The solution lies in continuous monitoring, especially on animal and poultry breeding centers, where antibiotics are used without control, resulting in human consumption of meat and poultry products. with Residues of antibiotics

The solution lies in continuous monitoring, especially on animal and poultry breeding centers, where antibiotics are used without control, resulting in human consumption of meat and poultry products. with Residues of antibiotics

In my view, antibiotics may be used only when absolutely necessary. Overuse need to be avoided.

Excellent topic dear Dr. Nihada Ahmetovic, yes, a solution to this problem must be found, we are waiting for the answer from experts having a high experience in this area.

Regards

• In 2016, 490 000 people developed multi-drug resistant TB globally, and drug resistance is starting to complicate the fight against HIV and malaria, as well (WHO, 2018).

Please have a look at following link:

http://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

I totally agree with Respected Prof. Ashok Pundir Sir . Overuse of Antibiotics increasing AMR Problem that can cause serious threats too.

Antimicrobial resistance (EFSA) - in attachment

Yes lam agree with dr.huda and dr.Ashook

Greeting

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These strains of CRE can cause devastating infection with high fatality rates, typically in people who are debilitated, ill, or subjected to invasive medical procedures. These infections result in an estimated 600 deaths per year in the US. While this number is a small fraction of all AMR deaths (the most deaths are due to methicillin-resistant Staphylococcus aureus and drug-resistant pneumococcus), these nearly pan-resistant CRE infections were unheard of just a few years ago and are spreading. Healthy people can spread these bacteria along with their resistance genes, but they are typically unaffected by them; thus, as people travel, the resistance genes have been able to spread around the world. KPC was first discovered in 1996 in North Carolina; it is now found in most states of the US and many other countries from all continents. In 2011, an outbreak of infections with KPC occurred at the National Institutes of Health Clinical Center that involved patients over more than 6 months and resulted in 6 deaths. NDM-1 was first discovered in Sweden in 2008 from a patient previously hospitalized in India and by 2010 was found on every continent

Up on my modest view, we can solvent and avoid this problem of resistance by produce of new generation of antibiotic through mixing or by a combinations of two or three types of antibiotics.

Regards,

Naseer Almukhtar

It is not my specialty but I think strengthening our self defence system is far more better than strengthening antibiotics. Recently I saw a video by an American Biochemist Doctor saying that one tea spoon of sugar may take more than quarter of our self defence for more than 2 hours.

The use of photosensitizers (especially cationic ones) has achieved some success in the last years due to their multi-target process at cellular level unlike to antibiotics that exert their functions according to the key-hole principle.

Have a look on this great publication (Maisch 2015):

Resistance in antimicrobial photodynamic inactivation of bacteria.

DOI: 10.1039/c5pp00037h

With every obstacle the mankind manages to overcome, new challenges are there. "AMR" is going to be one.

Before we can suggest, I guess why AMR like MRSA and Vancomycin & associated drug resistances appear. Simplistic answer remains "short cuts", " influence by pharmaceutical companies" & also being unaware of the depth of this problem

Solutions:

1- Stop injudicious use of antibiotics

2- Evidence based treatment

3- More forums, seminars & discussion to specifically target AMR

Regards

Main problem lies in the transfer of plasmid bound antimicrobial resistance genes to other bacteria, horizontally and vertically. The selection pressure facilitate more spread of such bacteria. The nosocomial infections of multi drug resistant bacteria (may be Super bugs!), are already causing many deaths even in ICU of hospitals.

continuing on with my discuss I need physicians to understand the empiric principles while advising antibiotics.

We forget most normal infections are viral & subsidizing in a normal immune person. Most data on culture & sensitivity support these words of mine.

The golden principles of physician examination, leading to evidence based diagnostic & therapeutic interventions are not applied as per scientific data.

Physicians play safe & do not spend time telling patients that they may not need antibiotics.

Almost a physician - antibiotic - patient vicious cycle only resulting in a massive surge in AMR.

@Nihada has highlighted an important area for improvement.

Regards

Dear Christopher J Graham

Your " The global threat of antibiotic resistance: what can be done? " clearly

"explains the situation and the threat associated with misuse of antibiotics

A very relevant article on the subject.

Thanks a lot on sharing this

Further to this the levels of antibiotic resistance have reached more lethal levels in developing worlds as depicted by some to the examples below:

1-Kaushik M et al. High Prevalence of Antibiotic Resistance and Integrons in Escherichia coli Isolated from Urban River Water, India. Microb Drug Resist. 2018 Oct 16. doi: 10.1089/mdr.2018.0194.

2- Basu S et al. Antibiotic prescribing behavior among physicians: ethical challenges in resource-poor settings. J Med Ethics Hist Med. 2018 May 12;11:5. eCollection 2018.

3- .GebreSilasie YM et al. Resistance pattern and maternal knowledge, attitude and practices of suspected Diarrheagenic Escherichia coli among children under 5 years of age in Addis Ababa, Ethiopia: cross sectional study. Antimicrob Resist Infect Control. 2018 Sep 12;7:110. doi: 10.1186/s13756-018-0402-5. eCollection 2018

So i guess the problem needs to have seriously addressed.It is is no more a problem for one region, its really gone global as shown by Christopher J Graham

Regards

Thank you dear RG colleagues for a wonderful discussion and your contribution

1.It's indeed a concern at global level

2. Public health is not only just related with AMR, but also going to be one of the major issues to be looked into in the perspectives of AMR dynamics.

3. We must address it immediately unitedly and comprehensively at the global level.

Thank you dear RG colleagues for a very interesting discussion, as well as exchange of information and opinions.

Its recommendations include:

• Scientists should step up the development of new antibiotics and vaccines as well as diagnostic tests to identify drug-resistant bacteria.
• Public health officials should monitor antibiotic resistance and track its spread.
• Doctors should help stop unnecessary antibiotic use and develop safer practices in hospitals and clinics.
• Farmers should stop giving animals antibiotics needed to treat diseases in people.
• Ref.
• https://www.webmd.com/cold-and-flu/qa/what-is-the-current-solution-for-antibiotic-resistance

Thank you dr Samy Selim

Antimicrobial resistance (AMR) has emerged as one of the principal public health problems of the 21st century that threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria no longer susceptible to the common medicines used to treat them. World Health Organization has declared antimicrobial resistance as global crisis.

To overcome the problem of antimicrobial resistance, the overall antibiotic use must be reduced. Physicians, pharmacists, and the general public must avoid careless use of these valuable drugs. Antibiotics must be prescribed only for bacterial infections and in the proper dose for the correct amount of time.

Please have a look at these useful links and PDF attachments.

Article Antimicrobial resistance: A public health challenge

Article Antimicrobial resistance: A global multifaceted phenomenon

Article Antimicrobial Resistance: Global Report on Surveillance

Article Antimicrobial resistance in India: A review

Article A One Health approach to antimicrobial resistance surveillan...

Thank you dr Arvind Singh

Number of new antibiotics approved by FDA decreased until 2012. compared ti late 80s. Pharmacy industry focus on vaccination ("MacDonalds of Medical Science!" by @ Sergio Manzetti ). Uncontrolled consummation of antibiotics in food industry and agriculture is serious problem. These are only some causes of AMR in my opinion.

Thank you dr Aleksandar P. Medarevic

Antimicrobial resistance occurs naturally over time, usually through genetic changes. However, the misuse and overuse of antimicrobials is accelerating this process. In many places, antibiotics are overused and misused in people and animals, and often given without professional oversight. Examples of misuse include when they are taken by people with viral infections like colds and flu, and when they are given as growth promoters in animals or used to prevent diseases in healthy animals.

Thank you dr Djaafar Zemali

To preserve the potency of existing antibiotics, overall antibiotic use must be decreased. Physicians, pharmacists, and the general public must avoid careless use of these valuable drugs. Antibiotics must be prescribed only for bacterial infections and in the proper dose for the correct amount of time.

Following

Best regards

It is a big problem that simply occurs during intensive courses or recurrent doses or abuse taking for the same antibiotics over the time, which may finally enhances for a genetic drifts.

Regards,

Naseer Almukhtar

AMR can not be solved completely but it be diminished or minimized.

To minimize antibacterial resistance:

• To give the antibiotic in sufficient dosage

• Give antibiotics only in bacterial infections

• Do not give antibiotics in viral or allergic conditions.

• Avoid exposure of microbes to a reserve drug like rifampicin.

Regards

Thank you for answers - drMuhammad Younas dr M. A. A. Al- Fatlawi dr Naseer Almukhtar dr Alaa Hani Al-Charrakh

Good question and I agree with all answers of all.

Thank you dr Samy Selim

Dear@Nihada

Though not a microbiologist but still i feel the problem of AMR is now out of hands and until and unless community, legislators and other related agencies do not work under the umbrella of experts in the field this problem is here to stay for long and will rather get aggravated by the attention it is getting.

Anyway a dedicated effort to create awareness.

Regards

I agree with you Sikandar Hayat Khan

Thank you dear dr Nirmala, very interesting article.

Yes indeed.

AMR has emerged as one of the principal public health problems of the 21st century. This has resulted in a public health crisis of international concern, which threatens the practice of modern medicine, animal health and food security.

Thank you dr Gulzar Shah dr Djaafar Zemali

Dear Dr. Nihada

In the following link you can find some information

ANTIMICROBIAL RESISTANCE (AMR) - global public health problem?

https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

Thank you dr Samy Selim

True, AMR is a major global problem, misuse of antimicrobials is an important cause

In fact the AMR issue is now globalized as mentioned above. We as medical doctors and to some extent the pharmacists must share some blame.

Organizations primarily originating from microbiology or relevant specialties must develop a task force which should provide a platform for legislation and must be enforced with true dedication

Community awareness programs are also needed

Regards

Thank you dr Sikandar Hayat Khan

Thank you dr Christopher J Graham

Of course , I’m making a presentation about overuse of antibiotics and mention the cause of resistance briefly.

Thank you dr Mohammed Mosleh Shwaish

Following

Of the many clinical and public health challenges created by antimicrobial resistance, among the most serious are multidrug-resistant infections in hospitals and nursing homes. Multidrug-resistant (MDR) healthcare-associated infections (HAI) are no longer exceptional occurrences.

Thank you dr Djaafar Zemali

AMT is a significant public health problem. Practices leading to obsessive overuse of antibiotics may be needed to reversed. Social theory perspectives explaind how:

https://scholar.google.com/scholar?q=addressing+antimicrobial+resistance+through+social+theory&hl=en&as_sdt=0&as_vis=1&oi=scholart

Thank you dr Gulzar Shah

AVOID THE MOLECULES OF SYNTHESIS

Antimicrobial resistance (AMR) is one of the most serious global public health threats in this century. The first World Health Organization (WHO) Global report on surveillance of AMR, published in April 2014, collected for the first time data from national and international surveillance networks, showing the extent of this phenomenon in many parts of the world and also the presence of large gaps in the existing surveillance.

Thank you dr @Salwa Bouabdallah dr Djaafar Zemali

Regarding Antibiotic resistance, the doctors should be more careful in writing the prescription to their patients. These days many of the doctors overprescribed antibiotics frequently leading to many adverse effects. Even self medication is also very common in many parts of the world which is also a very serious issue. The common people also need to follow the advice of the doctors as I have come across many patients who stop taking the antibiotic without completing the course as prescribed which is also one of factor for antibiotic resistance.

Thank you dr Sandhyarani Khomdram

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sensitivity test very important before describing any antibiotic for patients.

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Dear NIHADA Ahmetovic!

Firs of all Im SALUTING you and also other FRIENDS for the new entered 2019!!! Wishing your all the best!

YES, THE ANTIMICROBIAL RESISTENCE IS A VERY SERIOUS GLOBAL HEALTH PROBLEM,ad a REAL MENACE FOR HUMANITY!!!

It was leaked in technical reports and some specialized media on this issue of Antimicrobial Resistance in the US Budget Request. for 2016, by President Obama. In this request, the amount to be reversed is doubled to combat antibiotic-resistant bacteria, which cause 2 million cases of disease and 23,000 deaths per year in that country, dedicating 1.2 trillion USD to that ruble. Resistance to antimicrobials is the property acquired by pathogenic microorganisms through which they cease to be susceptible to the drugs used to eliminate them totally or to control their reproduction and render these medicines useless. The President's budget request is based on how the medical advances achieved by humanity and in particular in the US are seriously threatened, as this phenomenon can prevent or seriously hinder the performance of advanced medical procedures such as successful transplants, major surgeries, and to complicate to an important degree the successful treatment of millions of cases of patients, in addition to the enormous involvement in direct deaths from simple infections with resistant germs. The new funding proposal for 2016 foresees the allocation of USD 650,000 to the NIH for Advanced Biomedical Research and Development in order to accelerate the development of antimicrobial drugs. Another 280,000 USD will be devoted to counteracting the over-prescription of antibiotics by almost half of the population. Another $ 163,000 will go to the Department of Defense and Veterans Affairs to fight infections with resistant germs. This request for the 2016 budget is part of a Five-Year Plan announced since the end of last year to limit the spread and effect of resistant bacteria. Only for comparative purposes this 2.1 billion to fight resistant bacteria, see that the total dedicated to cancer is 4.9 billion. Special mention is given to the fact that the largest consumer of antibiotics in the USA. it is agriculture, up to 80%, that is dedicated to the raising of animals for consumption, so 77% of the requested budget would go to that ruble. USD 47,000 will be devoted directly to the evaluation of recently developed antibiotics, actually candidates, which may or may not be recordable. These figures do not explain the amounts to secret investigations of the army or the budgets of the big companies, it is known that they are even greater than this presidential request. Prof. Dr. V. Gustavo Sierra González

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Thank you dr Gustavo Sierra

It is a very difficult problem, but the rules for pharmaceuticals have been changed so that they can invest in new antibiotics , this helps to have new antibiotics to fight multiresistance cases.

Thank you dr Catia

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Hello Dear Dr NIHADA Ahmetovic

To prevent and control the spread of antibiotic resistance, individuals can:

• Only use antibiotics when prescribed by a certified health professional.
• Never demand antibiotics if your health worker says you don’t need them.
• Always follow your health worker’s advice when using antibiotics.
• Never share or use leftover antibiotics.
• Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safer sex, and keeping vaccinations up to date.
• Prepare food hygienically, following the WHO Five Keys to Safer Food (keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, use safe water and raw materials) and choose foods that have been produced without the use of antibiotics for growth promotion or disease prevention in healthy animals

Thank you dr @Sikandar Khan

You are welcome Dear Dr NIHADA Ahmetovic

you can also observe that AMR is not new and it arises usually after every 4 or 5 decade.The main problems is the use of medicine and its proper disposal.

Thank you dr Nadeem Ahmad Khan

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Thank you dear RG colleagues for an interesting and useful discussion.

The World Health Organization (WHO) is now leading a global effort to address antimicrobial resistance. At the 68th World Health Assembly in May 2015, the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance. It sets out five strategic objectives:

- to improve awareness and understanding of antimicrobial resistance.

- to strengthen knowledge through surveillance and research.

- to reduce the incidence of infection .

- to optimize the use of antimicrobial agents

- to develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

Thank you dr Djaafar Zemali

Antimicrobial resistance is a major problem in developing countries, where the one health is not view.

Thank you dr Cissé Hama

An alarming pattern of resistance involving multi and pandrug-resistant Gram-negative bacteria is currently emerging; multi-resistant Enterobacteriaceae is an increasing major concern worldwide. Comparative antimicrobial resistance data worldwide are difficult to obtain and inevitably suffer from bias. In high income countries, MDRO have historically been confined to the hospital setting. Since the middle of the 2000s, however, MDRO such as the extended-spectrum producing beta-lactamase Enterobacteriaceae (ESBLs) have been widespread in the community setting .

I put few suggestions to reduce microbial resistance

1.reduce the use of antibiotics in each minor infection.

2.use herbal drugs as remedy.

3. Dont use antibiotics at lower doses.

Before thinking solving the problem we need to control the source of problem causing factors. one of the most causing factor is overusing of antibiotics in medicine, the other factor include control the level of heavy metals which also contribute in increasing this problem, so, the problem need strategy not easy to solve in simple methods, also its worldwide problem so it must be a big congress to make agreement about this problem.

this is my opinion.

best regard Dr. Nihada Ahmetovic

Thank you dr Naimat Ullah Khan dr Shadman Sadiq

Good contribution Dr Nihada Ahmetovic

Thank you dr Samy Selim

We need better diagnoses, to allow us to very quickly diagnose a bacterium that is causing a particular disease, then treat it specifically with a narrow spectrum of antibiotics. And finally, there's a whole issue of better public hygiene

https://www.scientificamerican.com/article/how-to-solve-the-problem-of-antibiotic-resistance/

May be you can useful from the following article

https://journalfeed.org/article-a-day/2018/antibiotic-resistance-the-problem-and-solution

https://aac.asm.org/content/58/8/4253

Thank you dr Sikandar Khan

Yes. As multi-drug resistance potential of strain of various bacteria. pathogenic or non-pathogenic. Another the mutation power of bacteria.

Thank you dr Suparna Roy

Thank you dr Bryan Higgins

Nihada Ahmetovic

Dear NA,please,could you make a summary of ideas or recommnedation regarding the answers to your question on antibiotic-resitence!?

Gustavo

It is certain that antibiotic resistance can occur, especially for bacteria, because it possesses the plasmids that carry genotyping antibiotic resistance. This plasmid can be transferred from one bacteria to another via conjogation. For the purpose of this treatment, the chemical structure of these antibiotics is modified.