DRUG resistance II

Obama’s multi-year, billion-dollar effort

The USA’s President Barack Obama released a comprehensive plan in March to slow the emergence of drug-resistant bacteria, a multi-year, billion-dollar effort that includes getting doctors to stop over-prescribing antibiotics, developing new medications and rapid diagnostics, and real-time tracking of infection outbreaks.

Report: Lisa Chamoff

Two plates growing bacteria in the presence of discs containing various...
Two plates growing bacteria in the presence of discs containing various antibiotics. The isolate on the left plate is susceptible to the antibiotics on the discs and therefore unable to grow around the discs. The one on the right has a CRE that is resistant to all the antibiotics tested and can grow near the discs.
Source: Centers for Disease Control and Preventions
U.S. President Barack Obama
U.S. President Barack Obama
Source: The White House

‘We’re setting national goals for improving antibiotic use, and we’re asking doctors and hospitals to help us meet them,’ President Obama told Medscape in a March 27 interview about the plan. ‘And we’re going to help health departments across the country achieve these goals.’ The overall goal is to reduce the most serious health threats, including carbapenem-resistant Entero­bacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile, which cause approximately 23,000 deaths in the United States alone, according to the USA’s Centers for Disease Control and Prevention.

The plan will be overseen by a USA’S Government Task force and includes several strategies:

• Getting doctors to prescribe fewer antibiotics and ensuring patients receive the right antibiotic at the right time.
• Developing at least two antibiotics, or non-traditional therapies, to treat bacterial diseases in humans.
• Developing tests that rapidly distinguish between viral and bacterial pathogens, and tests to detect antibiotic resistance.
• Creating a network of laboratories to detect strains of resistant bacteria and a specimen repository that can be accessed by researchers, and providing  incentives to healthcare providers to report antibiotic resistance and antibiotic use.
• Eliminating the use of medically important antibiotics for growth promotion in food animals and having veterinarians oversee the use of drugs for treatment, control, and prevention of disease in animals.
• Working globally - with foreign ministries of health and agriculture, and organisations such as the WHO - to control the spread of antibiotic-resistant  bacteria.

Budget proposal

Obama has included the $1.2 billion plan in his proposed 2016 budget. Infectious disease experts applauded the White House for taking the lead and offering practical plans for improved stewardship of antibiotic use in medicine and the development of new drugs and tests, but they worry that the effort doesn’t go far enough to curb the use of antibiotics in animal agriculture.

Lance Price, a microbiologist at George Washington University, says the president’s plan does not offer measurable goals for reducing use of antibiotics in animals raised for food, and also does not address overcrowding and other conditions that cause infections to spread among them. ‘It’s really weak on the animal antibiotics side,’ Price says. ‘You can’t shut off one pipeline and expect the whole thing to be fixed without shutting of this other, huge pipeline.’

Europe has led the way in addressing the use of antibiotics in animals, says James Johnson MD, professor of medicine and an infectious disease expert at the University of Minnesota. Using antibiotics to promote growth in animals has been banned in Europe since 2006. Johnson also points to recent efforts in the Netherlands where, in 2009, the government directed farmers to cut antibiotic use in meat animals in half, and to Denmark, which has been reducing antibiotic use in animals since the 1990s.

‘I think the US has sort of moved into playing catch-up to Europe in handling antibiotic resistance,’ Johnson says. ‘I see the action plan as the US getting back in the game.’

Johnson also worries about what he considers the shortfalls of the White House plan, including the lack of an authority figure at the federal level to oversee efforts to curb antibiotic resistance. ‘Pulling it all together and making sure it all happens – there has been a glaring lack of that in the past,’ Johnson says. However, the healthcare community will likely embrace the effort, Price adds. ‘It seems like the medical community is ready for a change here. I think, with reimbursement rules changing and these time-bound quantitative goals, this is going to have a benefit for sure, and the medical community will rise up to the challenge.’


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