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Antimicrobial resistance: No action today, no cure tomorrow.

Statement by the Director-General
WHO World Day – 7 April 2011



In 2011, the World Health Organization (WHO) reported that 63,000 patients die each year in US hospitals and 25,000 patients lose their lives annually in the European Union due to antibiotic-resistant infections. The annual estimated economic burden is US $2.1 billion in the European Union, US $34 billion in the United States, and US $2.453 billion globally. 

Antimicrobial drug resistance (AMR or AMDR) is a multidimensional and systemic failure of the health, education, societal behavior, and medical policies and practices. 

Four major challenges should be recognized and addressed by the world medical community. 

  1. AMDR is extending beyond national boundaries, presenting a significant threat to health and increasing the costs of medical care. 
  2. Collaboration among healthcare, pharmaceutical, agricultural, and consumer communities is a prerequisite to ward off this evolving pandemic. 
  3. Adequate funding for proactive surveillance and development of new antimicrobial drugs and vaccines should be made available. 
  4. Antibiotic drug stewardship, including education of stakeholders, implementation of hygiene practices, and responsible dispensing and use, are essential strategic elements of all preventive practices.

Antimicrobial Drug Resistance (AMDR)

a Continuing Medical Education Activity


Needs Statement:

It is imperative that all healthcare providers are cognizant of and learn the stewardship of the dwindling inventory of effective antimicrobial drugs given the rising global spread of antibiotic drugs resistance and incidence of hospital- and community-acquired infections.

Learning Objectives:

At the end of this activity, participants should be able to:

  • Understand the global threats of antimicrobial drug resistance (AMDR), including epidemiology and multidrug resistance 
  • Explore the mechanisms responsible for the spread of AMDR
  • Recognize and apply the principles of antibiotic drug stewardship, encompassing medical policies and practices to control the spread of AMDR
  • Promote effective and safe healthcare delivery, prevent morbidity, save unnecessary costs, and above all, save lives

Release date: January 3, 2012
Expiration date: January 2014

Joint Sponsorship Statement:
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of MedEDirect, Inc. and the Center for the Study of International Medical Policies and Practices (CSIMPP), School of Public Policy, George Mason University, in collaboration with the World Medical Association (WMA) and the International Society for Microbial Resistance (ISMR). MedEDirect, Inc. is accredited by the ACCME to provide continuing medical education for physicians. 

Authors and Activity Planners: 

Arnauld Nicogossian, MD, FACPM, FACP
Distinguished Research Professor
Center for the Study of International Medical Policies and Practices
George Mason University
Fairfax, VA

Thomas Zimmerman, PhD
Executive Director, International Society for Microbial Resistance
Founding Dean, Palm Beach Medical College
Fairfax, VA

Edward Septimus, MD, FACP, FIDSA, FSHEA
Clinical Professor of Internal Medicine
Texas A&M University
Houston, TX

Otmar Kloiber, MD
Secretary General
World Medical Association


William Jacobs, PhD
Senior Scientist
International Society for Microbial Resistance
Fairfax, VA

Allan Morrison, MD, FACP, FIDSA, FSHEA
Professor of Medicine, George Washington University
Epidemiologist, INOVA Health Systems and Fairfax Hospital
Fairfax, VA

Disclosure of Conflicts of Interest:

All individuals participating in the development and implementation of activities sponsored by MedEDirect are expected to disclose any real or perceived conflicts of interest related to the content of the activity.

  • Arnauld Nicogossian – has nothing to disclose
  • Thomas Zimmerman – has nothing to disclose
  • Edward Septimus – reports that he serves on a paid speakers’ bureau as a planner, presenter or reviewer for Sage Pharmaceuticals, Inc, Merck & Co., Inc, and Cubist Pharmaceuticals, Inc.
  • Otmar Kloiber – has nothing to disclose
  • William Jacobs – has nothing to disclose
  • Allan Morrison – reports that he servers on a paid speakers’ bureau as a planner, presenter or reviewer for Cubist Pharmaceuticals, Inc., Care Fusion, Sage Pharmaceuticals Inc., Merck & Co., Inc, Pfizer, Inc., and Ortho-McNeil

Accreditation Statement:

This activity is planned and implemented in accordance with the Essentials and Policies of the Accreditation Council for Continuing Medical Education (ACCME) by MedEDirect, Inc. MedEDirect, Inc. is accredited by the ACCME to provide continuing medical education for physicians. MedEDirect, Inc. designates this activity for 2.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Target Audience:

This educational activity is intended for all physicians and healthcare professionals, especially those involved with the prevention, detection, and management of infectious diseases.

Estimated Time for Completion:

This activity should take approximately 2.0 hours to complete.

Method of Participation:

The participant should examine the objectives and read and study the report.

If online: Answer the multiple-choice post-test and complete both the registration form and activity evaluation form. Click “finished,” and if you have answered at least 70% of the questions correctly, you will receive certificate of completion for your records.

If by mail: Fill out the registration form, complete the post-test and activity evaluation, and mail to:

Attention: AMDR Course
George Mason University
School of Public Policy
Center for the Study of International Medical Policy
3351 Fairfax Drive
Arlington, VA 22201

Table of Contents

SECTION ONE: The global threat of AMDR
SECTION TWO: Understanding AMDR
    1. Etiology and Epidemiology
    2. Incidence and Prevalence of Microbial Resistance
    3. Major AMDR Pathogens
       a. Acinetobacter baumanii
       b. Clostridium difficile
       c. Escherichia coli
       d. HIV/AIDS and Sexually Transmitted Infection
       e. Influenza virus
       f. Malaria (Plasmodium)
       g. Methicillin-resistant Staphylococcus aureus (MRSA)
       h. Streptococcus pneumoniae
       i. Tuberculosis and MDR-TB
       j. Vancomycin-Resistant Enterococcus (VRE)
SECTION THREE: Control and Prevention of AMDR
    1. Implications of Microbial Resistance
    2. Infections and Chronic Diseases
    3. Policies and Best Practices
       a. Antimicrobial Drug Stewardship
       b. Surveillance
       c. Environmental Decontamination
       d. Infection Control
       e. Patient Education
    4. Antibiotic Development Pipeline
SECTION FOUR: Conclusions
Test Questions
Program Evaluation
Self Assessment

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