Solution Code: 1EIGJ
Question: Health Infection Prevention
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- “The end of the antibiotic era” is being widely predicted.
- What do you understand by this term?
- What factors have led to a situation in which such an era might be seriously predicted and what would be the consequences if the prediction were to come true?
- What measures are being or might be applied at international, national, community and hospital levels to delay or prevent such an outcome?
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In the 1940s the antibiotic era had begun with the use of an antibiotic. The first used antibiotic was penicillin. Subsequent development, discovery, and the clinical usage of other antibiotics ensured the effective interventions against the pathogens specifically bacteria. The pathogens consist of bacteria, viruses, fungi, protozoa, etc. Particularly, the bacteria are the single-celled organism, omnipresent, found outside and inside our bodies. The bacteria reside inside the human guts are not harmful to the individual called as inhabitant flora. Any misbalance occur in the number of the bacteria inside the body can make the only ill. However, the bacteria outside the body are also pathogens and responsible for the various disease. Antibiotics are the group of drugs also called antimicrobial drugs. The medicines which fight against the bacterial infection in both animals and human beings. The disease-causing bacteria now becoming the threat to the individual as this organism are no more killed by the antibiotics and threatens to remove antibiotics as effectual drugs for therapeutic use (Hryniewicz, 2011). “The end of the antibiotic era” is related to the antibiotic resistance develop against the antibiotic in the pathogen. This essay will evaluate the action of antibiotic against the bacteria. This would be followed by the undertaking discussion on the causes of antibiotic resistance develop by bacteria. This would be followed by the detailed discussion on the methods to avoid the development of resistance.
The “antibiotic” term refers to the natural material or chemicals that act on bacteria and kill them. These chemicals are secreted by the individual against the invading pathogens. Nowadays, the term “antibiotics” consist of both man-made and natural chemicals. The mechanism of the infection control includes killing the bacteria or make the condition hostile for the bacteria to resides inside the body. Antibiotics are specific to the bacteria and not effective against other pathogens. The common targets for antimicrobial medicines actions consist of inhibition of synthesis of a cell wall, protein synthesis, synthesis of nucleic acid, interfere with the metabolic steps inside the bacteria and the effects the sterols component of the cell wall. The group of drugs which kills the bacteria is called as Bactericidal. On the other hand, the drugs which inhibit the growth of the bacteria are categorized under Bacteriostatic. The bacteriostatic group consists of Tetracyclines, Macrolides, Chloramphenicol, Trimethoprim, etc. Penicillins, Cephalosporins, Fluoroquinolones, Carbapenems comes under the bacteriocidal group (Walsh C, 2003).
Recent research concluded that the usage of the antibiotics with in the community is relatively high. In 1993, 26 million of the prescriptions were written that reduce to 24 million in 1998. Before 1994, the antibiotics use in Australia was very high than the developed countries. The challenges are the attitude of the community towards the usage of the antibiotics (Donovan, 2001). Turnidge et al., in 2016 conducted a study on the usage of the antimicrobial in Australian hospitals. They presented the data from the National Antimicrobial Utilisation Surveillance Program 2014, and National Antimicrobial Prescribing Survey reports 2013 and 2014. They opined that the Australia had the high number of prescription of antibiotics. In 2014, 936 patients out of 1000 were under the antimicrobial drugs interventions. In 2014 only, approximately 72% were the prescribing rate. The antimicrobial prophylaxis after surgical procedure was 36%. The authors concluded that there is scope for the improvement in a prescription of antibiotics in Australian healthcare sectors(Turnidge et al., 2016; Van Boeckel, 2014). In Australia, mostly prescribed antibiotic are cefalexin, amoxicillin, and amoxicillin- clavulanate. (Australian Commission on Safety and Quality in Health Care. AURA 2016, 2017).
Antimicrobial resistance (AMR) is one of the global problems which has significant consequences for the public health. The ability of the pathogens to survive at the specific concentration of the antimicrobial agent, normally at that concentration the population of the pathogens would die. The stated situation came under the Antibiotic resistance I and called as “Epidemiological breakpoint.” The Antimicrobial resistance II or the clinical breakpoint is defined as the microbial ability to survive treatment with the antibiotic agent at clinical concentration. AMR occurs when some changes are occupied by bacteria in such a way that decreases the effect of a drug on them. The antibiotics are used for the killing of the targeted bacteria, but the pathogens survive and develop the resistance to the specific antibiotic and able to reproduce. These bacteria can pass the genetic trends to the new generation and carry on the trait to next generation. This whole process leads to the infectious disease untreatable. The resistance can be developed due to some point mutation occur at the genetic level of the bacteria. Some bacteria acquired the mutation by which it can neutralize the effect of antibiotic by make it harmless by changing the configuration of the drug. Others had learned the way to pump out the antimicrobial agent outside the bacterial cell before any harm. Some of the bacteria change their configuration concerning the cell wall so that the antibiotic can not attach to the cell wall and digest the bacteria. It is documented that one of the bacteria just survive and multiply and replace the bacteria having that resist character.
It is documented that the misuse and overuse of the antibiotics can increase the risk of the development of AMR. Every time the individual take antibiotic, the sensitive one will kill, and the rest resistant one will grow and multiply and pass on the trade to the new generation. As it is clear that the antibiotic is not effective against the viral infection, but still the practitioners prescribe the medicine in associated viral infection too. The corrupt practice can also increase the misuse and overuse of the antimicrobial drugs. Sometimes the patients are the dose and continue the medication as per not the instruction is given by the doctor. Some individual take the antibiotic on there own when they get sick. At the personal level, when the person is taking antibiotics can affect the healthy flora of the body. For example, if the person is taking antibiotic against the urinary tract infection, these antibiotic can have the impact on the healthy flora of gut, eyes, nose, etc. Most of the time the affected normal flora are the true defender of the body. This can make the individual more susceptible for resistance associated with the antibiotic spread by another infected person. In the same way, the person got the nosocomial infection in the healthcare sector (Smart, 2010).
After the one antibiotic course can increase the risk of resistance by approximately 50%. The government of the UK opined that there were 10 million death per year were recorded if the person was left untreated and coasting around $1.3 trillion. There are severe associated economic implications with the antibiotic-resistant pathogens. The US healthcare sector estimated approximately $34 billion expenditure associated with the infection due to antibiotic resistance. The pathogen that contaminates the food item can turn resistant due to antibiotic use in food animal and the people. The linkage is present between the antibiotic use in livestock associated with food production and antibiotic-resistant infections in people. As the overdose antibiotics are given to the dairy animal for the infection treatment can cause the AMR in person using that product.
The increased resistance rate had been observed to most frequently antibiotic usage. Pencillins is the most prescribed antibiotic group in Australia. In 2014, 44% of the penicillins was prescribed on the daily basis as compared to 46% during 1994. Recent data suggest that the efficacy against the bacteria is at risk. The Escherichia coli are resisted for amoxicillin-clavulanate in 20% of the cases and 50% for amoxicillin or ampicillin. In 2014, 13% of the cases showed multidrug resistance. Escherichia coli are associated with the Biliary tract infection, urinary tract infection, septicemia and abdominal infection. Neisseria gonorrhoeae is resisted to ciprofloxacin and benzylpenicillin in 30% of the cases. 2% to 5% cases are resistant to azithromycin (Royal Australian College of General Practitioners, 2016). Neisseria gonorrhoeae causes sexually transmitted infection, i.e., Gonorrhoea. In 83 to 88% cases the Staphylococcus aureus is resistance to benzylpenicillin in hospitals and community. This microbe is associated with wound and skin infections. Staphylococcus aureus (methicillin-resistant) strain is responsible for the disease in the hospital as well as in the community and related to soft tissue infection, joint infection, endocarditis, and bone infection. Approximately 16 to 18% cases are isolated as methicillin resistant. Streptococcus pneumonia is resistance to benzylpenicillin around 2% and 21 to 26 % resistance to macrolides and doxycycline. Streptococcus pneumonia is associated with the community and causes infection of ear, sinusitis, meningitis, and septicemia. According to recent news, the significant resistance is seen of N. gonorrhoeae strains of azithromycin in January and march in 2016. All the stains are ceftriaxone susceptible, and it is the responsibility of the physician to look for the cause of failure of the treatment and always collect the specimen for the sensitivity test. In U.S, 2 million individual develop AMR per year. Approximately 99,000 death occur due to antibacterial resistant microbes. In 2006, the American faced the resistance against pneumonia and sepsis that accounts for the 50,000 death and cost approximately $ 8 billon (Ventola, 2015).
It is suggested by the evidence that the unnecessary and inappropriate prescription of the antibiotic. According to data given by Australian government, the number of antibiotic prescribed is decreasing rapidly from 32% to 28% from 2011 to 2014 in treating urinary tract infection. The practical steps could be taken at the level of society to decrease the cases of AMR. The individual can use only prescribed antibiotic and follow the prescribed dose efficiently so that the risk of developing AMR would decrease. The person should never ask for the antibiotic if the physician advice not to take an antibiotic. Never use the leftover antibiotics. Prevent the infection by following the hygiene procedure by regular hand wash prior eating (Australian Government productivity commission, 2017).
The practical measures can be followed by the healthcare workers. The physician should avoid to write unnecessary antibiotic and only prescribed the needed medicine. The duration of antibiotic course should be appropriate and low. The dose should be specified according to the extent of the infection, site of the disease, age, weight and sex of the patient. It is mandatory to report the AMR cases to surveillance team. The physician should talk to the patient about how and when to take the antibiotic. The healthcare worker should prescribe the antibiotic according to the guidelines. Discussion with the patient about the infection prevention, safe sex, hand hygiene and overall hygiene method would help in the prevention of the infection (Therapeutic Guidelines, 2017).
The Australian government had released first strategies (2015-2019) on Antimicrobial Resistance. The government had issued these procedures in 2015. The goal is to decrease the spread and development of the AMR. Moreover, ensure the availability of the effectively acting antibiotic (Centers for disease control and prevention, 2017). There are seven objectives of the strategies includes increasing the understanding and awareness about AMR. The second action is to promote the proper usage of the prescribed antibiotic by following the stewardship practices. The next step is to monitor the use of prescribed antibiotic and AMR rate through Health surveillance program. Improve the control and prevention measures to decrease the AMR infection. Imply the national research and development plan to detect and prevent AMR. The sixth objective is to strengthen international partnerships to enhancing the response of entire world towards AMR. The last aim is to build the governance arrangements for the actions against AMR (Australian Goverment, 2017).
Rapidly emerging bacterial resistance threatens the health benefits which can be achieved by the use of antibiotic. This crisis is at the worldwide level and reflecting overuse and unnecessary use of the medicines. There is a great demand for the development of the new antibiotic by the pharmaceutical firms to handle the challenge. Antibiotic-resistant placed an economic as well as substantial health burden over the Australian government, healthcare service system and the population. The combined efforts to renew research, implement the policies, and pursues the guidelines to manage this global crisis.
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