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Antibiotic resistance in Libya-1970 2011
1. بسم ا الرحمن الرحيم
THE STORY OF ANTIBIOTIC
RESISTANCE IN LIBYA:
1970-2011
Prof. Khalifa Sifaw Ghenghesh
2. • Resistance to antimicrobial drugs is
a major problem that inflicts the
whole world.
• The problem is still worse in
developing countries where lack of
antimicrobial-resistance surveys and
lack of control policies are the norm.
3. Antimicrobial resistance of Salmonella isolated
from diarrheic fecal specimens in Libya
% resistant
Antibiotic
Ampicillin
Chloramphenicol
Gentamicin
Nalidixic acid
Ciprofloxacin (or
Norfloxacin)
Trimethoprimsulphamehtoxazole
*
1979-1980 1979-1980 1992-1993
Tripoli
Tripoli
Tripoli
(n=244)
(n=238)
(n=21)
89
29
52
79
89
52
17
14
43
12
17
0.0
NA*
NA
0.0
NA
NA=Data not available
NA
48
2000-2001
Zliten
(n=23)
100
96
78
4
0.0
2008
Tripoli
(n=19)
47
5
NA
84
63
4
21
4. Escherichia coli from UTIs in Libya
% resistant
Antibiotic
1981
1994-1995
Benghazi
Tripoli
(n=38)1
(n=534)2
Ampicillin
Chloramphenicol
Gentamicin
Nalidixic
acid
Ciprofloxacin
Nitrofurantoin
TMP-SMZ
2
2002-2005
Sirte
(n=1265)4
2005-2006
Tripoli
(n=29)5
2006-2008
Benghazi
(n=105)6
22
NA
74
29
75
45
49
23
59
21
57
14
0.0
0.0
7
11
18
10
9
28
10
28
7
23
NA
NA
NA
2
14
17
0.0
25
7
7
NA
0.0
NA
45
81
36
24
31
Outpatients.
Outpatients and inpatients.
1,3,4-6
1996
Benghazi
(n=148)3
5. Antimicrobial resistance of Gram-negative bacilli isolated
from hospital and community cockroaches (2000-2002)
No. (%) resistant
Antibiotic
Hospital
Community
Total
cockroach
cockroach
(n=193)
(n=246)
(n=439)
-----------------------------------------------------------------------------------------Ampicillin
141(73)
208(85)
349(80)
Augmentin
85(44)
88(36)
173(39)
Cephalothin
144(75)
145(59)
289(66)
Chloramphenicol
51(26)
39(16)
90(21)
Gentamicin
16(8)
0(0)
16(4)
Norfloxacin
0(0)
1(0.4)
1(0.2)
Tetracycline
59(31)
62(25)
121(28)
TMP-SMZ
48(25)
16(7)
64(15)
------------------------------------------------------------------------------------------
6. Resistance of different bacterial pathogens isolated
from ice cream in Tripoli (2001-2002).
% resistant
Antibiotic
Gram-negative bacilli Gram-positive cocci
(n=48)
(n=67)
-----------------------------------------------------------------------------------------Ampicillin
83
90
Amoxicillin40
45
clavulanic acid
Cefuroxime
25
NT
Ciprofloxacin
0.0
6
Gentamicin
0.0
12
Tetracycline
19
24
TMP-SMZ
12.5
25
------------------------------------------------------------------------------------------
10. Tuberculosis
•
•
Mycobacterium tuberculosis
A serious health problem in Libya.
– Estimated incidence rate per 100,000 population (1990-2010) = 40
•
First line drugs:
– Isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA) and ethambutol (EMB).
•
Second line drugs:
– Fluoroquinolones, aminoglycosides, ethionamide, D-cycloserine and peptides
(viomycin and capreomycin).
•
Isoniazid and rifampicin
– keystone drugs in the management of TB
– Resistance to either isoniazid or rifampicin may be managed with other firstline drugs
•
Multidrug-resistant TB (MDR-TB):
– Resistance to both isoniazid and rifampicin with or without resistance to other
drugs.
–
MDR-TB demands treatment with second-line drugs that have limited
sterilizing capacity, and are less effective and more toxic.
11. Primary, Acquired and Multidrug Resistance among
TB Cases in Libya
Type of
resistance
Primary
Acquired
MDR-New TB
cases1
MDRRetreatment
cases1
1970-1980
1984-1986
%
2002-2007
13 (9-17)
28 (15-33)
NA
11 (4-20)
22 (12-34)
NA
NA
NA
2.6 (0.4-14)
NA
NA
3 (0.0-8.0)
NA
NA
3.4 (1.9-5.0)
NA
NA
39 (10-77)
35 (0.0-75)
20 (14-25)
NA
NA
3 (0.8-15)
NA
NA
MDR-Total
TB cases1
Estimated by WHO.
1
2008
2011
12. Resistance of Neisseria gonorrhoea isolated in Tripoli
in 1988/1989 to antibiotics
Antibiotic
Penicillin
Erythromycin
Tetracycline
Kanamycin
Spectinomycin
% resistant
(n=42)
45.2
11.9
11.9
2.4
2.4
13. In Libya
• Lack of trained microbiologists.
• Antibiotic Susceptibility testing:
– Standard methods are not used.
– No control organisms.
– Data reporting is not reliable.
• Medical doctors:
– Lack of interest in infectious diseases.
– Misuse of antimicrobial agents in the treatment of
infectious diseases.
– Lack of interest in educating their patients regarding
proper use of antibiotics.
•
14. • The community:
– Lack of knowledge of the proper use of antibiotics.
– No knowledge of the antimicrobial resistance
problem.
– Misuse and abuse of antimicrobial agents.
• The Government:
– Lack of control over importation and quality of
antibiotics.
– Lack of surveys of antibiotic resistance in the
country.
– Lack of control of antibiotic use in animal
husbandry.
– Infection prevention and control programs not
implemented
– No support for research on antibiotic resistance.
15. THE PROBLEM
• The high prevalence of resistant bacteria
in Libya seems to be related to antibiotic
usage
– Easy availability without prescription at drug
stores,
– Injudicious use in hospitals, and
– Uncontrolled use in animal husbandry.
16. CONCLUSION
• The problem of antibiotic resistance is very
serious in Libya, as it appears to be on the
increase, particularly with the emergence of
resistance to newer drugs that include the
fluoroquinolones (e.g. ciprofloxacin) among
the clinically important bacterial species.
17. RECOMMENDATIONS
• It is urgently required:
– To ban the sale of antibiotics without prescription,
– To use antibiotics more judiciously in hospitals by
intensive teaching of the principles of the use of
antibiotics, and
– To establish better control measures of nosocomial
infections.
• Regulation of antimicrobials for other than
human use is also required.
• These issues are not easy to address and
require the collective action of health
authorities, the pharmaceutical community,
health care providers, and consumers
