抗生素英文课件精品Innovation Dilemma the case of antimicrobials .pptVIP

Innovation Dilemma- the case of antimicrobials - John Turnidge The trouble with antibiotics They are designed to be harmless to the host easy to prescribe “just in case” They select for resistance which is: only an uncommon problem for the host a major problem for the community doubly contagious (bugs and genes) We made them widely available to all prescribers right at the beginning (the 1940s) harder to take away a “right to prescribe” than grant it The trouble with antibiotics We have set the standard as “cheap” expectation that they stay that way We have introduced some high hurdles cost-effectiveness for the PBS when the international standard for comparative trials is non-inferiority prediction of resistance selection potential what models are available for estimating this? Resistance Issues NOW! Methicillin-resistant Staphylococcus aureus Vancomycin-intermediate Staphylococcus aureus Vancomycin-resistant Enterococcus faecium Drug-resistant Streptococcus pneumoniae Extended-spectrum β-lactamase producing and quinolone resistant E. coli and Klebsiella spp. Carbapenemase-producing Gram-negative bacteria Multi-resistant Pseudomonas aeruginosa Carbapenem-resistant Acinetobacter baumannii Four-letter words! MRSA VISA VREF DRSP ESBL CRAB MBla We are starting to lose our last-line antibiotics From a flood to a trickle And worse to come? Why are we losing antibiotics? The bugs are becoming resistant faster than we can make new ones Resistant bacteria Peak Antibiotics? In the last decade in Australia... New antibacterials that have come and stayed Moxifloxacin Tigecycline Daptomycin Doripenem Quinupristin-dalfopristin Ertapenem New antibacterials that have come and gone Gatifloxacin In the last decade in Australia... Old antibacterials that have gone Piperacillin (alone) Cefotetan Cefpodoxime-axetil Cefpirome Netilmicin Enoxacin Nalidixic acid Ofloxacin oral Spectinomycin In the last decade in Australia... New antifungals that have come and stayed Voriconazole Posacona