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Definitions
Antibiotic a substance produced by a living
organism (usually bacteria or fungi) that inhibits
the growth of other microorganisms, typically
bacteria.
Some targets are specifically named, such as
antifungals, antiprotozoals, anticoccidials.
Definitions
Resistance
Clinical resistance the inability of an
antimicrobial to make a difference in the
outcome of disease caused by an infectious
agent.
Defined through breakpoints which characterize the
potential for clinical effect by evaluating the
concentration of the antimicrobial necessary to inhibit
growth of the target organism in the laboratory.
Intrinsic this resistance is due to a characteristic of
the target organism which does not allow activity of
the antimicrobial, such as absence of the binding site.
Acquired the target organism was once susceptible,
and now has either developed (through mutation), or
received from another organism (acquired), a
mechanism to resist the effects of the antimicrobial.
Definitions
Resistance
Epidemiological resistance - a change in
the distribution of a bacterial population
as characterized by the minimal inhibitory
concentrations of multiple isolates.
Definitions
Medically important
In the U.S., the medically important antibiotics are
defined in Appendix A of Guidance for Industry #152.
These are antibiotics defined as being important,
highly important, or critically important to human
health.
Non-medically important
These are antibiotic groups not listed in GFI
An example is the ionophores, which are not used in
human medicine and have no demonstrated or
reasonably hypothesized link to any antibiotic used in
human medicine.
WHO list
The World Health Organization has a
list of medically important
antimicrobials also. They highlight 5
as the most critically important
Cephalosporins
Fluoroquinolones
Macrolides
Glycopeptides
Carbapenems
RESISTANCE
CHALLENGE
S IN HUMAN
MEDICINE
2,049,442
23,488
17,2
20
Fluoroquinolone Facts
Cephalosporin Facts
As of January 1, 2017
Food
Animal
Human
Sales 2011 Sales 2011
Aminoglycosi
des
More Total Use
Lincosamides
by Food
Animals
Macrolides
Tetracyclines
214,895
6,485
190,101
71,455
582,836
164,028
5,652,855
113,832
Animal Agriculture
Evolution
Today it takes less than 5 hogs
Regulation
Consumers
What is Stewardship?
1. Responsibility for appropriate
o:
N op
St
5. Is this
antibiotic
intervention still
necessary?
Yes
En
te
2. Is there a non-antibiotic
alternative which will appropriately
prevent, control, or treat this disease
challenge?
If
not
3. Selection of an antibiotic
While