newest group of beta lactam antibiotics. The members of the carbapenems that can be effective against Gram negative, Gram positive aerobic bacteria and anaerobic bacteria are imipenem and meropenem; In recent years, the third member of this group, ertapenem, has also been used.

Turkey Clinics

Escherichia coli (E. coli) In the treatment of urinary tract infections (fluoroquinolone antibiotics), resistance to one of the most commonly used drugs is very common. There are countries in many parts of the world where this treatment is currently ineffective for more than half of the patients.

The FDA reported that fluoroquinolone class antibiotics should not be used in the treatment of sinusitis, bronchitis and uncomplicated urinary tract infections. It has not emerged recently that this group of antibiotics has serious side effects; These have been known for a very long time and the FDA has warnings about it.)

Prof. Dr. Ahmet Rasim Kucukusta

Failure of last resort (3rd generation cephalosporin antibiotics) for gonorrhea treatment has been confirmed in at least 10 countries (Australia, Austria, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden, United Kingdom of Great Britain and Northern Ireland).

The World Health Organization (WHO) recently developed gonorrhea (WHO) to address Antibiotic Resistance.gonorrhea) has updated the treatment guide. The new WHO guidelines do not recommend quinolones (a class of antibiotics) for the treatment of gonorrhea due to their high resistance levels. In addition, chlamydia infections ve syphilis The treatment guides for

A common cause of serious infections in healthcare facilities and the community Staphlylococcus aureusResistance to first-line drugs to treat infections caused by is common. MRSA It is estimated that people with (methicillin-resistant Staphylococcus aureus) will die 64% more than people with a non-resistant form of infection. Also known as MRSA super virus.

Most MRSA infections occur in people who are in hospitals or other healthcare facilities such as nursing homes and dialysis centers.

Colistinresistant to carbapenems EnterobacteriaceaeIt is a last resort treatment for life-threatening infections caused by Resistance to colistin has recently been detected in many countries and regions, making infections caused by such bacteria incurable.

Tuberculosis resistance (TB)

The World Health Organization estimates that in 2014 there were approximately 2 new drug-resistant tuberculosis cases (MDR-TB), a form of tuberculosis resistant to the 480.000 most potent TB drugs. Only a quarter of these (123 000 cases) were detected and reported. MDR-TB requires much longer and less effective treatment courses than those for non-resistant TB. Globally, only half of MDR-TB patients were successfully treated in 2014. (source: WHO)

Among new TB cases in 2014, 3.3% multidrug resistant It is estimated to be. This proportion is higher among people previously treated for TB, at 20%.

Drug-resistant tuberculosis (XDR-TB), a form of tuberculosis resistant to at least 105 core anti-TB drugs, has been identified in 4 countries. It is estimated that about 9.7% of people with MDR-TB have XDR-TB.

Resistance to malaria

Malaria (Malaria), Plasmodium It is a disease caused by five different species of parasite (P.falciparum, P.vivax, P.ovale, P.masiae and P.knowlesi). As of July 2016, resistance to primary care for P. falciparum malaria (artemisinin-based combination therapies, also known as ACTem) has been confirmed in 5 countries under the Greater Mekong region (Cambodia, Lao People's Democratic Republic, Myanmar, Thailand and Vietnam).

In most places, patients with artemicin-resistant infections recover completely after treatment, provided they are treated with ACT containing an effective partner drug. However, along the Cambodia-Thailand border, P. falciparum became resistant to all available antimalarial drugs, making treatment more challenging and requiring close monitoring. There is a real risk that multi-drug resistance will soon occur in other parts of the sub-region. The spread of resistant strains to other parts of the world can cause a major public health problem and jeopardize significant gains in malaria control.

The WHO Greater Mekong Area Malaria Eradication Strategy (5-2015) has been approved by all 2030 countries as well as China.

HIV Resistance

HIV, Human Immunodeficiency Virus, or more commonly known as HIV, is a virus that causes infection by targeting immune system cells and can cause Acquired Immunodeficiency Syndrome (AIDS) if the infection progresses.

In 2010, 7% of people who started antiretroviral therapy (ART) in developing countries had drug-resistant HIV. In developed countries, the same figure was 10-20%. Some countries have recently reported levels of 15% or more among those starting HIV treatment, and up to 40% among those restarting treatment. This requires immediate attention.

Increased levels of resistance have significant economic implications, as second and tertiary regimens are 3 times and 18 times more expensive than first line drugs, respectively.

Since September 2015, WHO has recommended that all people living with HIV start antiretroviral therapy. More use of ART is expected to further increase ART resistance in all parts of the world.

To maximize the long-term effectiveness of primary ART regimens and to ensure that people receive the most effective regimen, it is essential to continue to monitor resistance and minimize its further emergence and spread. In consultation with countries, partners and stakeholders, WHO is now a new ” Global Action Plan for HIV Drug Resistance (2017-2021) ”.

Flu resistance

Antiviral drugs, epidemic and pandemic influence is important in treatment. So far, almost all circulating influenza A viruses are resistant to one category of antiviral drugs - M2 Inhibitors (amantadine and rimantadine). However, the frequency of resistance to the neuraminidase inhibitor oseltamivir remains low (1-2%). Antiviral susceptibility is continuously monitored through the WHO Global Influenza Surveillance and Response System.

The need for coordinated action

Antimicrobial resistance is a complex problem that affects society as a whole and is driven by many interconnected factors.

  • Single, isolated interventions have limited impact. Coordinated action is required to minimize the emergence and spread of Antibiotic Resistance.
  • All countries need national action plans at AMD.
  • More innovation and investment is required in research and development of new antimicrobial drugs, vaccines and diagnostic tools.

WHO response

The World Health Organization (WHO, WHO) provides technical assistance to help countries develop their national action plans and strengthen their health and surveillance systems so they can prevent and manage antibiotic resistance. Collaborates with partners to strengthen the evidence base and develop new responses to this global threat.

WHO, the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE).One Health'approach, he works closely to promote best practices to prevent the emergence and spread of optimal antibiotic resistance. These studies cover the use of antibiotics in both humans and animals.

A political statement approved by Heads of State at the United Nations General Assembly in New York in September 2016, to adopt a broad and coordinated approach to address the root causes of antimicrobial resistance in many countries around the world, particularly in human health, animal health and agriculture. He pointed to his commitment.

WHO supports Member States to develop national action plans on antimicrobial resistance, based on the global action plan.

WHO is leading many initiatives to address antimicrobial resistance:

World Antibiotic Awareness Week

In order to raise awareness of antibiotic resistance and rational use of antibiotics in the society and healthcare workers 18 November every year"European Antibiotic Awareness Day" events are held in

WHO has declared this week, which includes 2015 November, as "World Antibiotic Awareness Week" since 18. This week aims to promote best practices among the general public, healthcare professionals, the food, agriculture and livestock sector, and policymakers to prevent the spread of antibiotic resistance.

Global Antimicrobial Resistance Monitoring System (GLASS)

The WHO-supported system supports a standard approach to collecting, analyzing and sharing data on antimicrobial resistance at the global level to inform decision making and guide local, national and regional action.

Global Antibiotic Research and Development Partnership (GARDP)

GARDP, a joint venture of WHO and Medicines for Neglected Diseases (DNDi), promotes research and development through public-private partnerships. By 2023, the partnership aims to develop and deliver four new treatments through improving existing antibiotics and accelerating the introduction of new antibiotic drugs.

Interinstitutional Coordination Group (IACG) on Antimicrobial Resistance

The United Nations Secretary-General established the IACG to increase coordination between international organizations and to ensure effective global action against health security against this threat. IACG, Interagency Coordination Group on Antimicrobial Resistance.

The IACG is jointly led by the UN Deputy Secretary-General and the WHO Director-General and consists of high-level representatives of relevant UN agencies, other international organizations and individual experts from different sectors.

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