Hi Steward Mudenda , developing effective probiotics that support the immune system against microbial infections could be an alternative strategy. Using nanotechnology to improve cargo delivery at the infection site, thus reducing overdosing could be another option.

Dear Satwik Majumder , thank you very much for this response, very much appreciated. I hope to see many countries invest in nanotech soon

Dear Steward Mudenda, utilization of nanotechnology can anticipate the incidence of overdose. Many researchers have used it as an alternative strategy.

Dear Kurnia Fitri Jamil , thank you very much for this, much appreciated

The problem of the exacerbation of resistance against antibiotics is largely related to the excessive and misuse of antibiotics in the field of animal production... It is possible to use organic acids instead of these antibiotics as antimicrobials and growth stimulants. I have read about studies in this field... In addition to that calcium salts increase the oxidative stability of meat after slaughter... My sincere gratitude to all.

Dear Dr Manal Hadi Kanaan , thank you very much for your encouraging contributions. Much appreciated Manal Hadi Kanaan

The alternative approaches to antibiotics include immunomodulation, competitive exclusion of pathogenic bacteria via probiotics and their combination, natural and synthetic antimicrobial peptides, antibodies, bacteriophages and phage lysins.

Chapter Alternative Therapies to Antibiotics to Combat Drug-Resistan...

Also, I found these links that may be useful:

Article Antibiotic resistance: Alternative approaches

Article Integrative approaches to antimicrobial resistance

Article Futuristic Non-antibiotic Therapies to Combat Antibiotic Res...

Thank you very much Dr Manal Hadi Kanaan

Also, the following presentation may be useful about the use of predatory bacteria as a promising method to combat resistance, hope it is useful:

Presentation Predatory Bacteria As A Promising Method to Combat Antibioti...

Dear Manal Hadi Kanaan , we had lost almost all available antibiotics due to antimicrobial resistance. An alternatives of using antibiotics, so many are there. One great example is phage theraphy - old techqinue which has reviving after the antibiotic resistance and all products are still under pipeline except Intralytix (used only in food micrbiology not in clinical medicine). This stragety had already adapted and constionusly using in russian countries yet from pre antibiotic era. Other than phage theraphy, antimicrobial resistance breakers (ARB's) enhacing the efficacy of failed antibiotics. Recently, Avibactum ARB have done outstanding performance to control all kind of beta lactamase enzyme produced by resistant bacteria. Then, fecal transplanataion therapy and stem therpy tested under in vitro conditions to mitigate the resistance mechanism of pathogen.

Dear Doctor

Go To

TACKLING ANTIMICROBIAL RESISTANCE ENSURING SUSTAINABLE R&D Final note prepared by OECD, WHO, FAO and OIE

29 June 2017

"Antimicrobial Resistance is a threat to our health and our economies Antimicrobial resistance (AMR) is a major threat to global health and the world economy, and poses a unique challenge to humanity. All countries – regardless of their economic situation, the strength of their health systems or their level of antimicrobial consumption – will face disastrous consequences if the emergence and spread of AMR is not contained. Global solutions are needed, to promote prudent use of antimicrobials; to ensure that all people, regardless of where they live, have access to the antimicrobials they need; to find new vaccines, diagnostic tests and antimicrobials that are affordable, of good quality and effective against drug-resistant diseases; and to foster infection prevention and control. Existing international commitments need to be implemented promptly and energetically. In addition, a global deal is needed, with richer countries paying to kick-start the innovation pipeline, making new products available at an affordable price to low-income countries that commit to using medicines responsibly and increasing AMR surveillance.

AMR infections are killing more people Resistant bacteria double the probability of developing a complication and triple the risk of death compared with non-resistant forms.1 High levels of resistance have already been observed among common bacteria that cause serious hospital acquired-infections, urinary tract infections, and gonorrhoea, among others.

AMR also has the capacity to erode hard-won gains made against major infectious diseases like HIV/AIDS, tuberculosis (TB) and malaria. In 2010, an estimated 7% of people starting antiretroviral therapy in developing countries had drug-resistant HIV, and the figure rises to 10-20% in high income countries. In some countries, up to 40% of patients re-starting treatment for HIV show resistance. 3.3% of patients developing TB in 2014 showed resistance. The proportion is 20% among people previously treated for TB. In 2015, there were about 480 000 new cases of multidrug-resistant TB (MDR-TB), a form of TB that is resistant to the two most powerful anti-TB drugs. Globally, only half of MDR-TB patients were successfully treated in 2014. An estimated 9.7% of people across 105 countries have a form of TB that is resistant to at least four core anti-TB drugs. Even these disturbingly high rates of resistance understate the risk that AMR poses to the health of humans. Modern medicine and surgery are seriously weakened without antibiotics. Complex medical interventions, such as organ transplants, joint replacements, cancer care and care of premature babies are just a few of the procedures endangered by increasing spread of resistant organisms. The modern health care that people in high-income countries take for granted and that those in lower-income countries aspire to, is at stake.

Executive summary

Antimicrobial resistance (AMR) is a major threat to global health and the world economy, and poses a unique challenge to humanity. Millions of people in G20 countries are infected each year by microbes susceptible to the development of resistance. Resistant microbes double the probability of developing a complication and triple the risk of death compared to non-resistant forms. The development of resistance by microbes causing, among others, tuberculosis, HIV and hospital infections imposes the main brunt of this problem on low- and middle-income countries. But all countries, regardless of their economic situation, the strength of their health systems or the level of antibiotic consumption, will face disastrous consequences if the spread of AMR is not contained. The modern health care that people in high-income countries take for granted and that those in lowerincome countries aspire to, is at stake as medicine and surgery (e.g. organ transplants, cancer care and care of premature babies) are not possible without effective antimicrobial medicines. Existing international commitments need to be implemented promptly and forcefully. The development of national action plans is an essential first step for countries in an effective response to combat AMR. Plans should be developed as part of cross-sectoral efforts under the ‘One Health’ framework, acknowledging that the health of humans, animals and ecosystems are interconnected. In addition, countries should invest in robust national surveillance systems in the human, animal, plant and environmental sectors, perform integrated analysis of data generated from different sectors to inform national policy for containment of AMR using a ‘One Health’ approach, and feed the resulting data into the Global Antimicrobial Surveillance System (GLASS) and the OIE database on antimicrobial use in animals. Global solutions are needed, to promote prudent use of antimicrobials, and to foster effective infection prevention and control. Finally, inadequate access to any newly developed antimicrobial promotes AMR and represents a threat to global health. Although resistance develops naturally over time, it is accelerated by misuse and overuse of antimicrobial medicines. Many people around the world have little or no access to these medicines. Therefore, equitable and affordable access to medicines that work must also be ensured. Stronger actions and economic incentives to support the development of new antimicrobials, vaccines and diagnostics are also urgently needed. The research and development (R&D) pipeline for new antimicrobial therapies has been drying up due to scientific challenges, high uncertainty and low revenues, making such products less attractive as investments for industry. A number of initiatives and additional economic incentives have been put in place in the last few years which had some effects on the R&D landscape. Many of these incentives target the initial phases of R&D using push mechanisms, and some such as GARDP cover the whole development phase. While there have been various calls for pull mechanisms to correct market failures in the market for antimicrobials few have been implemented so far. Only a very small proportion of the available funding is aimed at R&D on diagnostics and vaccines. G20 could put in place a three-pronged approach to reactivate the R&D pipeline. First, it could commit to increasing funding of basic science driven by academic institutions and small- and medium-sized enterprises. Results of these projects should feed a G20 global collaboration platform that could become a knowledge hub for R&D to ensure coordination, and could promote best practices in conservation and access to antimicrobials. WHO, FAO, OIE and OECD could support this initiative by providing evidence and technical advice to inform debate. Second, the G20 could commit to support scientifically promising antimicrobials in the clinical development phase that target priority pathogens. Third, G20 could explore the effectiveness of other mechanisms, including pull mechanisms which would compensate for new antimicrobials while delinking R&D investments from sales revenues. Such schemes would help correct the market failure by giving industry the incentive to invest in new antimicrobials and will ensure that the antimicrobial is supplied to markets (especially in LMICs) at an affordable price and would help implement effective stewardship programmes and promote access to quality antimicrobials in countries at different levels of income. The three-pronged approach could be complemented by the creation of Target Product Profiles to align R&D efforts with government priorities and better collaboration and coordination of existing initiatives."