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Antibiotic Stewardship and Policy

As part of the 2010 Conference on Antimicrobial Resistance, Symposium 6

brought together experts in the area of Stewardship and Policy.

Dr. Susan J. Rehm, of the National Foundation for Infectious Diseases

(Bethesda, MD) moderated talks given by Dr. Neil Fishman, of

the University of Pennsylvania (Philadelphia, PA), Robert C. Owens, Jr., PharmD, of Maine Medical Center (Portland, ME), and Dr. Mike Apley, DVM, DACVCP, of Kansas State University

(Manhattan, KS).

antibiotics article.jpgDr. Fishman began his presentation with a history of antimicrobial use for infectious diseases.  Statistics show that today, over 70% of antibiotics bought in the United States are used for food livestock, he said.  Furthermore, Fishman said that as much as 50% of antimicrobial use in the US is either inappropriate or unnecessary.

Though numerous bills to combat the abuse of antibiotics for non-therapeutic use in the agricultural industry have passed through the halls of Congress, many die before they see a vote due to partisan politics and the influence of the large-scale agricultural lobby.

For example, the Strategies to Address Antimicrobial Resistance Act, or the STAAR Act (H.R. 2400) introduced by Representative Jim Matheson (D-UT) in May of 2009 lost traction last year. The STAAR Act aimed to strengthen federal antimicrobial resistance surveillance, prevention and control, and research efforts as well as enhance the collection of critical information on the sue of antibiotics in humans and animals, according to a summary by Infectious Diseases Society of America.  The bill died in Congress, but supporters hope it will resurface in 2010. 

In his presentation, Dr. Fishman emphasized the importance of identifying “high priority” products (such as new antibiotics) for research and development (R&D) and then create incentives for companies to create these drugs.  He suggested incentives such as tax credits, market exclusivity, and patent extensions. 

Dr. Fishman also noted that in comparison to Europe and the rest of the world, the United States is the only developed nation that does not have open access to antibiotic use data.  This creates a problem in that agencies and organizations are not able to communicate their findings and collaborate for R&D ventures.

In conclusion, Fishman stressed the extreme importance of promoting nationally coordinated public policies including antimicrobial stewardship and convincing the government to increase the budget for antimicrobial R&D.  The recent budget proposal released by the White House included a federal budget decrease in the area of antibiotic studies by $8.6 million dollars.    

Owens’ presentation, Antimicrobial Stewardship in 2010: When to Act, When to Study was primarily about stewardship programs within hospitals in order to optimize precious resources.  He described antimicrobial resistance as a multi-factorial issue in that it effects both agricultural animals and humans, but the larger problem is the lack of experts in the area.

He noted the usefulness of audits in order to make sure that Doctors and Pharmacists are paying attention to how many prescriptions they are writing in addition to monitoring whether or not the prescriptions are being appropriately prescribed.  For example, the obese population needs 27.7% of a general antibiotic prescription.  If patients are not given the correct prescriptions, it makes the problem even more dire.

Owens rhetorically asked, “Why create new antibiotics if we can’t use the ones we have the right way?”  He closed his presentation by encouraging hospitals to reduce their use of antibiotics, practice strategic prescribing, and invest in research and development.

The final presentation of Symposium 6 was Dr. Apley’s Antibiotic Stewardship in Veterinary Medicine.  Apley was one of the only presenters at the conference who was not extremely critical of the use of antibiotics in the agricultural industry. 
 
Dr. Apley encouraged farmers to follow judicious guidelines for use of antimicrobial in animals, and said that antibiotics can be used non-detrimentally for therapeutic, preventative, control, weight gain, and feed efficiency uses.  Extralabel use of antibiotics for aforementioned reasons is regulated by the Animal Medicinal Drug Use Clarification Act as well as numerous subcommittees and clinical and laboratory standards institutes, which Apley insisted means use is completely safe.

In addition to supporting the use of antibiotics in food animals for non therapeutic use, Apley also criticized Pork Unions for raising issues and releasing studies on antibiotic use without having their reports peer reviewed.  Apley was also extremely critical of and voiced his opposition to the PAMTA bill. 

The PAMTA bill–or the Preserving Antibiotics for Medical Treatment Act–introduced in March of 2009 by Rep. Louise Slaughter (D-NY-28) would curtail the growth of resistant bacteria on factory farms by amending the Federal Food, Drug, and Cosmetic Act to withdraw the use of seven different classes of antibiotics from use on factory farms for non-therapeutic use.  The seven classes of banned antibiotics essential to human health and fighting infectious diseases include penicillins, tetracyclines, macrolides, lincosamides, streptogramins, aminoglycosides, sulfonamides, and any other drugs used to treat bacterial illness in people.  

In conclusion, Dr. Apley did insist that as practitioners, the goal is to bring antibiotic use down, but that in order to do this, scientists and doctors must stop using human breaking points in veterinary medicine and focus on finding the breaking points for drugs used in animals.           

Read more about the conference here.

Abstracts from the Antibiotic Stewardship and Policy Symposium or the rest of the conference are also available here (pdf).

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