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Antibiotics
In The News
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
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 ţ-lactamases (ESBLS), which result
in resistance to a broad range of ţ-lactam antibiotics...news
article
Fourth
case of antibiotic resistant Staphylococcus aureus confirmed
in U.S.
Staphylococcus
aureus is one of the most common causes of hospital- and community-acquired
infections. Nosocomial methicillin-resistant S. aureus (MRSA)
infections have become common, and cases of community-acquired MRSA
infections also have occurred (1,2). Since 1996, vancomycin-intermediate
S. aureus (VISA; vancomycin minimum inhibitory concentration...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.
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