Antibiotics & resistance Q & A's Ecology Educational Publications What's happening News APUA int'l network Meetings Related websites About APUA About us Donate to APUA Work for APUA Contact us	Antibiotics In The News More articles Bioterrorism & antibiotics Antibacterial products Antibiotics in agriculture APUA in the news New Guidelines Advise Against Antibiotics to Prevent Endocarditis Genetic sequence available through TB Database Antibiotics in Failing Health June 17, 2007 Cefquinome: When Regulation Collides With Biology June 13, 2007 Strange But True: Antibacterial Products May Do More Harm Than Good June 7, 2007 Specialists to Say Drug-Resistant TB to Occur More June 5, 2007 APUA Participates in NARMS Public Meeting On April 10, 2007, Research Director Michael Feldgarden was an invited public speaker at the FDA Science Board Advisory Committee Subcommittee which provides advice to the National Antimicrobial Resistance Monitoring System (NARMS) where he conveyed APUA's strong support for NARMS. MSF Data Shows Drug-Resistant TB Treatment Succeeds in Barely Half of All Patients March 27, 2007 C. difficile Cases in Hospital Wards Reduced with Use of Narrow Spectrum Antibiotics March 26, 2007 Leading Food-Service Company to Serve Antibiotic Free Hamburgers Rise of Deadly TB Reveals a Global System in Crisis March 20, 2007   APUA's NARMS Summary abstract and slide presentation Off Label Use of Linezolid Linked to Increased Death Risk March 19, 2007 New Antibiotic Now Available to Battle MRSa in Canadian Hospitals March 6, 2007 FDA Rules Override Warnings About Drug Household Antibacterial Products Can Be Dangerous March 4, 2007 Genome Sequence Shows What Makes Bacteria Dangerous for Troops in Iraq March 1, 2007 Majority of South Africans with HIV Have Drug-Resistant TB February 27, 2007 CROI: Urgent Action Needed to Avert 'Catastrophic' Drug-Resistant TB Epidemic February 26, 2007 Hospitals' Hidden Danger February 25, 2007 New IDSA Guidelines for Treatment of Community Acquired Pneumonia Swimming 'To The Left' Gets Bacteria Upstream and May Promote Infection February 22, 2007 IDIBAPS Participates in European Network on Antibiotic Resistance and Hospital Infections Transmitted TB Resistance High in Shanghai February 21, 2007 Doctors Say Superbug Battle is Winnable Antibiotic Overuse Does Make Microbes Resistant February 8, 2007 No Reliable Risk Factors Found for CA-MRSA Anti-MRSA Pajamas Trialled February 6, 2007 Virulent TB in South Africa May Imperil Millions January 27, 2007 New Drug-Resistant Tuberculosis Cases Appearing in South Africa January 23, 2007 Quick Flu Tests Bring Down Antibiotic Use The Invisible Enemy in Iraq AstraZeneca Invests 100M for Infectious Disease R&D January 22, 2007 Staph Toxin Can Trigger Deadly Pneumonia January 18, 2007 What if We All Take Tamiflu? January 16, 2007 Researchers Discover Surprising Drug that Blocks Malaria January 15, 2007 Hospital Infections Kill 10,000 per Year- UK Seeking New Antibiotics in Nature's Backyard (PDF) December 1, 2006 Roche Says Tamiflu Resistance Fears Unfounded November 28, 2006 APIC Begins "Grand Rounds" Healthcare Education Series Antibiotic Indulgence: Misuse of a Miracle November 27, 2006 The Arms Race in Hand Soap Leads to Serious Overkill November 25, 2006 One Preop Antibiotic is as Good as Several Postop Skip the Antibacterial Soap November 20, 2006 New Treatment Uses Human Antibodies to Target C. difficile Toxins November 19, 2006 To Catch a Deadly Germ: New York Times Prior Hopital Room Occupants: A Source of Antibiotic Resistant Bacteria HIV/AIDS Linked to Extensive Drug Resistant TB November 14, 2006 MRSA Toxin Acquitted November 12, 2006 The Antibiotic Vitamin November 11, 2006 Untreatable Multidrug Resistant Tuberculosis- Hungary November 10, 2006 Return of Chloroquine Antimalarial Efficacy in Malawi- NEJM November 9, 2006 Most Ear Infections Host Both Bacteria and Viruses November 7, 2006 Superbug Vaccine Shows Promise- BBC October 31, 2006 Emergence of VRSA in North Indian Hospital October 26, 2006 Why Isn't the US Killing Off More Hospital Infections? October 24, 2006 Antibiotic Resistance Genes Found in Colorado River Water October 23, 2006 Prevalence of Drug Resistant Microbes in Hospitals Can Be Reduced October 20, 2006 HIV Could Fuel Deaths From XDR-TB in Africa Deadly XDR-TB Found in All Nine Provinces of South Africa October 18, 2006 E. coli Discovery Underscores Difficult Mix of Cattle, Spinach October 17, 2006 Increased Levels of Antibiotic Resistance in Gonorrhea, UK October 14, 2006 Antibiotics in Poultry May Pose Risk to Humans October 13, 2006 Carbapenems Still Effective Against Most Microbial Isolates: MYSTIC Data Presented at ICAAC October 3, 2006 Utilizing a Natural Enemy to Kill E. coli September 26, 2006 APUA Announces New E-mail Listserv A new e-mail listserv dedicated to AMR Issues for Health Journalists is now available. To subscribe, please write to: anibal.sosa@tufts.edu providing your complete name and country of residence. Scientists Find Anthrax 'Blocker' Protein Structure Reveals New Antibiotic Treatment August 29, 2006 Atheletes at Greater Risk for MRSA Infection August 28, 2006 Hospital MRSA Screening System Cut Infection Rates in Half August 25, 2006 Sick of Getting Sick? Embrace Your Inner Bacteria August 24, 2006 Skin Scourge- Boston Globe August 21, 2006 Study Finds MRSA Most Common Cause of Skin Infections in US ERs Staph Infection Outbreak in Duluth Prison August 19, 2006 APIC to Conduct National MRSA Prevalence Study August 15, 2006 EU Rejects Shrimp Import Due to Large Scale Antibiotic Presence August 8, 2006 UK Grants Support Antibiotic Resistance Research August 7, 2006 Multi-Drug Resistance Acinetobacter Found in Scottish Hospitals August 6, 2006 1 in 3 Patients Initially Receive Inappropriate Treatment for MRSA Infection Washington Redskins Take Precautions Against MRSA August 3, 2006 Pittsburgh VA Cracking Down on MRSA August 2, 2006 Resistant Hospital Acquired Pneumonia Doubly Lethal August 1, 2006 Oklahoma Health Sciences Center Joins Battle Against Antibiotic Resistance July 26, 2006 More than 51,000 UK Patients Over Age 65 Catch C. difficile per Year July 25, 2006 Inadequate Hospital hand Hygiene is Spreading MRSA July 24, 2006 Tygacil, a Broad-Spectrum Antibiotic for Treatment of MRSA Launched in UK July 20, 2006 Phase I Clinical Trials Start for New Anti-infective for Treatment of MRSA July 18, 2006 Bulky Biofilms Found in Kid's Ears July 11, 2006 Performance Measures May Lead to Overuse of Antibiotics July 10, 2006 Seafloor as Potential Source of New Antibiotics July 2, 2006 Biomarker Reduces Length of Antibiotic Treatment June 30, 2006 Use of Triclosan in Consumer Goods Should be Restricted - German Federal Institute for Risk Assessment (BfR) June 26, 2006 How Clostridium difficile can evade attack June 25, 2006 MRSA Infections Have Been Linked to Illegal Tattoos June 23, 2006 Overuse of Antibiotics in Aquaculture Encourages Bacterial Resistance June 20, 2006 Houseflies in Restaurants Carry Antibiotic Resistant Bacteria June 17 , 2006 Fishtanks: A Reservoir of Multi Drug Resistant Salmonella April 18, 2006 How Australia Saved Its Antibiotics April 18, 2006 APUA Launches New Home Hygiene Project March 24, 2006 APUA is pleased to announce its new "Hygiene for a Healthy Household" campaign, a research and education initiative funded through an unrestricted educational grant by the Clorox Corporation. While extensive guidelines exist for sanitation and disinfection procedures within health care environments, little work has been done to define practices of good hygiene within the home. Consumers consistently see conflicting messages regarding disease prevention and best methods of using household cleaners, soaps, and hand sanitizers in day to day life. We have assembled an expert advisory panel of cross-disciplinary experts who will work to address this gap by carefully reviewing the relevant issues and developing sound, science-based guidance for education efforts that will target consumers, including poor and minority populations. Check our website often for project updates. Will We Run Out of Antibiotics? March 17, 2006 Baby Antibiotics 'Link to Asthma' March 14, 2006 The results of a recent Canadian study suggest that children who receive a course of antibiotics during the first year of life are twice as likely to develop asthma later in childhood. Read more in the BBC article. APUA 2005 Member Reception and Leadership Award Presentation at ICAAC 2005 January 10, 2006 APUA held its annual Member Reception and Leadership Award Presentation at the 45th annual Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington, D.C. on December 17, 2005. This year Dr. Richard Besser of U.S. Centers for Disease Control & Prevention received the APUA Leadership Award in recognition of his national leadership of the Get Smart: Know When Antibiotics Work campaign. Anne Bolmström, of AB Biodisk, was also recognized for her instrumental role in advancing the use of antimicrobial resistance testing by APUA Chapters in the developing world. APUA would like to thank APUA collaborators from throughout the world who joined us for this eventful evening. We would also like to acknowledge our corporate sponsors and project partners for their generous support and invaluable collaboration in “preserving the power of antiobiotics®.” Our Platinum sponsors include: Bayer AG, the Libra Initiative; Procter & Gamble Pharmaceuticals; The Clorox Company; R.W. Johnson Pharmaceutical Research Institute; and JANSSEN Ortho-McNeil PC, Inc., Johnson & Johnson. We give special thanks to Wyeth-Ayerst Research for their generous support of this year’s reception. See additional information and event photographs. APUA President Stuart Levy to Speak on NPR's 'Talk of the Nation: Science Friday®' on Friday, August 19 August 12, 2005 APUA President Dr. Stuart B. Levy will be a guest on National Public Radio's "Talk of the Nation: Science Friday" radio show next Friday, August 19, from 2:00 to 4:00 pm. Science Friday® is hosted by veteran NPR science correspondent Ira Flatow. Dr. Levy will be discussing the recent FDA decision to ban the use of enrofloxacin (Baytril) for treatment of bacterial infections in poultry. Listen to and learn more about Science Friday. Drug-resistant Acinetobacter baumannii bacterial infections rising in American military August 4, 2005 Health providers have detected unexpectedly high rates of infection by drug-resistant Acinetobacter baumannii, a hardy, common bacterium, in American military personnel wounded in Iraq. A. baumannii carry natural drug resistance genes, in addition to developing resistance under antibiotic selective pressure. Because A. baumannii are able to survive on surfaces for up to 20 days, they pose a high risk of spread and contamination in hospitals, potentially putting immune-compromised and other patients at risk for costly and often deadly drug resistant infections. As more infected soldiers return from abroad, there is mounting concern for the possible implications for the U.S. health care system and the Veterans Affairs system in particular. For more information please see: Troops in Iraq Bring Resistant Bacteria Home. The New York Times, August 4, 2005 Acinetobacter baumannii Infections Among Patients at Military Medical Facilities Treating Injured U.S. Service Members, 2002-2004. CDC Morbidity and Mortality Weekly Report November 14, 2004 APUA GAARD Report Published in CID August 3, 2005 The 2005 Report of the Global Advisory on Antibiotic Resistance Data (GAARD), entitled "Global Antimicrobial Resistance Alerts and Implications" has been published as a supplement to Clinical Infectious Diseases, 15 August 2005, Volume 41. The report provides a uniquely comprehensive view of drug resistance patterns across the major infectious diseases by combining findings from diverse international surveillance systems run by the world's leading infectious disease experts. The document focuses on the most troubling and urgent infectious disease threats whose cures are imperiled by antimicrobial resistance: HIV/AIDS, tuberculosis, malaria, gonorrhea, pneumonia, and hospital-associated infections. See full report or learn more about the GAARD project. FDA Bans Use of Enrofloxacin (Baytril) in Poultry! July 28, 2005 The US Food and Drug Administration (FDA) is no longer allowing the use of the Cipro-like antimicrobial enrofloxacin for treating bacterial infections in poultry. Enrofloxacin is a fluoroquinolone antibiotic that is marketed by Bayer Corporation as Baytril. This represents the first time that the FDA has withdrawn the use of an animal drug due to concerns about emergence of antimicrobial resistance and its human health impact. Read the FDA’s Press Release and Final Decision. Also see APUA’s Ecology Program for more details. APUA Sponsors Congressional Staff Briefing on Capitol Hill July 19, 2005 APUA sponsored a Congressional Staff Briefing on Tuesday, July 19, 2005 from 2:00 – 3:30 p.m. in the Longworth House Office Building on Capitol Hill in Washington, D.C. The subject of the briefing was “Drug Resistant Infections in the U.S. -- A Threat to Patient Safety, National Security and Health Care Costs.” The presentation began with a welcoming speech by Congressman Stephen Lynch about the health problems of his constituents and extra Medicare and Medicaid costs caused by drug resistant infections. Kathleen T. Young, Executive Director of APUA, introduced the President of the organization, Stuart B. Levy, M.D., who then gave a short overview of the problem and introduced the expert panelists, who each gave a PowerPoint presentation. The panelists were: Dale N. Gerding, MD, Associate Chief of Staff for Research and Development, Hines Veterans Affairs Hospital; Professor Medicine, Loyola University Chicago Stritch School of Medicine; and a Chair of the National & Global Public Health Committee of the Infectious Diseases Society of America Gordon W. Grundy, MD, Regional Medical Director-Northeast Region, Aetna, Inc. Robert Scalettar, MD, Chair of the Coalition for Affordable Quality Health Care Save Antibiotic Strength Initiative; and former Corporate Medical Director for Medical Policy at Wellpoint, Inc. Drs. Gerding, Grundy and Scalettar related the problem of drug resistance to the following topics and made the following major points: Bioterrorism: Resistance to Ciprofloxacin among various bacteria continues to rise. The next bioterrorist agent may not be anthrax and will likely be engineered to be drug resistant. Health Care Costs: 55% of all hospital Staph infections are now multidrug-resistant. New epidemics of resistant bacteria are now appearing in ambulatory populations such as prisoners, children, and military recruits -an emerging threat to any non- hospitalized patient. Dwindling Supply of New Antibiotics and Misuse of Currently Effective Agents: Widescale misuse of antibiotics in human medicine and in food animal production. Companies are abandoning antibiotic development in favor of lucrative chronic disease drugs. Panelists concluded that targeted surveillance, research and education are key to warding off drug resistance epidemics. APUA gratefully acknowledges the generosity of Chiron Foundation and Aetna, Inc. for their partial funding of the briefing. A summary presentation is in preparation and will be available in the future. See summary of the Staff Briefing, expert panelists' Power Point presentations with current statistics, and photographs of the Staff Briefing. Powerpoint Presentations with current statistics (in pdf format): Antimicrobial Resistance in Hospitals: Lack of Effective Treatment for Gram Negative Bacilli and the Rise of Resistant Clostridium difficile Infections by Dale N. Gerding, MD, Chair, National and Global Public Health Committee, Infectious Diseases Society of America Antibiotic Resistance: Strategic Solutions by Gordon W. Grundy, MD, Regional Medical Director - Northeast Region - Aetna Inc. Save Antibiotic Strength Health Plans Address the Challenge of Antibiotic Resistance by Robert Scalettar, MD, Chair of the Coalition for Affordable Quality Health Care Save Antibiotics Strength Initiative Congressman Stephen F. Lynch (D-MA) opens the Staff Briefing with a plea to his colleagues to support AMR initiatives. Dr. Gordon Grundy presents strategic solutions to antibiotic resistance. Dr. Dale N. Gerding discusses AMR in hospitals, the lack of effective treatment for gram- negative bacilli and the rise of resistant Clostridium difficile. Dr. Robert Scalettar presents the "Save Antibiotic Strength" Campaign, the cost of AMR, and the need for appropriate antimicrobial use. Dr. Stuart B. Levy (APUA President) and Kathleen Young (APUA Executive Director), and Dr. Gerding greet Congressman Lynch (D-MA).   Dr. Levy and Kathleen Young chat with Staff Briefing attendees, including Voice of America Reporter, Sarita Ang. Dr. Gerding meets with Tanisha Parker and Robert Guidos of Infectious Diseases Society of America (IDSA). Dr. Stuart Levy's Comments on Suggestion That Breast Cancer is Linked to Use of Antibiotics. February 20, 2004 See further information Release of Antibiotic Policies: Theory and Practice, edited by Ian Gould and J.W. van der Meer. Preface written by Stuart Levy and a chapter on Antibiotic Policies in the Developing World written by Anibal Sosa. See excerpt from the book. 2003 Annual Leadership Award Reception Sept 15, 2003 The Alliance for the Prudent Use of Antibiotics (APUA) honored McDonald's Corporation and scientists at the Danish Veterinary Institute at its 2003 Annual Leadership Award Reception, held at the 43rd International Conference on Antimicrobial Agents and Chemotherapy in Chicago. See the complete press release. Drug-Free Food July 14, 2003 By Valerie Reitman, LA Times Staff Writer McDonald's decision to remove antibiotics from meat products could be an effective weapon in the fight to prevent drug resistance. For nearly half a century, farmers have been feeding poultry and some livestock the same antibiotics - penicillin, tetracycline, bacitracin - used to treat sick human beings. See the complete article. Visit Latimes.com. SARS --Severe Acute Respiratory Syndrome April, 2003 The recent epidemic of Severe Acute Respiratory Syndrome, or SARS, underscores the increasingly global nature of infectious disease and the need for international public health vigilance. Having emerged in November 2002 in southern China's Guangdong province, the deadly illness has since spread to Asia, Europe, and North America. SARS --which appears to be caused by a new strain of coronavirus-- also illustrates the important differences between disease-causing viruses and bacteria. Viruses are submicroscopic structures that can only reproduce inside a cell; they are unaffected by antibiotic drugs. Because most upper respiratory infections such as colds are caused by viruses, it’s unnecessary (and potentially even harmful) to take antibiotics for these illnesses. Bacteria, by contrast, are one-celled living organisms that reproduce outside of our body’s own cells. Unlike viruses, bacteria can be killed by antibiotics, which is why bacterial infections are often cured by these drugs. But when exposed to antibiotics, bacteria may also develop ways to defy or elude the medications. Indeed, drug-resistant bacteria --such as those causing tuberculosis, diarrheal diseases, and pneumonia-- are a growing health threat worldwide. APUA is dedicated to preventing these infections and stopping their spread. Doctors are currently treating suspected SARS cases with antiviral agents such as oseltamivir or ribavirin. In some cases, they are also administering broad-spectrum antibiotics as a precaution in case an undiagnosed patient’s pneumonia may be caused by disease-causing bacteria in the lower respiratory tract. For current information on SARS: U.S. Centers for Disease Control and Prevention World Health Organization Department of Health, Hong Kong SAR, China Ministry of Health, Singapore Health Canada: New Wave of Community MRSA in Boston and in San Francisco Alarms Doctors. March 5th, 2003 APUA is concerned to see the recent reports of methicillin resistant Staph aureus (MRSA) appearing in patients in communities and in community hospitals in Los Angeles, San Francisco, and Boston. This finding is further evidence of the emergence and threat of a critically important resistance problem in the community which was previously primarily faced in tertiary care settings. Clearly, the misuse and overuse of antibiotics in the community is the major contributing force. APUA through its GAARD and ROAR programs, aims to find ways to identify an incipient resistance problem before it occurs and to recommend appropriate interventions to prevent the resistance problem from emerging and spreading in the community. For now, we must continue to encourage the prudent use of antibiotics for common bacterially-caused illnesses. See the San Francisco Chronicle article FDA issues Final Rule on Labeling Requirements for Systemic Antibacterial Drug Products Intended for Human Use. February 5, 2003 Second confirmed case of Vancomycin-resistant S. aureus in the US October 11, 2002 see the CDC report. Curb farm antibiotics August 29, 2002 Panel recommends restricting drugs used on livestock as fears of risk to humans increase See the full article Experts Issue Report to Health Canada on Use of Antimicrobials in Food Animals June, 2002 An Advisory Committee, represented by a wide range of experts and stakeholders submitted its consensus report, Uses of Antimicrobials in Food Animals in Canada: Impact on Resistance and Human Health, to Canada in June 2002. The Report was made available to the public in September. The Committee made 38 recommendations for actions by public health officials, veterinary professional organizations or industry to better protect the health and interests of Canadians. Vancomycin-resistant S. aureus in the US July 5, 2002 In 1996, the first case of reduced susceptibility of Staphylococcus aureus to vancomycin was reported in Japan. In July 2002, the CDC reported the first case of vancomycin-resistant S. aureus in the US (vancomycin MIC >32 µg/mL). The CDC cautions that "The emergence of VRSA underscores the need for programs to prevent the spread of antimicrobial-resistant microorganisms and control the use of anti-microbial drugs in health-care settings." See the CDC report. Decline in antibiotic prescribing reported June 19, 2002 Antibiotic prescriptions for children have decreased dramatically in the US over eleven years. A survey conducted by the CDC of office-based physicians shows that antibiotic prescriptions for children under 15 years-old decreased from 46 million to 30 million from 1989 to 2000. The number of visits to physicians' offices remained constant during that time. The study found specific declines in prescriptions for pharyngitis and upper respiratory tract infection; however, prescribing rates for sinusitis did not change. The original study is published in JAMA 2002, 287:3096-3102. See also the CDC press release and an article in the Washington Post. Strep throat bacteria show resistance to antibiotics April 17, 2002 A recent study from the U.S. reports an outbreak of Group A Streptococci (GAS) that are resistant to erythromycin, an antibiotic commonly used to treat strep throat. GAS are the most common cause of strep throat, a disease that can lead to rheumatic fever in a small percentage of patients. In a study reported in the New England Journal of Medicine, 48% of throat cultures from schoolchildren containing GAS were resistant to erythromycin. Alerted by this unusual outbreak in the school in Pittsburgh, PA, the researchers gathered similar data from the surrounding Pittsburgh community. Of 100 throat cultures containing GAS, 38% of them were resistant to erythromycin. This study suggests that erythromycin-resistant strep throat infections may be more widespread than is commonly acknowledged. The original study was published in NEJM 2002 Vol 346, No 16, pgs 1200-1206. More information about Streptococcal infections. Pharmacy at U. Pennsylvania Restricts Antibiotic Sales October 16, 2001 In response to the ongoing stockpiling of antibiotics, the pharmacy at the Hospital of the University of Pennsylvania is restricting sales of ciprofloxacin, levofloxacin, doxycycline and amoxicillin in the outpatient pharmacy. All prescriptions for these agents must include an indication to justify use. Only a 10-day supply of antibiotics will be dispensed; however, proven infections requiring longer courses of therapy will be handled on an individual basis. Prescriptions for personal stockpiles will not be filled. The University of Pennsylvania adopted this policy to be proactive, to prevent depletion of existing stores of antibiotics, and to reduce the sense of paranoia and alarm concerning the hospital's antibiotic supply. This action by the pharmacy at the Univ. of Pennsylvania is in keeping with the recommendations of Dr. Stuart Levy, President of APUA, that third party payers and pharmacists should not dispense ciprofloxacin or other antibiotics without a specific indication for their use. AMA: Don't Prescribe Antibiotics for Potential Bioterrorism October 15, 2001 The American Medical Association (AMA) is advising physicians not to give antibiotic prescriptions "just in case" of an anthrax attack. The AMA suggest that patients could take the antibiotics unnecessarily which can lead to greater antibiotic resistance. The AMA notes that antibiotic resistance is a public health threat in its own right. See the text of AMA statement WHO Global Strategy     September, 2001 To combat the growing threat of antimicrobial resistance, the World Health Organization (WHO) released its first Global Strategy for Containment of Antimicrobial Resistance. APUA developed one of the technical documents supporting the WHO Global Strategy, Antibiotic resistance: synthesis of recommendations by expert policy groups. AMA Recommends Restricting Antibiotic Use in Animals      June 2001 The policy making group of the American Medical Association (AMA) adopted a resolution at its 2001 annual meeting opposing the sub therapeutic uses of antimicrobials in animal agriculture and called for regulations to support this stance. The AMA resolution says that almost 80% of antimicrobial use in agriculture is for growth promotion, as pesticides, or prophylactic (disease prevention). The resolution notes that this prolonged low-level use of antimicrobials is likely to promote the development of resistance. The resolution states that the increase of antimicrobial resistance is a threat to human health. The Animal Health Institute (AHI) responded with a statement saying that the AMA's resolution was too sweeping and was "an ineffective solution to addressing antibiotic resistance." In particular, the AHI says that there is little scientific evidence indicating a transfer of antibiotic resistance from animals to humans. The AHI advocates additional efforts into research and monitoring antimicrobial resistance. The Antibiotic Resistance Act of 2001      May 15, 2001 On May 9, Rep. Sherrod Brown, (D. Ohio) introduced HR 1771, the Antibiotic Resistance Act of 2001. (The version appended here is the one that was introduced, despite its not having a bill number nor cosponsors listed on the bill.) This bill seeks funding for the Department of Health and Human Services (DHHS) to implement the priority items in the Federal Government's Interagency Action Plan, adopted in January 2001. The bill pertains only to DHHS agencies. The bill begins with a list of findings and then includes the priority action items. Rep. Brown is the Ranking Minority Member of the House Energy and Commerce Committee's Subcommittee on Health. The Chairman of the Subcommittee, Rep. Bilikraus, (R. Florida), joined in support of the bill. At a press conference announcing the bill, Rep. Brown was joined by other Members of Congress -- Rep. Slaughter (NY)(a microbiologist), Rep. Waxman (CA) (former chair of House Committee on Energy and Commerce), Rep. Ganske (Iowa)(a physician), Rep. Pallone, and Rep. Greene. Other cosponsors of the bill included: Rep. John Dingel, Ranking Member, Energy and Commerce (Michigan), Rep. DeGette (Colorado), Rep. Jones (Ohio), Rep. Kildee (Michigan), Rep. Towns (NY), Rep. Lee (California), Rep. Filner (CA), Rep. Capuano (MA), and Rep. Kucinich (Ohio). Last year the Science Committee in the House expressed interest in holding hearings on antibiotic resistance and one possibility is that this Committee might hold a hearing on this bill sometime during the summer. If you have questions on the bill, please contact Earl Seeley, staff to Rep. Brown, or Barbara Souder at APUA. Five Patients Show Resistance to Linezolid, a Novel Antibiotic      April, 2001 As the first structurally different antibiotic introduced in almost 3 decades, Linezolid held, and still holds, great promise as a powerful new drug for treating difficult infections. However, the emergence of resistance to this new antibiotic in 5 patients, recently reported in The Lancet (vol. 354:1179 April 14, 2001), undermines confidence in its continued efficacy. All five patients received the drug for prolonged periods of time (21-40 days). The findings again demonstrate that long-term use of a single antibiotic increases the chance for emergence of strains bearing resistance. A major lesson is that any new antibiotic can quickly become ineffective due to resistance in patients undergoing chronic long-term use. New classes of antibiotics are needed to fight these resistant infections. National Press Club Discusses Antibiotic Resistance        Apr. 17, 2001 Dr. Tom O'Brien, vice-president of APUA, joined a roundtable discussion "Save Antibiotic Strength, a national dialogue on antibiotic resistance risks and solutions" at the National Press Club in Washington DC. The event brought together physicians from health plans, medical specialty societies, government health organizations, and nonprofit health organizations to discuss innovative solutions to the antibiotic resistance problem-a problem which kills almost two people in the US every hour! View a video webcast of the Save Antibiotic Strength discussion. US Interagency Action Plan      Jan. 18, 2001 The US Department of Health and Human Services released its Interagency Action Plan for fighting antimicrobial resistance. The Action Plan sets priorities and deadlines for ten US agencies and departments in the following areas: 1) surveillance, 2) prevention and control, 3) research, and 4) product development. These four areas contain 84 action items, including 13 priority action steps considered essential to addressing antimicrobial resistance. Of these 13 priorities, seven are already underway, and six are planned to begin within the next one to two years. press release comparison of the draft and final Action Plan APUA's comments on the draft Action Plan FDA Antibiotics Labeling Requirements     Dec. 2000 The FDA has proposed specific labeling requirements for all systemic antibacterial drugs intended for human use. The APUA supports this effort and suggests strengthening and clarifying the regulations. read APUA's letter to the FDA FDA to Withdraw Approval of Two Poultry Antibiotics     Nov. 2000 The US Food and Drug Administration Center for Veterinary Medicine (CVM) is withdrawing its approval of two fluoroquinolones for use in poultry. According to an FDA risk assessment statement, consumption of poultry that contains fluoroquinolone-resistant Campylobacter is the main cause of fluoroquinolone-resistant Campylobacter infection in humans.The drugs are enrofloxacin, manufactured by the Bayer Corp., of Shawnee Mission, Kansas, and sarafloxacin hydrochloride, manufactured by Abbott Laboratories, of North Chicago, Illinois. read more read APUA's letter to Bayer ICAAC Symposium: Global Resistance Day     Sept. 2000 Global Resistance Day, co-sponsored by the APUA at the 40th ICAAC, brought a global perspective to the issues of surveillance and detection of antimicrobial resistance and the need for education, research and development in this area. For more information, see the Medscape article (free password required) "Global Resistance Day: Unprecedented and Promising", by Robert A. Weinstein, MD. Physician Survey Identifies Factors That Influence Antibiotic Prescribing A pilot survey of primary care physicians in Massachusetts, conducted in 1998 by APUA, the Massachusetts Infectious Disease Society, and the Massachusetts Department of Public Health, will enable us to develop tools to improve prescribing habits. read more Drug Resistance Threatens to Reverse Medical Progress- WHO Report Dr. David Heymann, Executive Director for Communicable Diseases at the World Health Organization, and Dr. Jeffrey Koplan, Director of the US Centers for Disease Control and Prevention had issued a press release entitled "Drug Resistance Threatens to Reverse Medical Progress." WHO warns in its recent annual report on infectious diseases, "Overcoming Antimicrobial Resistance," that the world is facing a dangerous situation as once-effective medicines are becoming increasingly ineffective. Dr. Gro Harlem Brundtland, Director-General of WHO, stated that, "We risk losing these valuable drugs -- and our opportunity to eventually control many infections." read more Clinical Practice In a Clinical Infectious Disease article, researchers found that single-dose therapy for acute bacterial cystitis, in women, is less effective than longer durations. A three-day course of TMP/SMX is considered the current standard. B-lactams are considered inferior for three-day therapy. It is important to note that to control emergence of resistance, quinolones should not be used as first line agents, unless there is existing resistance to TMP/SMX. For acute pyelonephritis in young non-pregnant women, with normal urinary tract anatomy, 14 days of therapy is adequate, quinolones are preferred for mild cases that can be treated orally. Severe cases require hospitalization, and parenteral quinolones, aminoglycosides (without ampicillin) or an extended-spectrum cephalosporin can be used. However, note that gram positive organisms should be treated with ampicillin or amoxicillin. Please realize that these recommendations are based on the antimicrobial susceptibilities of pathogens during the late 1990s, and can change regionally where resistance patterns are occurring. Therefore, careful monitoring of trends is essential. Warren JW, et. al. “Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and pyelonephritis in women”. Clinical Infectious Disease 1999 Oct., 219: 745-58 New Interventions Kaiser Permanente in Denver Co. examined the effects of antibiotic use for acute bronchitis. An educational intervention was aimed at primary care providers and 2500 household receiving services. Additionally posters in waiting rooms distinguished between chest colds and bronchitis and actively discouraged the use of antibiotics for the former. After the intervention, there was a 26% reduction in the use of antibiotics and a 28% reduction in the number of office visits. This article stressed the significance of the public health crisis in antimicrobial resistance of common respiratory pathogens. In addition, that problem should be foremost on the minds of providers, when they are prescribing medications. Gonzales R., et. al.. JAMA 1999; 281: 1512-1519.. Co-trimoxazole Used in the Treatment of AIDS by Dr. Stuart Levy With great concern, I read the recent report by Donald G. McNeil, Jr., which describes recommendations by the World Health Organization and the United Nations AIDS program to provide "regular doses" of the antibiotic co-trimoxazole for the prevention of bacterial and parasitic diseases in AIDS patients in Africa. I understand why the recommendation has been made, but am considerably worried by the potential consequence of this action -- the emergence of resistance to the drug...comments New Antibiotics Inject Hope, Underscore Misuse The drug, Zyvox, can fight deadly bacteria that had learned to defeat the best antibiotics doctors could throw at it. And more arrows will fill doctors' quivers soon, with six drugs awaiting FDA approval and another 11 in late stages of clinical testing. About a third of the 150 million antibiotic prescriptions written each year are inappropriate. One study found that as many as 70% of patients with colds and upper respiratory tract infections and other ailments most often caused by viruses -- which can't be treated by antibiotics -- were prescribed antibiotics anyway. Doctors confronted with these alarming trends are quick to point fingers. A survey of Massachusetts doctors by the Alliance for the Prudent Use of Antibiotics (APUA), for instance, finds doctors often blaming patients who demand antibiotics when they feel bad. Other doctors complain about drug company marketing. Still others say heavy workloads imposed by HMOs makes proper diagnosis difficult...news article CDC Warns About Overuse of Antibiotics In an effort to reduce the growing numbers of drug-resistant bacteria, officials at the Centers for Disease Control and Prevention (CDC) are urging physicians to stop prescribing antibiotics where the drugs are not necessary.Director of Antimicrobial Resistance for the CDC, Dr. Richard Besser, told an audience of physicians attending a medical conference that each year US physicians write $50 million worth of prescriptions that are ineffectual and unnecessary. A common reason for unnecessary prescriptions is patient demand for treatment. "We are facing a crisis because doctors are pressured to prescribe antibiotics for the common cold and inner ear infection, yet we know that it is not prudent to do so...news article Laboratory Capacity to Detect Antimicrobial Resistance Emerging mechanisms of antimicrobial resistance have clinical, microbiologic, and infection-control implications for health-care providers. Antimicrobial resistant organisms include Staphylococcus aureus with reduced susceptibility to vancomycin (minimum inhibitory concentration [MIC] greater than or equal to 4 µg/mL), including vancomycin intermediate S. aureus (VISA; vancomycin MIC=8-16 µg/mL) (1-4) and Enterobacteriaceae that produce extended spectrum þ-lactamases (ESBLS), which result in resistance to a broad range of þ-lactam antibiotics...news article FDA modifies antibiotic use in livestock In response to increasing concern over foodborne resistant bacteria, the Food and Drug Administration (FDA) is tightening regulations governing the use of antibiotics in livestock. The FDA expects new guidelines to go into full effect within the next two years, requiring pharmaceutical companies to provide predictive information about how quickly resistance may develop to certain pathogens. Prior to this, the agency had simply mandated additional information only if an agricultural drug was slated for subtherapeutic use. The agency has zeroed in on fluoroquinolones, a class of antimicrobial recently approved for use in livestock. Organisms resistant to this drug class have started to make an appearance, prompting concern over future use. A recent government report, for instance, suggests that up to 5,000 Americans may have suffered long-lasting food poisoning as a result of infection by resistant Campylobacter, a bacterium commonly found in poultry, and one that is often treated with fluoroquinolones. The organism's resistance to the drug may have contributed to longer illnesses...news article Antibiotic resistant bacteria in human colon Bacteria that normally reside in the human colon have been found to be significantly more resistant to the antibiotic tetracycline than colonic bacteria of thirty years ago. A recent study funded by the National Institutes of Health has shown that Bacteroides, a strain of bacteria not harmful in the lower intestines, but often life-threatening when they escape during surgery or trauma, increasingly carry a gene that confers this resistance. Furthermore, this gene can be passed from bacteria to bacteria, regardless of species, in a form of bacterial sex that transfers segments of their DNA. Eighty percent of colonic bacteria are now carriers of this gene, demonstrating just how rapidly the genetics of resistance can spread through a bacterial population...news article Antibiotic may help prevent heart attacks In what may be a major breakthrough for patients suffering from heart-related conditions, doctors are examining a growing body of evidence that suggests infectious agents may be at least partly responsible. Bacteria may play a role in heart attacks, atherosclerosis (plaque build-up along artery walls), and the invasive procedures that often accompany these conditions, including bypass surgery and angioplasty. The bacteria suspected of triggering heart disease is Chlamydia pneumoniae, a relative of the sexually transmitted which causes pneumonia and bronchitis. "Antibiotic therapy could become a major breakthrough treatment against a disease that kills more Americans each year than any other," says Dr. Jeffery Anderson, chief of cardiology at the University of Utah Medical Center, in Salt Lake City. Test groups will be given the antibiotic azithromycin, in part because it can get inside cell walls where the persistent Chlamydia may hide, often dormant for years. Patients will be compared to a control group and monitored for four years to see just how effective their antibiotic therapy is against their disease...news article New drug effective against common infections For the first time in over 35 years, a new antibiotic with a unique mechanism of action has been developed and has been found to be highly effective in the treatment of infections caused by Gram-positive bacteria in both adults and children. The new drug, Zyvox, blocks bacterial growth by disrupting the organism's protein synthesis. Worldwide, over 50% of all infections treated in hospitals involve Gram-positive bacteria, causing illnesses such as pneumonia and infections of the skin and blood. These organisms are frequently difficult to kill, and doctors often rely on powerful drugs like vancomycin to treat the resistant, often life-threatening infections they may cause, particularly in cases involving burns or surgical procedures. But studies have shown that in some instances, Zyvox is more effective than vancomycin, offering clinicians one more line of defense against these dangerous types of infection...news article Most cases of chronic sinusitis caused by fungi Researchers at the Mayo Clinic believe they have found what is thought to be the culprit of many sinus infections, a disease with acute and chronic manifestations, and one that is often treated with antibiotics. Sinusitis, characterized by the inflammation of the membranes of the nose and sinus cavity, affects an estimated 37 million people in the United States, and its symptoms include runny nose, headache and congestion. But in many instances, antibiotics are ineffective because they target bacteria, and researchers now believe that in the vast majority of chronic cases, sinusitis is caused by a fungus. It is the body's own immune reaction to the fungi that results in irritation of the nasal membranes, and research is underway to control the presence of these microbes. Ultimately, such studies may lead to proper and effective treatment of the disease-and less improper use of antimicrobials...news article Seaweed extract improves animal health Farmers of livestock have long relied on antibiotics to protect their animals against infection and to promote their growth -- practices that are documented to contribute to the global reservoir of resistant bacteria. Now scientists in Texas, Mississippi and Virginia are experimenting with a seaweed extract that, when fed to cattle and swine, boosts the animals' immune system and increases their weight gain. Cattle farmers feed their livestock antibiotics in part to counter the toxic effects of a fungus that naturally grows on the tall fescue grass their animals graze on -- a grass that is a staple of the industry. While this fungus provides the plant with protection, its toxicity to animals results in their lowered performance, elevated temperature and weakened immune system. The seaweed appears to reverse some of the poisonous effects of the fungi, and cattle that are fed the extract are better able to fight disease, resulting in a healthier animal. Scientists are also looking into what effects the seaweed extract might have on horses and poultry...news article Use of medicated feeds for minor species The US Food and Drug Administration's announced the availability of a draft compliance policy guide (CPG) entitled "Use of Medicated Feeds for Minor Species.'' The purpose of the draft CPG is to provide guidance to the FDA's field offices concerning the agency's exercise of regulatory discretion with regard to the extra-label use of medicated feeds for minor species. Note: Written comments on the draft CPG should be submitted to the FDA by November 23, 1999. The initial notice was published in the Federal Register, the draft CPG may be accessed from the CVM's website. Community-acquired MRSA: pediatric deaths and illnesses reported in the United States APUA. 1999. APUA Newsletter 17(3): 5. Four fatalities and several hundred illnesses have recently been reported in the United States as a result of infection by a community-acquired strain of methicillin-resistant Staphylococcus aureus (MRSA). Once confined to recently hospitalized patients, intravenous drug users, and those in long-term care facilities, the incidence of MRSA has steadily increased since it was first reported in 1968. Nosocomial MRSA isolates rose from 2% in 1974, to roughly 50% in 1997. More ominously, it appears that a variant has made its way into the community, infecting patients without established risk factors. Over the past two years, four children ranging in ages from 1 through 13 have died as a result of MRSA infection, and over 200 others have become ill. Such outbreaks pose serious concerns to healthcare providers and decision-makers, and reiterate the pressing need for sound antibiotic policies. “Continued excessive use of antibiotics is driving the appearance of this strain,” said Dr. Tim Naimi, medical epidemiologist for the Centers for Disease Control and Prevention (CDC), in Atlanta. In all four fatalities, MRSA strains were multidrug susceptible, except to the beta-lactams. The most widely used drug class for antibiotic therapy, these antimicrobials have seen their efficacy erode during the last 25 years. The children arrived with a variety of symptoms, including high fever, sepsis, pneumonia and/or empyema. “When we have otherwise healthy kids dying of S. aureus infections, it tells us something is very wrong,” said Dr. Stuart B. Levy, APUA President, and Director of the Center for Adaptation Genetics and Drug Resistance at Tufts University. The CDC suspects that all four patients were compromised by an initial dose of a cephalosporin, which may have delayed their treatment by more powerful antimicrobials. As a result, CDC officials are advising all healthcare providers to obtain appropriate cultures of infected sites before initiating treatment, especially in areas where MRSA infections have been reported. The diverse patient backgrounds described in these recent cases have officials concerned. The implications are that MRSA colonization may be widespread, particularly in the Midwestern states. Initial cases were reported in Minnesota and North Dakota. Other suspected cases have been identified in Illinois and Tennessee, in facilities like day-care centers and pediatric hospitals. A recent study, conducted at the University of Chicago Children's Hospital, suggests that community-acquired MRSA is on the rise. The number of children hospitalized with community-acquired MRSA went from 8 in 1988-1990, to 35 in 1993-1995. Additionally, during those same years, the incidence of MRSA infection in patients without identifiable risk factors rose to 259 per 100,000 admissions, up from 10 per 100,000. The strain is also showing up in minority communities in other countries. What role increased antibiotic use particularly in children has played in the growing incidence of community-acquired MRSA, has yet to be determined. Resistance in MRSA strains is conferred by the chromosomal mecA gene, which encodes a penicillin-binding protein. Many nosocomial strains are multidrug resistant, and 50% of isolates at hospitals identified by the National Nosocomial Infection Surveillance system are susceptible only to vancomycin. Clinicians use this antibiotic as a last resort, in an effort to maintain its effectiveness. “In the long run, if these strains continue to be common, an important consequence will be the altering of prescribing habits,” cautioned Naimi, saying that ultimately what he hoped to see was a “change in attitude, not necessarily a change in the knowledge base” of doctors and healthcare providers....CDC's full report Streptococcus pneumoniae resistance to fluoroquinolones on the rise in Canada...abstract Chen DK, McGeer A, de Azavedo JC, Low DE. 1999. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. New England Journal of Medicine 341(4): 233-239. Antibiotic resistance appears stable for gonorrhea; however, picture less clear for Chlamydia...full report DiCarlo, RP. 1999. Monitoring STD resistance to antimicrobials: Stable or rising? Thirteenth Meeting of the International Society for Sexually Transmitted Diseases Research in Denver, Colorado, July 11-14. US government report on food safety and the use of antibiotics in agriculture...to order US General Accounting Office. 1999. Food Safety: The Agricultural Use of Antibiotics and Its Implications for Human Health. GAO/RCED-99-74 Food Safety, April 28, 1999...full article Using antibiotics wisely: when they work, when they don't...full article Tangley L. 1999. Pill poppers: Using antibiotics prudently. US News Online, May 10. Scientists worry about antimicrobial cleaning products...full article Couzin J. 1999. Cleaning up: Battling bugs in the home. US News Online, May 10.
ALLIANCE FOR THE PRUDENT USE OF ANTIBIOTICS © 1999
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