2) Below is a graph of antibiotic use for human and veterinary practice in Denma
ID: 66300 • Letter: 2
Question
2) Below is a graph of antibiotic use for human and veterinary practice in Denmark. Although the use of antimicrobials as growth promoters in livestock was discontinued following a ban around 2000, the use of antimicrobials for veterinary care has remained high and has been rising.
2a) During the most recent couple of years reported in this graph, approximately what fraction of the total antimicrobials being prescribed in Denmark are being prescribed in humans? _____________ %
2b) An important goal for improving the efficacy of antibiotics in humans is to reduce the incidence of antibiotic resistant infections in humans. Based on the information in this graph and your understanding of antibiotic resistance, suggest a policy (by describing it in 1-2 sentences) that could be enacted by this country to dramatically reduce the incidence of antibiotic-resistant infections in humans.
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3) Watch part of the following movie on drug-resistant tuberculosis (TB), specifically from minute 10:00 to minute 16:40.
• PBS Nova Episode on Evolution of Microbes and Antibiotic Resistance: https://www.youtube.com/watch?v=0zsWdW7eJ1M 1a) Based on the information in the movie clip, list two conditions that have contributed to the high number of individuals becoming symptomatic for TB (developing the disease) in Russian prisons.
1. ________________________
2. ________________________
1b) Below are two copies of the same graph, which plots the frequency distribution of TB bacteria with a range of heritable resistance to an antibiotic, antibiotic X. When an individual takes an antibiotic, the antibiotic stops bacterial cell division and can eventually kill the cells, but cells differ in how long they can persist when the antibiotic is present. You can assume this distribution of bacteria represents natural heritable variation in resistance within an infected human individual who has never previously taken antibiotic X (as is often the case in real-life scenarios).
1b1) LEFT curve: If the infected individual takes antibiotic X for 5 days, but then stops taking the antibiotic, what will be the frequency distribution of TB cells with varying antibiotic resistance in this individual after antibiotic treatment? On top of the curve on the left, draw the distribution of antibiotic resistance in the TB cell population within the individual on day 6 after the individual started taking the antibiotic.
1b2) RIGHT curve: If the infected individual takes antibiotic X for 10 days, and then stops taking the antibiotic, what will be the frequency distribution of TB cells with varying antibiotic resistance in this individual after antibiotic treatment? On top of the curve on the left, draw the distribution of antibiotic resistance in the TB cell population within the individual on day 11 after the individual started taking the antibiotic. ?
1c) Based on your knowledge of the evolution of TB resistance, assuming that the duration of antibiotic treatment impacts the distribution of cells as explored in 1b (above), and assuming that TB cells previously exposed to an antibiotic can begin dividing again when they are no longer exposed to the antibiotic (e.g., if they infect a new individual not on antibiotics), rank the long-term public health threat of the following individuals. We will define "public health threat" according to the mean antibiotic resistance of the TB cell population in the individual, with individuals with a high mean antibiotic resistance being defined as a high public threat. Put a 1 next to the individual who would be the greatest public health threat to others, a 2 next to the individual representing the next-greatest threat, a 3 next to the individual who would present the third-greatest threat, and a 4 next to the individual who would be the least public health threat to others.
_____ An infected person prior to taking antibiotics.
_____ An infected person who took antibiotics for 4 day and then stopped.
_____ An infected person who took antibiotics for 6 days and then stopped.
_____ An infected person who took antibiotics for 10 days and then stopped.
Figure 4.1 Annual antibiotic use for human and veterinary practice in Denmark .1 Annual antibiotic use f 220 200 180 160 140 120 100 80 60 A0 20 Antimicrobial growth promoters Prescribed veterinary antimicrobials Prescribed human antibacterials Source: Reproduced from 2 with permission.Explanation / Answer
2a. Since 1997, among the total antimicrobials, humans have been prescribed about 26% approximately.
2b. Antibiotic resistance in humans can be reduced by- taking less or ignoring the use of antibiotics in mild fever or cough conditions. And since in hospitals cases of antibiotic resistance are most common, hygiene of the patients in ICU or neonatal department is most required to prevent or reduce the use of antimicrobials for the patients.
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