Tag Archives: Antibiotic Prescribing

Obama Administration Issues Detailed Plan National Action Plan for Combating Antibiotic-Resistant Bacteria

National Action Plan for Combating Antibiotic-Resistant Bacteria.

The Obama administration has issued a detailed plan to address the problem of antibiotic resistance, complete with milestones to help ensure the goals are actively addressed.

Drug-resistant bacteria cause 23,000 deaths and two million illnesses a year in the United States, according to the Centers for Disease Control and Prevention. Resistance also threatens animal health and agriculture, said the White House.

The 63-page National Action Plan for Combating Antibiotic-Resistant Bacteria, released                     March 27, 2015 was developed by a task force made up of representatives from at least a dozen federal agencies. The task force began meeting in September 2014, taking its cues from an executive order issued by President Obama on September 18, 2014, and from recommendations in a report on antibiotic resistance that was issued by the President’s Council of Advisers on Science and Technology around the same time.

The action plan aims “to enhance domestic and international capacity to prevent and contain outbreaks of antibiotic-resistant infections; maintain the efficacy of current and new antibiotics; and develop and deploy next-generation, diagnostics, antibiotics, vaccines, and other therapeutics,” according to the White House.

Five Goals

The plan sets 1-, 3-, and 5-year targets in each of the five overarching goals, which are to:

  • slow the emergence of resistant bacteria and prevent the spread of resistant infections;
  • strengthen national one-health surveillance efforts to combat resistance (the “one-health” approach to disease surveillance integrates data from multiple monitoring networks, according to the White House);
  • advance development and use of rapid and innovative diagnostic tests for the identification and characterization of resistant bacteria;
  • accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines; and
  • improve international collaboration and capacities for antibiotic resistance prevention, surveillance, control, and antibiotic research and development.

Having specific benchmarks is something that the Infectious Diseases Society of America (IDSA) has advocated, said Amanda Jezek, vice president of public policy and government relations at IDSA. “That helps ensure that this isn’t just an action plan that will sit on the shelf and collect dust,” Jezek told Medscape Medical News.

Hospitals will be required to implement programs to increase infection controls, such as judiciously washing hands, hospital surfaces and equipment, and reducing the use of antibiotics in patients.

Doctors working with the government’s Medicare and Medicaid health plans will be required to report their prescribing patterns for antibiotics, particularly when used to treat non-bacterial infections, such as common colds.

The plan calls for CDC to increase its screening of people arriving from countries with high rates of multi-drug resistant tuberculosis. The CDC currently screens 500,000 such arrivals per year, and the plan calls for doubling that within five years.


Urgent and Serious

Among other targets, the plan sets goals for eradicating pathogens that have been labeled urgent or serious threats by the Centers for Disease Control and Prevention. The 2020 targets include:

  • a 50% reduction from 2011 estimates in the incidence of Clostridium difficile,
  • a 60% reduction in hospital-acquired Carbapenem-resistant Enterobacteriaceae infections,
  • a 35% reduction in hospital-acquired multidrug-resistant Pseudomonas species infections, and
  • a 50% reduction from 2011 estimates in methicillin-resistant Staphylococcus aureus bloodstream infections.

Also by 2020, the action plan seeks a 50% reduction in inappropriate antibiotic use in outpatient settings and a 20% reduction in inpatient settings, as well as routine reporting of antibiotic use and resistance data to Centers for Disease Control and Prevention’s National Healthcare Safety Network by 95% of Medicare-eligible hospitals.

The plan also envisions by 2020 the development and wide dissemination of rapid diagnostic tests that can be used in a physician’s office or at the hospital bedside to distinguish between viral and bacterial infections, and thus help ensure more appropriate use of therapeutics.

Under research and development, the plan calls for the characterization of the gut microbiome of at least one animal species raised for food to potentially treat bacterial diseases without antibiotics, and at least three new probiotic therapies for animals by 2020.

In the same time frame, the plan dictates the development of at least two new drug candidates or nontraditional therapeutics and/or vaccines for the prevention of human disease.

The action plan also outlines proposals to work with other governments around the world to enhance the capacity to identify resistant pathogens and to help low- and middle-income countries develop stewardship plans.

$1 Billion to Start?

The White House said the plan’s aspirations are “consistent” with the president’s fiscal 2016 budget proposal, which seeks more than $1 billion to combat antibiotic resistance.

Jezek, from the IDSA, said the $1 billion is a good start and notes that there is bipartisan support for battling antibiotic resistance. “To me, the big question is, Can we get Congress to actually allocate all of that money?” she said.

The automatic budget cuts known as sequestration loom large over any request for funds that are not for mandatory programs, which could make it hard to get the full 2016 request from lawmakers, said Jezek.

The IDSA is also calling on the federal government to ensure the establishment of antibiotic stewardship programs in all healthcare facilities and to pass incentives to encourage drug, diagnostic, and vaccine development.

The federal interagency task force is scheduled to provide a progress report on the action plan within 6 months of its release — by September. It will then make annual progress reports and make recommendations to modify goals if necessary.

The task force is also supposed to work in conjunction with the Presidential Advisory Council on Combating Antibiotic Resistance, a 30-member board that has yet to be constituted.

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Antibiotic Prescribing; Clinicians Know the Recommendations

Clinicians know the recommendations regarding when and when not to prescribe antibiotics, but they do not always follow them, according to in-depth interviews with 36 Physicians, Nurse Practitioners (NPs), and Physician Assistants (PAs).

Guillermo Sanchez, MPH, from the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues report the results of their interview-based study in an article published online November 13, 2014  in Emerging Infectious Diseases.

Reasons for straying from the guidelines range from believing that a non-recommended antibiotic will work better for a patient, particularly when considering allergies or complicated medical histories; concern about patient dissatisfaction; fear of related infection; and concerns about legal action.Clinicians indicated that although they are concerned patients could build up a resistance to antibiotics, those concerns do not usually affect their choice of drug.

Researchers Recorded Telephone Interviews

The researchers conducted in-depth interviews via digitally recorded telephone calls and transcribed the recordings to accurately assess primary care providers’ prescribing behaviors. The breakdown of participants was nine pediatricians, nine family medicine physicians, nine internal medicine physicians, five NPs, and five PAs.

Dr. Sanchez and colleagues used a screening questionnaire to recruit potential participants from a nationwide marketing database. Eligible participants spent at least half of their time with patients in a primary care setting and were older than 30 years. The authors excluded clinicians with a board certification outside of primary care or if they had practiced medicine for more than 30 years.

Before the interview, participants filled out a questionnaire that asked them to rank 12 factors on their influence on antibiotic selection, such as illness severity, patient demand, or practice guidelines. They then discussed their answers with trained interviewees during the recorded interviews.

To evaluate clinical decision-making, each participant received a specialty-appropriate clinical vignette about a patient who had a diagnosis of an acute bacterial infection. The participant was asked to explain why he or she chose an antibiotic and why other primary care providers might choose non-recommended antibiotics.

The researchers found that participants had inconsistent definitions of broad- and narrow-spectrum antibiotics. “Although some participants correctly identified amoxicillin as a narrow-spectrum agent, and azithromycin as a broad-spectrum agent, many participants were uncertain of the spectrum of antimicrobial activity for these 2 widely used antibiotics.”

In addition, clinicians often thought broad-spectrum antibiotics would be more successful in curing an infection, although those beliefs are unfounded, the authors say. That thinking may regularly lead to inappropriate selection and should be addressed, the authors note.

Clinicians, however, were more likely to choose narrow-spectrum drugs when the diagnosis was more certain or when they saw a patient’s condition as relatively benign.

The authors have disclosed no relevant financial relationships.

Source: Medscape

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