Exam (elaborations)
AMR POLICIES AND SOLUTIONS QUESTIONS AND ANSWERS
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AMR POLICIES AND SOLUTIONS QUESTIONS AND ANSWERS
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Name: Score:35 Multiple choice questions
Term 1 of 35
What are some potential unintended consequences of increasing the costs of antibiotics to
stimulate new antibiotic production?
Increasing costs will lead to better quality antibiotics available
Increasing costs of antibiotics (i.e. by withdrawing/reducing reimbursement) can leave
some patients unable to pay ==> inequities
Higher prices will ensure that all patients receive antibiotics
Raising prices will eliminate the need for antibiotic production
Term 2 of 35
What are some factors inversely correlated with aggregate antibiotic resistance?
1. Differences in methodology and data collection make it difficult to compare across
regions
2. Need to integrate measurements on the multiple dimensions of the problem
1. Coordinating interprofessional teams
2. Obtaining by-in from people in hospital (i.e. from doctors and hospital administration)
Antimicrobial stewardship, rapid diagnostic tests, reduction in frequency of non-
prescription use of antimicrobials, etc.
Good infrastructure (sanitation, electricity, safe water,
internet) good governance, public health-care spending, etc.
,Term 3 of 35
Why is there a dwindling supply of new antibiotics?
1. Prevalence of E. coli resistant to fluoroquinolones and 3rd generation cephalosporins
2. Aggregate resistance: combined average prevalence of 1) MRSA and 2) E. coli and K.
pneumoniae resistant to third-generation cephalosporins, fluoroquinolones, and
carbapenems
People think antibiotic resistance happens when
the body becomes resistant to antibiotics (its the bacteria that are resistant)
People believe individuals are not at risk of a
drug-resistant infection if they personally take antibiotics as prescribed (BUT
transmission of resistance bacteria from others!)
People think antibiotic resistance is only a problem for people who take antibiotics
regularly (anyone can get an antibiotic-resistant infection)
People think that antibiotics can treat viral infections
People think taking antibiotics that they do not need has no effect on the effectiveness
of antibiotics for
other people in the community
1. Improve awareness and understanding of AMR through effective communication,
education and training
2. Strengthen knowledge and evidence base through surveillance and research
3. Reduce the incidence of infection through effective hygiene, sanitation, and infection
prevention measures
4. Optimize the use of antimicrobial agents in human and animal health
5. Ensure sustainable investment that takes account of the needs of all countries
Net present value (NPV) of a new antibiotic is -$50
million (~$1 billion for a drug used to treat a neuro-muscular disease)
•Antibiotics priced at a peak charge of $1000-$3000
per course (plus given in short courses)
, • Pharmaceutical development is dominated by for-profit companies (they set
investment priorities on the basis of projected revenues, rather than perceived public
health needs)
•Antimicrobials are the only drugs that lose benefit
by extensive use (resistance)
•Once a new antibiotic is marketed, physicians may
hold the new agent in reserve
Term 4 of 35
The ______________________of resistant organisms may be the dominant factor of AMR in many
countries.
Countries may have to reach a certain level of social and economic development before
relationships between antimicrobial resistance and use are observed
High frequency of non-prescription use of antimicrobials in the general population
based on published papers
Sources of antibiotics used for self-medication antibiotics included pharmacies and
leftover drugs
Incentives ($$) from drugs private clinics are selling
Private doctors = more likely to give into patients who want antibiotics but don't need
them, etc.
transmission!
The spread of resistant bacteria (or genes that for resistance) may be a more important
determinant of the prevalence of antibiotic resistance than antibiotic consumption
Term 5 of 35
Why is GDP per capita positively correlated with aggregate AMR?
Countries are experiencing a decline in population health
Countries have more money to spend on antibiotics
Countries have less access to healthcare resources
Countries are investing in alternative medicine practices
, Term 6 of 35
Will vaccines against respiratory viruses help combat resistance to bacteria?
1. Reducing in prescription of antibiotics
2. Reducing of colonization and infection = decreased transmission and exchange of
resistance genes by bacteria
3. Reduction of mis-prescribing antibiotics for viral infections because there are less viral
infections
4. Vaccines don't have as much as a problem with development of resistance compare to
antibiotics
5. Childhood vaccines reduce AMR in other susceptible populations (i.e. >65 years old)
YES!
Antiviral vaccines have no direct effect on organisms that cause antibiotic resistant
infections
•Antiviral vaccines often target viral diseases that cause acute febrile illnesses =
reduction in the rates illnesses = reduction of antibiotics prescribed (often
inappropriately)
•Influenza infection increases the risk of secondary bacterial infections (i.e. pneumonia
and otitis media, which may require antibiotic treatment)
Definition: Plans to optimize clinical outcomes while
minimizing unintended consequences related to antimicrobial usage
Requires:
1. Measuring antibiotic prescribing
2. Improve prescribing practicies (Right dose, right duration and right drug)
3. Minimizing misdiagnosis or delayed diagnosis (which often leads to underuse of
antibiotics)
4. Coordination of interdisciplinary teams, system innovation, education, and feedback
People think antibiotic resistance happens when
the body becomes resistant to antibiotics (its the bacteria that are resistant)
People believe individuals are not at risk of a
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