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Combating Antibiotic Resistance: Are We On Our Way?

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By: Ashley Parker, Ph.D

Antibiotics have been used to treat bacterial infections for more than 70 years. Bacteria and fungi naturally produce these antimicrobial compounds to kill other microbes in their environment. The first antibiotic, penicillin, was discovered by Alexander Fleming, a professor of bacteriology at St. Mary’s Hospital in London. Most people are familiar with this antibiotic, which has saved many lives since the 1940s. Unfortunately, what was once considered to be a “miracle drug” in treating infectious diseases is no longer effective against some bacterial strains. Many classes of antibiotics have been discovered since the discovery of penicillin but unfortunately, the widespread use and abuse of those antibiotics has led to increased selection for antibiotic resistant bacteria. Microbes use various mechanisms to prevent antibiotics from killing, and thus fail to respond to antibiotic treatments. Due to the rise of antibiotic resistant bacteria, it is important to understand current strategies and developments to combat antibiotic resistance, and the various challenges.

There have been several reports of “superbug” outbreaks in the United States and across the world. Tuberculosis outbreaks in Europe are a major concern, with increasing cases of multidrug resistant tuberculosis (MDR-TB). The World Health Organization (WHO) reported in the 2014 Antimicrobial Resistance Global Report on Surveillance that 3.6% of new TB cases and 20.2% of previously treated cases were estimated to be MDR-TB with higher incidences in Eastern Europe and central Asia. Within the report on antimicrobial resistance, the WHO also reported national data on the bacterial pathogens: E. coli, K. pneumonia, and S. aureus showing that the proportion of these bacteria resistant to commonly used antibiotics was more than 50% in various settings. Recent outbreaks in the U.S. involved two California hospitals and one in Hartford, Connecticut that were associated with carbapenem-resistant Enterobacteriaceae (CRE) and drug resistant E. coli respectively.

Over the past 40 years, no new classes of antibiotics have been developed to treat gram-negative bacilli, such as E. coli and those seen in recent outbreaks. The U.S. Food and Drug Administration (FDA) has only approved two systemic antibiotics for use in humans from 2008 to 2014. According to the Centers for Disease Control and Prevention (CDC), at least 2 million people become infected with drug resistant bacteria in the United States and 23,000 deaths are reported to be directly related to these infections. As of December 2014, the Pew Charitable Trusts, published that 37 new antibiotics were in development. Of the 37 antibiotics, 10 were in Phase I clinical trials, 18 in Phase II, 8 in Phase III, and only one had been submitted for a new drug application. Most of these antibiotics are reported to be potentially effective against the current drug resistant bacteria; however, not all of the antibiotics. Considering there is only a single drug that has passed phase 3; this is clearly a major public health concern, and combating antibiotic resistance in the future will likely require national and international efforts. The U.S. has begun efforts to deal with this multifaceted problem with Congress passing the Generating Antibiotic Incentives Now (GAIN) law as part of the FDA, to extend the time of generic competition by 5 years for antibiotics that are proven to effectively treat infectious diseases.

On September 18, 2014, President Obama signed an executive order to direct federal departments and agencies to combat the rise of antibiotic resistance. In addition, with sponsorship from the National Institutes of Health and the Biomedical Advanced Research and Development Authority, the Obama administration announced a $20 million prize to rapidly implement point-of-care diagnostic tools, to identify multidrug resistant infections in healthcare facilities. In this executive order, the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria was established to provide oversight for programs and policies that intend to preserve antibiotic effectiveness, along with many other efforts. To preserve the power of current antibiotics, the CDC is encouraging hospital CEOs and medical officers to appoint leaders to support program outcomes and improve prescribing practices, monitor prescribing and antibiotic resistance patterns, and offer education about antibiotic resistance to health care providers. The Departments of Health and Human Services, Defense, and Veteran Affairs will also serve a major role in improving antibiotic stewardship in compliance of the efforts outlined by the CDC.

Aside from the healthcare industry, the agricultural industry also plays a significant role in combating antibiotic resistance due to the use of antibiotics for farm animals — which may have led to reported outbreaks of antibiotic resistant strains in animal livestock. In 2007, the U.S. experienced the first reported outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in farm pigs. MRSA infections can be life threatening and account for half of the more than 14 million skin and soft-tissue infections seen in the U.S each year. According to the CDC, there are approximately 100,000 cases of invasive infections each year. However, the White House has advised the U.S. FDA to continue making efforts to eliminate the use of antibiotics for the growth-promotion of animals in agricultural settings, but allow for medically important antibiotic usage that will be monitored by the National Healthcare Safety Network. In addition, the White House advisory council will provide insight and recommendations for strengthening the surveillance of antibiotic resistant infections, promote advanced research on new antibiotic treatments, seek antibiotic alternatives used for agricultural purposes, and improve global efforts to tackle antibiotic resistance.

On March 16, 2015, Gerard O’Dwyer published an article discussing a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in Norway. The Norway food safety authority discovered six new pig herds infected with livestock-associated methicillin-resistant S. aureus, also known as LA-MRSA. International actions on combating antibiotic resistance, particularly for MRSA and C. difficile infections, are of political interest in England. In September 2013, the United Kingdom (UK) released its Five Year Antimicrobial Resistance Strategy, cosponsored with the Veterinary Medicines Directorate of the Department for Environment, Food and Rural Affairs, the Northern Ireland Executive, the Scottish government, the Welsh government, and the UK Public Health agencies. The antimicrobial resistance action plan covered seven core areas: addressing the efforts to improve infection prevention and control practices, optimizing prescribing practice, improving professional education, training, and public engagement; developing new drugs, treatments, and diagnostics; improving access and use of surveillance data; improving identification and prioritization of antimicrobial resistance; and strengthening international collaboration.

Overall, fighting antibiotic resistance is a major public health concern in the U.S. and abroad and must involve multiple entities, including the federal government and agencies, health care professionals, and individuals of the general public. The Obama administration and other international governments have prepared extensive guidelines and taken the necessary measures to effectively address the threat of antibiotic resistance; however the battle against antimicrobial resistance will be a continuing effort that is not expected to resolve immediately.

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Written by sciencepolicyforall

March 25, 2015 at 9:00 am

Posted in Essays

Tagged with , , , ,

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