HLTB21H3 Lecture Notes - Lecture 10: Antimalarial Medication, Navi Mumbai, Plasmodium Vivax

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25 Nov 2013
HLTB21- Lecture 10- November 21
Drug (Antibiotic) Resistance
Occurs because drugs target very specific bacterial proteins; with such
specificity, any mutation in these proteins will interfere with or diminish its
microbe destroying effect
• Changes in bacteria: 1) spontaneous or induced genetic mutation; or 2) acquisition
of resistance genes from other bacterial species (horizontal gene transfer via
conjugation, transduction, transformation); can also use enzymes to modify the
antibiotic itself (to be less effective)
REMEMBER: exposure to antibiotics will naturally select for the survival of
organisms with genes for Resistance
Factors in Anti-Microbial Drug Resistance
At population and individual levels
Overuse in different contexts: health care settings, nursing homes, livestock
farming, aquaculture, agriculture, home (bactericidal chemicals, cleaners)
Hospital use of broad-spectrum antibiotics while waiting for test results
Poor adherence / compliance (incomplete usage)
Counterfeit drugs (under-dosed, incorrectly dosed)
Prophylactic use (preventative, e.g., pre-surgery)
Misuse for viral infections (e.g., upper respiratory)
Overuse of antibiotics to re-assure patients
From 1990-2003, the number of available antibacterial products jumped from 23 to
more than 700 (Levy 2003)
leading to drug-resistance
Living in a too-clean environment can be problematic
Ex. children and allergies: there’s an association between kids with allergies
and more sterile environments
Malaria in India
Medical Malpractice and the Spread of Malaria
Good example of how drug resistance develops
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Protozoan parasitic infection
Plasmodium falciparum, vivax, ovale, malariae
Transmitted by female Anopheles mosquito
Flu-like symptoms: fever, chills, headache, muscle pains, sweats, tiredness,
nausea, diarrhea, anemia, vomiting
No vaccine, only prophylactic drugs: quinine, chloroquine and artemisinin
derivatives and preventative measures (bed nets, screens, activity timing,
insecticides, reducing water sources)
We just don’t have as many treatments as we used to
Chloroquine: least effective drug
• Note: syndemic with other diseases of poverty
Prevalent in Africa, Latin America, Asia (endemic in 100+ countries)
Approx. 219 million affected in 2010, killing 490,000 - 836,000
Majority of malarial deaths: sub-Saharan Africa, mostly kids
Mortality rates have fallen by more than 25% globally since 2000
Up to 5% of malaria episodes are severe, with case-fatality rate for severe
episodes in epidemics possibly up to 20% (WHO)
Persistence of malaria is problematic due to changing climates
Healthcare Systems and Malaria
Between 60 and 86% of those in need of ambulatory care in both rural and
urban areas of India resort to unregulated private health facilities Why?
greater access, convenience of timing, non-availability of alternative source
of health care (publicly-funded)
Private Health Care in India
Challenges: (Kamat 2001)
Irrational therapeutics, overprescription, and unnecessary investigations
and surgery
Unscientific disease diagnosis
Inappropriate prescription habits (e.g., poly-
prescription/overprescription, sub-optimal dosages, even
mistreatment/malpractice) -anti-malarial drug resistance?
Malaria is not bacterial infection- it’s protozoan
Economic interests of private practitioners
Intense pharmaceutical competition
Doctor-patient interactions (blame and misperceptions)
Ignorance of disease causation (vector, breeding sites)
Poor coordination between public/private health care
There is state care in India but very underfunded, so they have to go to
private practitioners
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