抗生素的过去、现在与将来(英文PPT)Antibiotics Past, Present and Future
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抗生素的将来？(英文PPT)What future for antibiotics？
Mechanism of resistance
b-lactams Glycopeptides Aminoglycosides Tetracyclines Chloramphenicol Macrolides Fusidic acid Oxazolidinones Quinolones Rifampicin
b-Lactams - mode of action
OH
RN H
O
D-Ala-D-Ala
O
R
HN H
NH O
COOH
HO
Amoxicillin
O H N
NH2 O
S CH3
N
CH3
COOH
•
Is the emergence of antibiotic resistance inevitable?
1950
1960
MRSA
methicillin resistance
1970
Epidemic 1980 strains 1990 1996 2000 2002
gentamicinresistant MRSA
GISA VRSA
MRSA in Europe (2002 data)
• Greece • UK • Germany
inhibit peptidoglycan synthesis
NAG
NAM
Glycopeptides
Bind terminal D-Ala-D-Ala Prevent subunit incorporation
NAG
NAM
NAG
NAM
NAG
NAM
Beta-Lactams
Bind ‘PBPs’ Prevent trans and carboxypeptidation
抗生素英文课件精品ANTIBIOTICS(33p)
killed the bacteria that causes syphilis • Compound was called salvarsan but was
quite toxic to the host
Antibiotics
• Natural compounds produced by microorganisms that inhibit the growth of other microbes
class of antibiotics
Penicillin
• Wonder drug
• Killed bacteria with few side effects on the patient
• SELECTIVE TOXICITY
• Penicillin was NOT the first anti-bacterial compound
• Chloramphenicol, erythromycin (G+), streptomycin, tetracyclines
Injury to plasma membrane
• Changes to permeability of membrane causes loss of metabolites
ANTIBIOTICS
From the Greek: anti - against bios - life
Chemotherapy
• Paul Ehrlich • Use of chemical agent to kill bacteria and
not harm the host • Search for the “Magic bullet” • Developed an arsenic compound that
quite toxic to the host
Antibiotics
• Natural compounds produced by microorganisms that inhibit the growth of other microbes
class of antibiotics
Penicillin
• Wonder drug
• Killed bacteria with few side effects on the patient
• SELECTIVE TOXICITY
• Penicillin was NOT the first anti-bacterial compound
• Chloramphenicol, erythromycin (G+), streptomycin, tetracyclines
Injury to plasma membrane
• Changes to permeability of membrane causes loss of metabolites
ANTIBIOTICS
From the Greek: anti - against bios - life
Chemotherapy
• Paul Ehrlich • Use of chemical agent to kill bacteria and
not harm the host • Search for the “Magic bullet” • Developed an arsenic compound that
抗生素的历史沿革及演变(英文PPT)UHCW NHS Trust Clostridium difficile rates 2002 - 2005
Antimicrobial resistance
• Multiple resistance genes
• Plasmids • Spread
• Factors leading to resistance:
– Inappropriate clinical use of ABx – Poor infection control – Excessive ABx use in non clinical settings:
A bit of background A potted history of Antibiotics
• The use of antimicrobials in the treatment of infection is one of the triumphs of modern medicine.
Coventry and Warwickshire Pathology
History of Antibiotics
Decade 1940s & 1950s
1960s 2000s
Antibiotics Streptomycin Synthetic penicillins Cephalosporins Chloramphenicol
Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11
£3,000 £2,500 £2,000 £1,500 £1,000
£500 £0
Expenditure
Diagnostics and Service Division Medicine and Emergency Division Rugby St Cross Specialised Networks Division Surgery Division Women and Childrens TRUST TOTAL
抗生素 (英文PPT)ANTIBIOTICS
*Treatment of chronic adult periodontitis almost totally amenable to mechanical therapy.
*Administration instead of mechanical therapy for periodontitis.
✓ Unwanted effects ✓ Precautions ✓ Contraindications ✓ Patient’s point if view ✓ Patient
PATTERNS OF MISUSE
➢ They are used as “drugs of fear” to cover for potential errors of omission or commission & thereby prevent a claim of negligence.
PERIOD OF EMPIRICAL USE • Use of mouldy curd by chinese on boils •Chaulmoogra oil by hindus in leprosy •Chenopodium by aztecs for intestinal worms •Mercury by paracelsus for syphilis •Cinchona bark for fevers
•NON-EFFECTIVE CONDITIONS IN DENTISTRY
•NEWER ANTI-MICROBIAL APPROACHES
•MACROLIDES
•ANTIBIOMA
•MISCELLANEOUS ANTIBIOTICS
•ANTI FUNGALS &ANTI VIRAL DRUGS
*Administration instead of mechanical therapy for periodontitis.
✓ Unwanted effects ✓ Precautions ✓ Contraindications ✓ Patient’s point if view ✓ Patient
PATTERNS OF MISUSE
➢ They are used as “drugs of fear” to cover for potential errors of omission or commission & thereby prevent a claim of negligence.
PERIOD OF EMPIRICAL USE • Use of mouldy curd by chinese on boils •Chaulmoogra oil by hindus in leprosy •Chenopodium by aztecs for intestinal worms •Mercury by paracelsus for syphilis •Cinchona bark for fevers
•NON-EFFECTIVE CONDITIONS IN DENTISTRY
•NEWER ANTI-MICROBIAL APPROACHES
•MACROLIDES
•ANTIBIOMA
•MISCELLANEOUS ANTIBIOTICS
•ANTI FUNGALS &ANTI VIRAL DRUGS
抗生素PPT课件(英文精品) Proper Use of Antibiotics
Points to note when taking antibiotics (1)
➢ Follow your doctor’s instruction.
➢ Take the drugs on the right time at the right dose.
➢ If you miss one dose, take it as soon as you remember but never take a double dose.
Always consult your doctor for the use of antibiotics.
FAQ If I have fever, do I always need an antibiotic?
Fever is a common symptom for infections and not necessarily caused by bacterial infection.
抗生素PPT课件（英文精品） Proper Use of Antibiotics
Antibiotics
Antibiotics ≠ Anti-inflammatory drugs
Antibiotics ≠Panacea
Are there any risks for the use of antibiotics?
diarrhoea
Side effects of Antibiotics (2)
Allergic reaction - rash - itchiness - breathlessness
Antibiotic resistant bacteria
Predispose to the emergences of antibiotics resistant bacteria.
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Landmarks continued…..
• 1940: Oxford University pathologist Howard Florey isolates pure penicillin and demonstrates how it can cure a wide range of pathogens, including strep infections, gonorrhea and syphilis.
Source: CQ Researcher online: compiled by Denver Post Librarian Barry Osborne
Landmarks continued
• 1976: Several weeks after attending an American Legion convention in Philadelphia, 34 people die from a mysterious form of pneumonia that thwarts available treatments and comes to be known as Legionnaires’ disease.
Source: CQ Researcher online: compiled by Denver Post Librarian Barry Osborne
Landmarks continued
• 1988-95: Studies in Finland, the Netherlands and other European Countries find increasing drug resistance in farm animals. Many of the livestock are fed antibiotics as growthpromoters.
Landmarks continued
• 1995: A form of staph infection that is resistant to methicillin results in almost a halfbillion dollars in direct medical costs and claims 1,409 lives in New York City Hospitals.
• 1943: Penicillin becomes the first antibiotic to be put in widespread use.
Source: CQ Researcher online: compiled by Denver Post Librarian Barry Osborne
Source: Senate Hatch Provision Speech, May 7th, 2007
Objectives
• Review the History & Milestones of Antibiotics
• Show Resistance Trends and Impact • Share the Challenges at Hand • Antibiotic Stewardship Programs • IDSA Wish-list • What’s Coming?????
• 1967: The first penicillin-resistant pneumonococcal bacteria are reported in New Guinea.
Source: CQ Researcher online: compiled by Denver Post Librarian Barry Osborne
• 1992: The federal government is spending just $55,000 a year monitoring drug resistance.
Source: CQ Researcher online: compiled by Denver Post Librarian Barry Osborne
Landmarks continued
• 1968: Drug-resistant Shigella diarrhea kills 12,500 people in Guatemala.
• 1970-72: Penicillin-resistant gonorrhea spreads around the world, transmitted in part by U.S. servicemen, who contract the disease from prostitutes in Southeast Asia.
Antibiotics Past, Present and Future
Jay King Ortho-McNeil A Division of Johnson & Johnson
DISCLAIMER
Things aren’t so bad?
Or Are They?
“Past, Present and Future”…. Or a more appropriate title…..
Landmarks continued
• 1997: Health officials report the percentage of antibiotic-resistant cases has surged from 2% in 1991 to 43% in 1997.
• 1998: The Institute of Medicine contends that overuse of antibiotics has brought about widespread drug resistance, estimating that as many as half of the prescriptions for the drugs given each year are unnecessary. The U.S. Centers for Disease and Prevention spends more than $11 million a year monitoring drug resistance.
Source: CQ Researcher online: compiled by Denver Post Librarian Barry Osborne
Landmarks continued
• 1980s-90s: The public-health effects of drugresistant bacteria become clear, prompting new concerns about infectious disease.
“The Good, Bad and the Ugly”
Antibiotic Quotes
• In 1969 the U.S. Surgeon General, William H. Stewart declared “It’s time to close the book on infectious disease and declare the war against pestilence won.”[1]
• 1986: The U.S. Food & Drug Admin., the Center for Disease Control and Prevention, and the Dept. of Agriculture establish a national anti-microbial-resistance monitoring system to track food-borne microbes.
• 1996: Japanese bacterial geneticists detect the world’s first staph infection capable of resisting the powerful antibiotic, vancomycin.
Source: CQ Researcher online: compiled by Denver Post Librarian Barry Osborne
Thedmark Dates
Antibiotic Landmark Dates
• 1920’s-50’s: Scientists harness the power of living organisms to fight bacteria, ushering in the era of antibiotics
Landmarks continued….
• 1944: Russian-born microbiologist Selman Waksman, working in the United States with soil microbiologist Albert Schatz, discovers streptomycin, a powerful antibiotic that proves effective against tuberculosis.
• August 3, 2002, Infectious Disease Specialist Dr. Andrew Simor stated “We’re not at the point where all antibiotics are useless, that’s overstating it…..But there’s no question we have a problem with increasing bacterial resistance to current antibiotics.”[2]
Quote From Nobel Prize Winner Joshua Lederberg