BAD BUGS, FEW DRUGS
October 25, 2007
The Centers for Disease Control (CDC) estimates methicillin-resistant Staphylococcus aureus (MRSA) -- a strain of bacteria resistant to many antibiotics -- kills 18,000 Americans each year and causes serious infections in more than 90,000. To combat this public health emergency, important initiatives are under way by both government and the private sector, says Henry I. Miller, a physician, molecular biologist and fellow at Stanford University's Hoover Institution.
- Regulators and livestock producers are collaborating to reduce the amounts of antibiotics used to prevent disease in livestock.
- HMOs have adopted policies that restrict antibiotics to infections that seem unequivocally to be caused by bacteria.
- The CDC is promoting four strategies to prevent antibiotic resistance in health-care centers -- prevent infection, diagnose and treat infection, use antimicrobials wisely, and prevent transmission.
But federal officials have paid little attention to the flip side of the problem: the shortage of new antibiotics. To address this, we need multiple strategies, says Miller:
- In the short term, improved infection-prevention procedures at hospitals would have a tremendous impact.
- A pilot program at the University of Pittsburgh found that screening tests, gowns and other precautions that cost only $35,000 a year saved more than $800,000 a year in infection costs.
- A review of similar analyses published last year concluded that screening for MRSA bacteria both increases hospital profits and saves lives.
In the longer term we need the kinds of critical policy reforms suggested by the Infectious Diseases Society of America. Among them:
- Expediting the publication of updated guidelines for clinical trials of antibiotics, including a clear definition of what constitutes acceptable surrogate markers as endpoints.
- Encouraging "imaginative clinical trial designs that lead to a better understanding" of antibiotics' efficacy.
- Exploration of animal models of infection, in vitro technologies and microbiological surrogate markers.
Source: Henry I. Miller, 'Bad bugs, few drugs,' Washington Times, October 23, 2007.
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