U.S. Agencies Announce Plan to Combat Antimicrobial Resistance

(for Australian Doctor)

 

Departments and agencies of the United States have put forward a plan to reduce the development of antimicrobial resistance (AR) in pathogenic microorganisms.  The plan provides for coordinated efforts made by nine federal agencies, led by the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH).

 

Many species of clinically important bacteria have developed resistance to antimicrobial drugs, including Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, and Salmonella and Klebsiella spp.  At present 11% of S. pneumoniae in the U.S. are resistant to third generation cephalosporins. Bacterial resistance to fluoroquinolones has also occurred, and resistance to vancomycin has arisen among strains of S. aureus and enterococci.

 

Released on January 19, 2001, the plan results from the work of the Interagency Taskforce on Antimicrobial Resistance, created in 1999. Although it does not identify specific factors contributing to AR, the document identifies four focus areas for intervention: surveillance, prevention and control, research, and product development. It assigns lead agencies responsible for addressing each of 82 separate action items, and it calls attention to thirteen of these items for top priority effort.

 

At the present time, no coordinated national system for tracking AR currently exists in the U.S.  Top priorities will include developing and implementing a national monitoring system that defines and coordinates the roles of federal, state, and local agencies, clinics, and laboratories.  Such a system will survey the occurrence of AR, as well as the patterns of use of antimicrobials in clinical and veterinary medicine, and in agricultural and consumer product use. 

 

Educational programs are also assigned top priority under the plan. Campaigns directed at patients and health professionals will aim to promote the appropriate use of antimicrobials. These efforts will include the development of culturally appropriate materials to help physicians explain to patients the benefits and limitations of antimicrobial treatment, and to promote patient adherence to prescribed treatment.  Databases of drug resistant organisms and guidelines for proper antimicrobial treatment will be created to aid physicians in making decisions about use of these drugs.  In conjunction with these efforts, a program will be established for evaluating current infection control practices and assessing the effectiveness of new strategies.

 

Another priority item will be the refinement and implementation of a proposed FDA framework for approving new antimicrobials for use in agricultural food-animals and, when appropriate, for re-evaluating currently approved veterinary drugs.  Drugs will be classified according to their importance in human medicine, and procedures will be developed for assessing the risks for human health of using important human antimicrobials in food-animals.

 

Top priorities in scientific research will include the application of genomics and other powerful technologies to the development of new diagnostic methods and preventive and    therapeutic interventions.  The plan directs the conduct of human clinical studies of antimicrobial resistance, especially when such investigations are unlikely to be done in the private sector. It also supports the development and testing of accurate, affordable, and easily implemented methods of rapid diagnosis of infection, for use in point-of-care settings. In each of the areas targeted by the plan, the governmental agencies will cooperate with and coordinate similar efforts by private industry and academia.  An Interagency AR Product Development Working Group will pinpoint needs for new drugs, vaccines, disinfectants, diagnostics, and devices to combat infections.