UK drafts Guidelines for changing public behaviour to reduce antibiotic resistance

Contributed by Siddarth David and Dr. Tamhankar

The National Institute for Health and Care Excellence (NICE) in the UK last week released its draft guidelines aimed at the general population in order to address the challenge on antimicrobial resistance in the country. The statutory body has drafted these guidelines complimenting the guidelines on antibiotic stewardship which were published last month to be implemented in the UK.

The draft guidelines which are open for public consultation, emphasize the need for public awareness to reduce risk-related behaviours among the general public. It reports that basic hygiene guidance such as hand-washing can reduce majority of infectious diseases like cough and cold which account for one-fifth of the days lost at work in the UK rather than depend on antibiotics for treatment. 

The draft guidelines also state that when people seek medical advice for self-limiting conditions, they should be told how they could treat their symptoms themselves and explained why they are not being prescribed antibiotics. The draft guidelines are commendable in having recognized that the patient and the public at large also have an important role to play in tackling antibiotic resistance. Once finalized it could be used as advocacy tool for other countries across the world to push for robust policies on the issue. 

South-Asian countries assess progress of Antimicrobial strategies in the region

Contributed by Dr. Tamhankar and Siddarth David

Health ministers of 11 countries in South Asia are meeting from today in Dili, Timor-Leste for the 68th WHO Regional Committee for South East Asia. An important agenda is the implementation of action plan for antimicrobial resistance by the 11 countries in the region.

The meeting conducted by the highest policy making body of the WHO in the region meets once a year to discuss, deliberate and plan health priorities and action policies for the entire region. Given the critical global challenge posed by antibiotic resistance, it features high in the agenda of this year's Regional Committee Meeting. 

It will be especially significant as it would be an opportunity to review the commitments and progress made by the 11 countries on the resolution passed in the May 2015 World Health Assembly in Geneva that every member country would have to develop and implement national action plans for  controlling antibiotic resistance in their respective countries by May 2017. 

US creates new database to track antibiotic resistance

Contributed by Dr. Tamhankar and Siddarth David

The U.S. Centers for Disease Control and Prevention (CDC) have released a new tool that tracks the spread of antibiotic resistance in the country. The" National Antimicrobial Resistance Monitoring System (NARMS): Human Data" (http://wwwn.cdc.gov/narmsnow/) covers data for the last 20 years with interactive maps both bacteria-wise and antibiotic-wise helping for comparisons between states and overall national resistance rates.

This is in response to growing  demand in the US by various academicians , government officials and civil society groups for more data on antibiotic resistance in the US. This is a welcome step ahead, as data to determine the extent and nature of the problem is essential in the process of addressing antibiotic resistance.

" 9 out of 10 GPs say they feel pressured to prescribe antibiotics": NICE, UK

Contributed by" Dr. Tamhankar and Siddarth David

On August 18, 2015, the National Institute for Health and Care Excellence (NICE) in the UK released its first guidelines on antimicrobial stewardship "Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use". https://www.nice.org.uk/guidance/ng15 The NICE is the statutory body in the UK that provides national guidance and advice to improve health and social care.

The Guidelines are designed to promote judicious antibiotic use by reviewing prescribing and resistance data and providing feedback, education and training to prescribers. The NICE reports that " 9 out of 10 GPs say they feel pressured to prescribe antibiotics, and 97% of patients who ask for antibiotics are prescribed antibiotics”. The Guidelines have been aimed at health practitioners, pharmacists, nurses and provider organisations.

The current edition of the Lancet has an editorial on the strengths and weaknesses of the Guidelines. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61522-7/fulltext The NICE guidelines are pioneering antibiotic stewardship in the UK, which is particularly significant given that the UK lags way behind countries like Sweden and Norway in implementing policies to address antibiotic resistance. The NICE Guidelines are a welcome step to global measures on antibiotic stewardship and hopefully would push other countries to take notice and follow with their own guidelines.

MRSA from smokers' lung may be more dangerous and resistant says research from University of California

Article contributed by Dr. Akilesh Ramasamy & Dr. A. J. Tamhankar

MRSA (Methicillin Resistant Staphylococcus Aureus), a deadly resistant pathogen, can become deadlier when exposed to cigarette smoke, says Laura Alexander and her team, from University of California, San Diego School of Medicine based to their experimental study.

They exposed the bacteria to cigarette smoke extracts and found that MRSA, though engulfed by macrophages, was not effectively killed by the macrophages.

The first requirement of a pathogen to be able to cause a disease is the ability to adhere to tissues, because when they adhere to the tissues, they are able to then invade inside. The MRSA exposed to cigarette smoke extracts revealed better adherence capabilities which means they can stick to tissues more tenaciously and able to cause deadly infection. They were able to duplicate these findings on a mouse model as well. The MRSA exposed to cigarette smoke were also resistant to killing by antibiotic peptides.

Even though definitive study from humans is not available, it may be possible that MRSA infections / pathogens present in lungs of a smoker can be more deadlier and tenacious. This can have devastating effects as smoking is widely prevalent and even non smokers are often exposed to large quantities of second hand smoke.

Source: The New Indian Express

Global Scenario of Bacteria, Infections, Antibiotics and Resistance- By Dr. A. J. Tamhankar (Research Associate: Sandeep Nerkar)

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• Bacterial toxin sets the course for serious infection
• Government cuts putting patients at risk of Clostridium difficile infection say experts, UK
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• Novel imaging technique, a new weapon in the fight against superbugs
• Multi-resistant bacteria defeated by new substance
• Veterans hospitals nationwide sustain decline in MRSA
• Human decomposition: study maps internal bacteria
• Opportunities for improvement identified through evaluation of hospital infection prevention policies
• The science of toxins and illness associated with E. coli
• Listeria's resistance to disinfectants
• Risk of clostridium difficile infection may be higher in the obese
• Increase in pediatric musculoskeletal MRSA infections
• Novel technique addresses antibiotic resistance
• Community-associated MRSA rife in nursing homes
• Proposed social network modeling may help in the fight against hospital infections

Increased antibiotic resistance cause for concern: Researchers

http://bangalore.citizenmatters.in/articles/increased-antibiotic-resistance-cause-for-concern-researchers

The World Health Organisation recently announced a ‘global health crisis’ of increased antibiotic resistance. The studies done by WHO have marked India as one of the countries to be suffering from the consequence.

Three medical researchers working as an Associate Professors at R D Gardi Medical College, Ujjain, Dr. Ashish Pathak, Vishal Diwan and Dr. Megha Sharma, conducted a study in Ujjain to get to know the real cause of the problem and to find out solutions for the same. 

Infectious diseases experts raise alarm at growing superbug risk – Louise Milligan | ABC News

Infectious diseases experts raise alarm at growing superbug risk 

 – Louise Milligan | ABC News

http://www.abc.net.au/news/2013-07-24/infectious-diseases-experts-raise-alarm-at-growing-superbug-risk/4841740

Medical experts have raised fears of a new strain of antibiotic-resistant superbug spread through food and even drinking water, and the British chief medical officer has described the superbug threat as ranking with terrorism or global warming. Australia’s chief scientist this month warned antibiotic resistance could mean an end to modern medicine as we know it.

Antibiotic resistance – The last resort - Maryn McKenna | Nature

Antibiotic resistance – The last resort - Maryn McKenna | Nature

http://www.nature.com/news/antibiotic-resistance-the-last-resort-1.13426

Thomas Frieden and Sally Davies have recently been speaking publicly about the soaring increase in a little-known class of antibiotic-resistant bacteria: carbapenem-resistant Enterobacteriaceae (CREs). Davies, the United Kingdom’s chief medical officer, described CREs as a risk as serious as terrorism (see Nature 495, 141; 2013). “We have a very serious problem, and we need to sound an alarm,” said Frieden, director of the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

Their dire phrasing was warranted. CREs cause bladder, lung and blood infections that can spiral into life-threatening septic shock. They evade the action of almost all antibiotics — including the carbapenems, which are considered drugs of last resort — and they kill up to half of all patients who contract them. In the United States, these bacteria have been found in 4% of all hospitals and 18% of those that offer long-term critical care.

Global Scenario of Bacteria, Infections, Antibiotics and Resistance- By Dr. A. J. Tamhankar (Research Associate: Sandeep Nerkar)

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