Antimicrobial Resistance Scan for Aug 31, 2016

Antibiotic prescribing by dentists
;
Incentives for antibiotic development
;
Polymyxin resistance in Brazil

Study: Written reports help dentists reduce antibiotic prescribing

A new UK study has found that dentists prescribe fewer antibiotics to their patients after receiving a report on their past prescribing habits.

According to the study, published yesterday in PLoS Medicine, dentists prescribe roughly 10% of the antibiotics dispensed in UK community pharmacies, often in the absence of clinical need. Using dental prescribing and treatment claim data routinely collected by the UK National Health Service (NHS), researchers with the RAPiD (Reducing Antibiotic Prescribing in Dentistry) trial set out to determine whether an individualized audit and feedback intervention could have an impact on prescribing habits.

The trial included 795 dental practices in Scotland, with 632 practices in an intervention group and 163 in a control group. The intervention group was further subdivided into two groups: one that received a line graph showing an individual dentist's monthly prescribing rate, and another that received a line graph with a written "behavior change" message containing national guidelines for dental antibiotic prescribing.

At the start of trial, the rate of antibiotics prescribed per 100 NHS treatment claims was 8.3 in the control group and 8.5 in the intervention group. After 12 months, the researchers found that both groups were prescribing fewer antibiotics. But the drop in the prescribing rate in the intervention group—from 8.5 to 7.5—was 5.7% greater than it was for the control group. And the subset of dentists who received a written message saw their prescribing rate drop by an additional 6%.

The authors of the study wrote that the findings are significant because they indicate that a "relatively straightforward, low-cost public health and patient safety intervention" could help the entire healthcare system address antimicrobial resistance.
Aug 30 PLoS Med study

 

Review outlines economic incentives for antibiotic development

Limited commercial returns are considered a primary factor in why pharmaceutical companies are not investing in antibiotic development. That's why a "constellation of economic incentives" will be needed to promote antibacterial drug development going forward, according to an article published yesterday in Clinical Infectious Diseases.

The article, written by members of the Trans-Atlantic Task Force on Antimicrobial Resistance (TATFAR), is a review of the various economic incentives identified in policy documents, peer-reviewed publications, organization proposals, and government-sponsored reviews that have addressed the question of how to spur new antibiotic development. In October 2015, TATFAR agreed to make an informed recommendation on a package of economic incentives to be considered and implemented in the future.

In those documents, the authors found a consensus around the idea that economic incentives must contain both "push and pull" mechanisms that will guarantee return on investment. Push incentives include subsidies (in the form of grants, public-private partnerships, and tax credits) to fund early-stage development of antimicrobials, which is often risky and expensive. The idea is to provide incentives to academic institutions and companies by providing up-front money for research and development.

Pull incentives, on the other hand, are meant to encourage antibacterial drug development by promising a substantial financial reward to companies that successfully develop new antibiotics. Examples include large milestone or prize payments, patent buy-outs, advanced market commitments, and extended market exclusivity.

Pull incentives, the authors found, will be most successful if they rely on a "de-linkage" model that would remove the motivation for pharmaceutical companies to market and oversell their product. Negating the need for high product sales, they argue, would ensure that new antibiotics are not overused, thereby linking new antibiotic development to conservation and stewardship.

Finally, the authors found widespread agreement that global coordination will be needed to administer the funding of these incentive programs.
Aug 30 Clin Infect Dis literature review

 

Growing polymyxin resistance reported in CRE in Brazil

Brazilian researchers are reporting increasing resistance to polymyxin antibiotics in clinical Klebsiella Pneumoniae strains that are already resistant to carbapenem antibiotics.

In a letter to Emerging Infectious Diseases, the researchers report on an analysis of more than 3,000 K pneumoniae isolates recovered from patients at 10 private tertiary-care hospitals in Sao Paulo from January 2011 to December 2015.

The analysis showed a dramatic increase in carbapenem resistance in the K pneumoniae isolates—from 6.8% in 2011 to 35.5% in 2015. And among the carbapenem-resistant K pneumoniae isolates, polymyxin resistance rose from 0% in 2011 to 27.1% in 2015. Polymyxin resistance among carbapenem-susceptible K pneumoniae isolates also rose, from 0.7% in 2011 to 3.9% in 2015.

The authors said the findings are worrisome because carbapenem-resistant Enterobacteriaceae (CRE) are more deadly than carbapenem-susceptible strains, and carbapenem-resistant K Pneumoniae bacteria are endemic in Brazil. Furthermore, most resistant infections are treated with polymyxins.
Aug 30 Emerg Infect Dis letter

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