1. Nasratullah Rasa
MD‐MPH
Project Director
Health Partners International of Canada

2. 2000 B.C. – Here, eat this root
1000 A.D. – That root is heathen. Here, say this prayer.
1850 A.D. – That prayer is superstition. Here, drink this potion.
1920 A.D. – That potion is snake oil. Here, swallow this pill.
1945 A.D. – That pill is ineffective. Here, take this penicillin.
1955 A.D. – Oops....bugs mutated. Here, take this tetracycline.
1960‐1999 – 39 more "oops"...Here, take this more powerful antibiotic.
2000 A.D. – The bugs have won! Here, eat this root.
Source: World Health Organization http://www.who.int/infectious‐disease‐report/2000/

5. 
The Correct Drug

Administered by the Best Rout

In the Right Amount

At Optimum Intervals

For the Appropriate Period

After an Accurate Diagnosis
Source: World Health Organization http://www.who.int/infectious‐disease‐report/2000/

6. 
Natural Selection

Poverty and low access to medicine

Misdiagnosis

Counterfeit medicine

Pay‐offs by companies for broad spectrum antibiotics
Source: World Health Organization http://www.who.int/infectious‐disease‐report/2000/

7. 
Patient Pressure resulting from advertisements

Lack of education among health providers and public

Resistance in Hospitals (40 – 91% inappropriate use)

Use of Antibiotics in animals and food production

International travels
Source: World Health Organization http://www.who.int/infectious‐disease‐report/2000/

8. • Increased Morbidity
• Prolonged Illnesses
• Greater Risk of
Complication
• Higher Mortality Rates
• Loss of Productivity
• Time spent by family
• Increased Cost of
diagnosis and
treatment
Health
Economic
• Pain
• Change in Daily
Activities
• Psychosocial Cost
Additional
Human Burden

9. Malaria
• Resistance to various Antimalarial
including Artimisinin Derivatives
• Change of National anti malarial
policy if reach over 10% Failure
Tuberculosis
• 290,000 MDR cases estimated in
2010 (only 18% notified)
• 3.4% of all new cases were MDR
(2010)
• Extensively drug ‐ resistant seen
in 77 countries
HIV
Infection
• Resistance rate in Anti‐HIV
regimens 10‐20% Europe, USA
• Rate of transmission is low in LICs
though
• HIV infection with comorbidity of
AMR bacteria

10. 25,000
Extra
deaths
(Per year)
1.5 billion
Extra cost
(Per year)
Less clear
in
Community
Acquired
Source: WHO, The Evolving Threat of Antimicrobial Resistance

11. Source: WHO, The Evolving Threat of Antimicrobial Resistance

12. Source: WHO, The Evolving Threat of Antimicrobial Resistance

13. Source: WHO, The Evolving Threat of Antimicrobial Resistance

14. Source: WHO, The Evolving Threat of Antimicrobial Resistance

15. Source: WHO, The Evolving Threat of Antimicrobial Resistance

16. Source: WHO, The Evolving Threat of Antimicrobial Resistance

17. Source: WHO, The Evolving Threat of Antimicrobial Resistance

18. Only 5 antibiotics (1.6%) produced by 15 companies producing (93%) between 1980 ‐ 2003
Source: WHO, The Evolving Threat of Antimicrobial Resistance

19. 
Reducing the disease burden and spread of infection

Improving access to appropriate Antimicrobials

Improving the use of Antimicrobials

Strengthening Health Systems and their surveillance
capabilities

Enforcing regulation and legislation

Encouraging the development of appropriate new
drugs and vaccines
Source: WHO, The Evolving Threat of Antimicrobial Resistance

20. Patient and General
Community
• Education
Hospitals
• Management
• Diagnostic Labs
• Interaction with Pharma Companies
Source: WHO, The Evolving Threat of Antimicrobial Resistance
Prescribers and Dispensers
• Education
• Management Guidelines and
Formulary
• Regulation
Health System and
Government
•
•
•
•
•
Advocacy and Intersectoral Action
Regulation
Policy and Guidelines
Education
Surveillance

21. THANKS