Presidential Response

On Thursday, September 18, President Barrack Obama issued an Executive Order which created a Task Force with the Mission to Combat Antibiotic-Resistant Bacteria in response to this report published by the President’s Advisory Council (PAC) on Science and Technology. The CDC estimates that there are have been over 2 million illnesses and 23,000 deaths from antibiotic-resistant bacteria in the United States.

Culprit Bacteria

The PAC report outlines a 5-step plan to combat these specific pathogens:

• Carbapenem-Resistant Enterobacteriacea
• Methicillin-Resistant Staphylococcus aureus
• Ceftriaxone-Resistant Neisseria gonorrhea
• Clostridium difficle

The CDC also includes Extended-Spectrum Beta Lactamase producing Enterobacteriacea, Multi-Drug Resistant Salmonella, and Pseudomonas on its list of pathogens to target.

The PAC offered these 5 objectives to accomplish its goal:

1. Slow the emergency of resistant bacteria and prevent the spread of resistant infections
2. Strengthen national One-Health surveillance efforts to combat resistance which promotes integration of public health, veterinary disease, food and environmental surveillance
3. Advance development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria
4. Accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines
5. Improve international collaboration and capacities for antibiotic resistance, prevention, surveillance, control, and antibiotic research and development

Obama’s Executive Order mirrors many of these objectives, stating:

Success in this effort will require significant efforts to: minimize the emergence of antibiotic-resistant bacteria; preserve the efficacy of new and existing antibacterial drugs; advance research to develop improved methods for combating antibiotic resistance and conducting antibiotic stewardship; strengthen surveillance efforts in public health and agriculture; develop and promote the use of new, rapid diagnostic technologies; accelerate scientific research and facilitate the development of new antibacterial drugs, vaccines, diagnostics, and other novel therapeutics; maximize the dissemination of the most up-to-date information on the appropriate and proper use of antibiotics to the general public and healthcare providers; work with the pharmaceutical industry to include information on the proper use of over-the-counter and prescription antibiotic medications for humans and animals; and improve international collaboration and capabilities for prevention, surveillance, stewardship, basic research, and drug and diagnostics development.

The FDA created this video to inform the lay public about the importance of not misusing antibiotics:

And this Ted-Ed video explains how antibiotic-resistance occurs:

 

Public Health Response

What active steps are being taken to combat these pathogens?

Urgent action needed now to prevent antibiotic resistance (AR). President’s Nat’l Strategy to Combat AR impt start: http://t.co/p8ujGTT24B

— Dr. Tom Frieden (@DrFriedenCDC) September 19, 2014

The CDC’s Antibiotic Resistance Initiative is working closely with the National Institutes of Health to achieve the following five goals over the next five years with $30 million in annual funding. With this funding they aim to improve education on resistance and susceptibilities for physicians and other healthcare providers, improve communication between hospitals and the community to better detect and contain antibiotic-resistant outbreaks, create a resistant-bacteria bank in the national laboratories to further study and create treatments for these diseases, and more.

It is also important to remember that the current practice of using antibiotics to grow our nation’s livestock can be contributing to the current epidemic, something critics of Barack Obama’s plan feel is not being addressed adequately by the Executive Order.

Global Impact

The growing awareness of antibiotic resistance is not limited to the United States. Cases of multi-drug resistance to diseases such as tuberculosis and malaria are also rising.

The World Health Organization is also getting involved in this international problem and has issued a call-to-action.

People can help tackle resistance by:

• using antibiotics only when they are prescribed by a certified health professional;
• completing the full treatment course, even if they feel better;
• never sharing antibiotics with others or using leftover prescriptions.

Health workers and pharmacists can help tackle resistance by:

• enhancing infection prevention and control;
• prescribing and dispensing antibiotics only when they are truly needed;
• prescribing and dispensing the right antibiotic(s) to treat the illness.

Policymakers can help tackle resistance by:

• strengthening resistance tracking and laboratory capacity;
• strengthening infection control and prevention;
• regulating and promoting appropriate use of medicines;
• promoting cooperation and information sharing among all stakeholders.

Policymakers, scientists and industry can help tackle resistance by:

• fostering innovation and research and development of new vaccines, diagnostics, infection treatment options and other tools.

Unified Response

In a comment in the journal, Nature, the authors  call for an international panel to work together in combating the growing epidemic – especially to call for all nations to institute regulations to control the misuse of antibiotics. They also claim that better incentives must be made to pharmaceutical companies to fuel further development of novel antimicrobials.

Between 1983 and 1992, 30 new antibiotics were approved by the US Food and Drug Administration. From 2003 to 2012, the number was just seven. Why? Because there are too few incentives and too many regulatory barriers for the commercial sector to invest what is needed for the development of new antimicrobials⁸. Drug development is risky, and antibiotics do not generate as much revenue as drugs for chronic conditions do. Drug companies find that research in other diseases is a better return on investment.

It is clear that the world is slowly awakening to this growing epidemic. Hopefully with active collaboration, innovative thinking, and judicial use of antibiotics we will be able to combat this threat before we are faced with an unbeatable pandemic.

Report written by Vidya Eswaran