ADAMA SCIENCE AND TECHNOLOGY

UNIVERSITY

COLLEGE OF APPLIED NATURAL SCIENCE

DEPARTMENT OF PHARMACY
AHMC HOSPITAL PHARMACY MORNING PRESENTATION
TITLE:ANTIMICROBIAL RESISTANCE(AMR)
Group Members ID NO
1. Kinde Yigezaw UGR/23455/13
2. Koket Solomon UGR/23306/13
3. Mekdes Kokobe UGR/23208/13
4. Mihret Asefa UGR/23223/13
5. Muaz Teha UGR/23987/13
6. Nebiyat Nura UGR/23308/13
7. Rediet Wendowosen UGR/23245/13
8. Tadele Nagesa UGR/23255/13
9. Telila Chala UGR/23037/13
10. Tolesa Dejene UGR/23285/13
11. Tsion Asnake UGR/24020/13
12. Yeamlak Mebea UGR/23217/13
13. Yitagesu Eshetu UGR/23180/13
14. Yoseph Galana UGR/23272/13
Contents
• Objectives
• Introduction.
• Timeline.
• Factors.
• Mechanisms.
• Control strategy.
• Conclusion.
• References
Knowledge Objectives

• Understand the definition, global burden, and local epidemiology of

antimicrobial resistance.
• Explain key mechanisms by which bacteria, viruses, fungi, and
parasites develop resistance to antimicrobial agents.
• Describe the principles of, the “4 Rights” (right drug, dose, route, and
duration).
• Recognize the role of infection prevention and control (IPC) measures
in limiting the spread of resistant organisms.
 INTRODUCTION

•Antimicrobial Resistance (AMR) occurs when

bacteria, viruses, fungi, and parasites change over time
and no longer respond to medicines, making infections
harder to treat and increasing the risk of disease
spread, severe illness, and death.

•As a result of drug resistance, antibiotics and other

antimicrobial medicines become ineffective, and
infections become increasingly difficult or impossible
to treat.
• Impact and Evolution:The discovery of antimicrobial agents ushered in
a revolutionary era in medical science, but microbes quickly developed
mechanisms to counteract these drugs. AMR enables microbes to resist
previously effective medications, contributing to millions of deaths
globally and representing a major public health threat.
• Global Concern:AMR jeopardizes effective prevention and treatment
of infections caused by various microbes and significantly increases
healthcare costs for patients with resistant infections.
Ethiopia’s AMR Burden
• Over 81,000 deaths were associated with AMR in 2021 alone.
• Children under 5 are disproportionately affected, with 35,800 deaths
in this age group.
• Ethiopia ranks 25th globally in age-standardized AMR mortality rate
What is the difference between antibiotic and antimicrobial
resistance?

 Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic

resistance occurs when bacteria change in response to the use of these medicines.
Bacteria, not humans, become antibiotic resistant. These bacteria may then infect
humans and are harder to treat than non-resistant bacteria.

 Antimicrobial resistance is a broader term, encompassing resistance to drugs to

treat infections caused by other microbes as well, such as parasites (e.g. malaria),
viruses (e.g. HIV) and fungi (e.g. Candida).
Why resistance is concern?
• Resistant organisms lead to treatment failure
• Increased mortality
• Resistant bacteria may spread in Community
• Low level resistance can go undetected
• Added burden on healthcare costs
• Threatens to return to pre-antibiotic era
• Selection pressure
Factors
Environmental factors:
e.g : poor sanitation , huge population and overcrowding , Ineffective infection
control program…
Drug related Factors
e.g : OTC drug availability of antimicrobials , counterfit and substandard drug ,
irrational fixed dose combination of antimicrobials…
Patient related factors
e.g: poor adherence of dosage regimen ,self medication , lack of education..
Prescriber related factors
e.g : inappropriate use of antibiotics , overuse of antimicrobials , inadequate dosing ,
prolonged use of antimicrobial…
 TIMLINE
Year Event Description

Paul Ehrlich develops the first synthetic

1907 Salvarsan discovered
antimicrobial to treat syphilis.

Alexander Fleming identifies penicillin from

1928 Penicillin discovered
Penicillium mold.
Resistance in Staphylococcus aureus
1940 Penicillin resistance observed reported shortly after penicillin’s
introduction.
Discovery of major antibiotic classes:
1944–1966 Golden Age of Antibiotics streptomycin, tetracyclines, cephalosporins,
etc.
Methicillin-resistant Staphylococcus aureus
1961 MRSA identified
(MRSA) first reported.

1986 Vancomycin resistance detected Resistance in Enterococcus species emerges.

Last new class of antibiotics (lipopeptides) No major new antibiotic classes discovered
1987
discovered since.
EU bans growth-promoting antibiotics in First major policy move to curb agricultural
1997
livestock antibiotic misuse.
New Zealand bans antibiotics as growth
2002 Strengthens global efforts against AMR.
promoters

2015 WHO declares AMR a global emergency Launch of Global Action Plan on AMR.

Policymakers emphasize stewardship,

2023 Post-antibiotic era concerns intensify hygiene, and vaccination to combat
resistance.
Causes of Antimicrobial Resistance

A. Intrinsic or Natural Resistance

• Some microbes have always been resistant to certain
antimicrobials.
• They lack the metabolic processes or drug target sites affected by
specific agents.
• Typically not a major clinical concern.
Examples:
• Mycobacterium tuberculosis is resistant to tetracycline.
• Aerobic organisms are unaffected by metronidazole.
• Gram-negative bacilli are normally resistant to penicillin G.
B.Acquired Resistance
• Occurs when previously sensitive organisms develop resistance after exposure to antimicrobial
agents over time.
• Can affect any type of microbe and is a major clinical concern.
• Develops via:
• Mutation,Gene transfer,Altered biochemical mechanisms
Examples;
• MRSA (Methicillin-resistant Staphylococcus aureus)
• ESBL-producing E. coli – Resistant to penicillins and cephalosporins due to extended-spectrum
beta-lactamase enzymes.
• MDR-TB (Multidrug-resistant Mycobacterium tuberculosis) – Resistant to rifampin and
isoniazid.
• Vancomycin-resistant Enterococci (VRE)
Mechanism of Resistance to Antimicrobial Agents

1.Decreased antibiotic penetration: Many hydrophilic antibiotics—

such as β-lactams, tetracyclines, and some fluoroquinolones—penetrate
the outer and cytoplasmic membranes of bacteria (particularly Gram-
negative bacteria) through water-filled diffusion channels called porins.
Alterations of porins can reduce antibiotic penetration.
Example:
• Vancomycin, a glycopeptide antibiotic, is not effective against Gram-
negative bacteria due to its inability to pass through porins.
2.Activity of efflux pumps: Efflux pumps are the membrane proteins
(transport) that export antibiotics from the cell and maintain their low
intracellular concentrations. Efflux pumps can be specific to antibiotics.
They extrude the specific antibiotic out of the cell as fast as it enters
the cell.
• Drug resistance to most antimalarial drugs and tetracycline is due to
this mechanism.
3.Antibiotic inactivation by bacterial enzymes: Bacterial enzymes like
β-lactam hydrolyze nearly all β-lactams that have ester and amide bonds,
e.g., penicillins, cephalosporins, monobactams, and carbapenems.
Aminoglycoside modifying enzymes (AMEs) like phosphoryl-
transferases, nucleotide transferases or adenylyl transferases, and
aminoglycoside 3-N-acetyltransferases (AACs) provide extended
spectrum resistance to aminoglycosides and fluoroquinolones.
4.Changes in target sites: Natural variations or an acquired modification
in the target site of an antimicrobial that protects the site from
antimicrobial binding is a common mechanism of resistance.
5.Biofilms:A biofilm can be described as a group of microbial cells
embedded in a thick, slimy barrier of sugars and proteins. The biofilm is
irreversibly associated (not removed by gentle rinsing) with a living or
inert surface. This barrier protects the microorganisms from external
threats.
PREVENTION OF ANTI-MICROBIAL RESISTANCE
1. Rational Use of Antimicrobials
• Avoid prescribing antibiotics for viral infections (e.g., colds, flu).
• Use narrow-spectrum agents when possible.
• Ensure correct dose, duration, and route of administration.
2. Antimicrobial Stewardship Programs (ASPs)
• Monitor and audit antimicrobial use in hospitals and clinics.
• Educate healthcare professionals on resistance trends and prescribing
guidelines.
• Implement decision-support tools for evidence-based prescribing.
3. Infection Prevention and Control (IPC)
• Promote hand hygiene and use of personal protective equipment (PPE).
• Sterilize medical equipment properly.
• Isolate patients with resistant infections when needed.
4. Water, Sanitation, and Hygiene (WASH)
• Ensure access to clean water and sanitation in healthcare and community
settings.
• Encourage regular handwashing to reduce infection transmission
5. Vaccination
• Use vaccines to prevent infections that might otherwise require
antibiotics.
ROLE OF PHARMACIST IN PREVENTION OF AMR

Ensuring Rational Use of Antibiotics

Educating Patients and the Public
Supporting Antimicrobial Stewardship Programs (AMS)
Surveillance and Reporting
Advocacy and Policy Engagement
The “4 Rights” of Antimicrobial
Prescribing
• Right drug: select the narrowest-spectrum agent that effectively targets the
identified or suspected pathogen based on culture results and local
susceptibility data
• Right dose: determine optimal dosing regimens using pharmacokinetic and
pharmacodynamic principles, adjusting for renal/hepatic function, weight, and
drug interactions
• Right route: choose the most appropriate administration route, facilitating early
transition from intravenous to oral therapy when clinically feasible to reduce
risks and resource use
• Right duration: adhere to evidence-based treatment durations, prescribing the
shortest effective course to achieve clinical cure and reduce selective pressure
for resistance
The WHO’s Global Action Plan includes 5 key
objectives:

• Improve awareness and understanding of antimicrobial resistance

through effective communication, education, and training.
• Strengthen the knowledge and evidence base through surveillance and
research.
• Reduce the incidence of infection through effective sanitation, hygiene,
and infection prevention measures.
• Optimize the use of antimicrobial medicines in human and animal health.
• Develop the economic case for sustainable investment that considers the
needs of all countries and increase investment in new medicines,
diagnostics, vaccines, and other interventions.
Summary
AMR is a growing global public health crisis that threatens the effective
the effectiveness of antibiotics, antivirals, and antifungals, making
common infections harder to treat and increasing mortality rates. Hospital
pharmacists play a crucial role in combating AMR through Antimicrobial
Stewardship Programs (ASPs), optimizing antibiotic use, reducing
resistance, and improving patient outcomes.
To mitigate AMR, stronger policies, better education, global collaboration,
and sustained investment in research for new antimicrobials are essential.
Without urgent action, we risk returning to a pre-antibiotic era where
simple infections become deadly. The time to act is now—preserving
antibiotics today ensures they remain effective for future generations
REFERENCES
• https://www.healthdata.org/sites/default/files/2023-09/Ethiopia.pdf
• Velez R, Sloand E. Combating antibiotic resistance, mitigating future
threats and ongoing initiatives. J Clin Nurs 2016 (March).
• Akova M. Epidemiology of antimicrobial resistance in bloodstream
infections. Virulence 2016 (March).
• Mühlen S, Dersch P. Anti-virulence strategies to target bacterial
infections. Curr Top Microbiol Immunol 2016 (March).
• Chellat MF, Raguž L, Riedl R. Targeting antibiotic resistance. Angew
Chem Int Ed Engl 2016 (March).