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under supervision ofProfessor Dr. Heba Abdel-Aaty
Head of parasitology department MUST College of Medicine
Presented by:Hatem Refaat El-Sheemy
Undergraduate MBBSMUST College of Medicine
Resistance.. What is the solution?
2nd Medical Integrated Students, Research (MISR) Conference
2nd Medical Integrated Students, Research (MISR) Conference
Aim of the Work
• Review of Current state of AMR (Anti-microbial resistance) in Egypt
• Review of Triclabendazole resistance as an example of resistance against anti-parasitic drugs.
• Review of current approaches for control of AMR and APR.
WHO Definition
It’s when microorganisms
change when exposed to
antimicrobial drugs
2nd Medical Integrated Students, Research (MISR) Conference
2nd Medical Integrated Students, Research (MISR) Conference
Started From Here
Then…
2nd Medical Integrated Students, Research (MISR) Conference
2nd Medical Integrated Students, Research (MISR) Conference
And another causes are..
Give me some antibiotics
The earlier, the better
2nd Medical Integrated Students, Research (MISR) Conference
Antimicrobials Abuse Life cycle
Ahram Canadian Univ. Campaign
2nd Medical Integrated Students, Research (MISR) Conference
Time for some WHO numbers• Up to half of antibiotics used in humans are unnecessary and inappropriate.
• the common cold is the most common reason antibiotics are prescribed.
• For example, a third of people believe that antibiotics are effective for common cold
• 60% of people understand effect of AMR on them and their families but don’t understand why it occurs
• Antiseptics are still under investigation either effective or not in reducing infection rate and causing AMR.
WHO 2015 Report
2nd Medical Integrated Students, Research (MISR) Conference
Prevalence of Carbapenem -R
Laxminaryan R. et al 2014
2nd Medical Integrated Students, Research (MISR) Conference
With the same rhythm.. This will be 2050
Epidemiology: Future,,,
2nd Medical Integrated Students, Research (MISR) Conference
Egyptians and AMR
64% (231) Used antibiotics last 12m without prescription
47% (109) Main reason was to save time and effort
60% (212)Most Used antibiotic: Amoxicillin – clavulanic
acid21% (18) Reported
administrating antibiotics to their
children
SelfMedication
MR. El Hawty et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Most common indication
M. Talaat et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Most common indication
Human Case50% Believed that common diseases don’t worth
consulting
Where,
M. Talaat et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Epidemiology in Egypt
MO Ibrahim et al 2012
2nd Medical Integrated Students, Research (MISR) Conference
Epidemiology in Egypt
MO Ibrahim et al 2012
2nd Medical Integrated Students, Research (MISR) Conference
Antibiotic Misuse rate
MO Ibrahim et al 2012
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA st rains
Hospital Acquired Infection
Community Acquired Infection
183448
MRSA?MRSA? 34321
Out of 631 Staph. Aureus sample isolated during study period (2005 -2013)
Abdel Maksoud M. et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA st rains
Hospital Acquired Infection
Community Acquired Infection
183448
MRSA?MRSA? 34321
Out of 631 Staph. Aureus sample isolated during study period (2005 -2013)
2005: 48.6%2013: 86.6%
Moreover,
Abdel Maksoud M. et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA st rains
Hospital Acquired Infection
Community Acquired Infection
183448
MRSA?MRSA? 34321
Out of 631 Staph. Aureus sample isolated during study period (2005 -2013)
2005: 48.6%2013: 86.6%
Moreover,
Occurrence of Multi-Drug resistance
48.6% 85.8% Abdel Maksoud M. et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA st rains
Hospital Acquired Infection
Community Acquired Infection
183448
MRSA?MRSA? 34321
Out of 631 Staph. Aureus sample isolated during study period (2005 -2013)
2005: 48.6%2013: 86.6%
Moreover,
Occurrence of Multi-Drug resistance
48.6% 85.8% Abdel Maksoud M. et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA st rains
Hospital Acquired Infection
Community Acquired Infection
183448
MRSA?MRSA? 34321
Out of 631 Staph. Aureus sample isolated during study period (2005 -2013)
2005: 48.6%2013: 86.6%
Moreover,
Occurrence of Multi-Drug resistance
48.6% 85.8% Abdel Maksoud M. et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA st rains
Hospital Acquired Infection
Community Acquired Infection
183448
MRSA?MRSA? 34321
Out of 631 Staph. Aureus sample isolated during study period (2005 -2013)
2005: 48.6%2013: 86.6%
Moreover,
Occurrence of Multi-Drug resistance
48.6% 85.8% Abdel Maksoud M. et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Resistance is now reported for
PraziquantelMetronidzole
Triclabendazole
AlbendazoleAnti-Malarial
Drugs
2nd Medical Integrated Students, Research (MISR) Conference
Triclabendazole for fascioliasis• Benzimidazole derivative• First introduced in 1980
• Drug of choice for both: 1- Animal and Human fascioliasis 2- Acute and Chronic infection. 3- Adult and immature stage of parasite.
All these factors contributed in Over-Reliance on TCBZAnd Thus, development of Triclabendazole
resistance
2nd Medical Integrated Students, Research (MISR) Conference
Human Resistant cases reported
Gil, L.C. et al. (2014)
. Winkelhagen, A.J.S. et al. (2012)
71y Livestock FarmerMultiple TCBZ dose failure (2007-2010)The patient remains asymptomatic but infected.
4 Cases Between 2011-2013 with follow-upMultiple TCBZ dose failure
NL
ChileGil, L.C. et al. (2014)
1st
2nd Medical Integrated Students, Research (MISR) Conference
Human Resistant cases reported
Cabada et al. (2016)
Peru7 of 19 F.hepatica Cases Between January 2014 and April 2015Multiple TCBZ dose failure
Gülhan, B. et al. (2015)
9-year-old girl Multiple TCBZ dose failure + othersunderwent right hepatectomy.
Turkey
2nd Medical Integrated Students, Research (MISR) Conference
Current research efforts
TCBZ double
dose
AntihelminthicVaccine
New
TCBZ single dose Resistance
2nd Medical Integrated Students, Research (MISR) Conference
Other route.. New agents?
FlukicideRoute of
administration
Age of Fasciola hepatica
stage
Reports of resistance on farm
Albendazole Oral Adult 3 Cases
ClorsulonInjectable, Oral Adult, late
immature respectively
3 cases
Closantel Pour-on, injectable, oral
late immature 1 case
Nitroxynil Injectable Adult 1 case
Nitroxynil + clorsulon
Injectable early immature No reports to date
Oxyclozanide Oral Adult No reports to date
2nd Medical Integrated Students, Research (MISR) Conference
Other route.. Vaccine?
Leuicine Amino-peptidase
(89% in sheep)
Total Cathepsin L(69% in Cattle)
Fatty acid binding protein(55% in Cattle)
No commercial vaccine
2nd Medical Integrated Students, Research (MISR) Conference
General Approaches for AMR Control
• Common Cold DOESNOT NEED Antibiotics.
• Work on community understanding that antibiotics over-use has its side effect.
• Health care providers awareness of AMR• OCT Antibiotics prescription reduction.
2nd Medical Integrated Students, Research (MISR) Conference
General Approaches for AMR Control
• Common Cold DOESNOT NEED Antibiotics.
• Work on community understanding that antibiotics over-use has its side effect.
• Health care providers awareness of AMR• OCT Antibiotics prescription reduction.
2nd Medical Integrated Students, Research (MISR) Conference
General Approaches for AMR Control
• Common Cold DOESNOT NEED Antibiotics.
• Work on community understanding that antibiotics over-use has its side effect.
• Health care providers awareness of AMR• OCT Antibiotics prescription reduction.
Some recent Approaches Used• Poster and media approach• Performance- reward approach• Antibiotic justification approach
2nd Medical Integrated Students, Research (MISR) Conference
Limitations for project
• Need for more national wide studies about AMR and parasitic diseases in Egypt.
• Many Thesis related to the topic were found with high sample size but aren’t yet published.
• No specific guidelines are available for antihelminthic drugs administration.