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Stewardship / Resistance Scan for Apr 01, 2021

ReAct report lays out challenges, solutions for antibiotic access

A new report from antibiotic research and development (R&D) advocacy group ReAct outlines the challenges and solutions for creating a new model that will deliver sustainable access to antibiotics for all countries.

Arguing that governments around the world have so far failed to respond with either the scale or the urgency required to address rising antibiotic resistance, the decreasing effectiveness of current antibiotics, and the weak pipeline of new antibiotics, the report lays out five key challenges that governments must solve to achieve sustainable access to affordable, effective antibiotics. The model outlined considers how the entire chain of stakeholders in antibiotic development, from pharmaceutical companies to investors to governments, should work together.

The five challenges identified are setting research priorities that address the most significant and unmet global health needs; overcoming the scientific barriers in the early discovery and research phases for new antibiotics; financing late-stage clinical R&D without relying on price and sales revenues of the end-products; ensuring sustainable, environmentally appropriate production, quality, procurement, and registration of novel antibiotics; and ensuring sustainable, equitable access to new antibiotics in all countries in a manner that guarantees safe and responsible use.

Among the recommendations to address these challenges are establishment of a global entity for early-stage R&D, increasing public funding of early-stage research, fully delinking the cost of antibiotic R&D from the expectation of sales revenues, and adopting national legislation that sets antibiotic production standards.

“Today it is almost thirty-four years since the last class of antibiotics was discovered. The world cannot afford another 30 years of stalemate,” ReAct founder Otto Cars, MD, PhD, a professor of infectious diseases at Sweden’s Uppsala University, writes in the introduction to the report. “New ways forward must be explored and seen as an opportunity to create a system that by design serves the health needs of us all—rich and poor.”
Mar 30 ReAct report

 

Study finds high use of topical antimicrobials in Australian nursing homes

A national point-prevalence survey found that topical antimicrobials are frequently prescribed in Australian nursing homes, researchers reported yesterday in the American Journal of Infection Control.

To evaluate patterns of topical antimicrobial prescribing at Australian residential aged care facilities (RACFs), a team led by researchers from the University of Melbourne extracted all data submitted by RACFs in 2018 and 2019 to the National Antimicrobial Prescribing Survey. Data included the antimicrobial selection, start date, frequency, route of administration, therapy type, and indication. Antimicrobials were classified as topical if applied to skin or mucous membranes and included drops for eyes, nose, and ears.

The results showed that 4,277 of 52,431 residents at 629 RACFs were prescribed one or more antimicrobial, for a prevalence of 8.1% (95% CI, 7.9% to 8.4%). Of those residents, 1,500 were prescribed a topical antimicrobial (2.9%; 95% CI, 2.7% to 3.0%). Of all prescribed antimicrobials, 33% (1,614 of 4,899) were for topical application, mainly antifungals and antibacterials. The most frequently prescribed topical antifungals were clotrimazole (85.3%) and miconazole (9.1%), and the most frequently prescribed antibacterials were chloramphenicol (64.1%) and mupirocin (21.8%). 

Tinea (38.3%) and conjunctivitis (23.8%) were the two most common indications. Topical antimicrobials were sometimes prescribed for pro re nata (as-needed) administration (38.8%) and for more than 6 months (11.3%). The review or stop date was not always documented (38.7%).

The study authors note that widespread use of mupirocin has been known to cause increased resistance rates in Staphylococcus aureus and that the widespread use of clotrimazole (86.4%) and chloramphenicol (95.1%) for tinea and conjunctivitis, respectively, is questionable. Based on their findings, they have recommended the implementation of some simple antimicrobial stewardship (AMS) practices at RACFs to improve prescribing of topical antimicrobials.

“It is recommended that those RACFs who need to develop or revise AMS policies and practices to improve topical antimicrobial use, do so using a multidisciplinary team based approach,” they wrote. “Significant benefits in engaging all staff responsible for prescribing, dispensing and administration of antimicrobials is improved communication and coordination of care.”
Mar 31 Am J Infect Control abstract

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