Stewardship / Resistance Scan for Jun 28, 2017

Opposition to AMR budget cuts
Antibiotics for skin wounds

Letter urges Congress to oppose Trump administration's AMR cuts

The Infectious Diseases Society of America (IDSA) today sent a letter to members of congressional appropriations committees urging them to reject President Trump's proposed cuts to antimicrobial resistance (AMR) initiatives.

The letter, signed by more than 60 organizations representing the human and animal health sectors, expresses concern that the "gravity and importance" of AMR is not reflected in the president's budget request, which was released in May. The president's FY18 budget seeks reductions to AMR programs administered by several different agencies, including the Centers for Disease Control and Prevention (CDC), the National Institute of Allergy and Infectious Diseases (NIAID), the US Department of Agriculture (USDA), the Food and Drug Administration (FDA), and the US Agency for International Development (USAID).

The budget cuts $22.7 million from the CDC's Antibiotic Resistance Solutions Initiative (ARSI), which funds statewide efforts to detect and track resistance threats, and seeks to move ARSI's funding source to the Prevention and Public Health Fund, which would disappear if Congress is successful in repealing the Affordable Care Act. "A cut of this magnitude would impact every aspect of CDC's work to protect us from AMR, including its support for state public health labs and research collaborations with academic institutions," the letter says.

In addition, the budget proposes a $76 million cut from the CDC's Center for Global Health, which studies global resistance patterns, a $1.1 billion cut to the NIAID, a significant funder of research into new antimicrobials, and a $50 million cut to the FDA's Center for Veterinary Medicine, which promotes antimicrobial stewardship in agriculture. A $62.6 million cut to USAID's global tuberculosis program would diminish efforts to screen, diagnose, and treat patients who have multidrug-resistant tuberculosis.

The letter asks the chairs and ranking members of the Labor-HHS-Education, Agriculture, and State-Foreign Ops Appropriations subcommittees to not only reject the cuts detailed in the budget but "continue Congress's bipartisan support for AMR that reflects the US commitment to infection prevention, antimicrobial stewardship, surveillance, and innovation."
Jun 28 IDSA letter


Study finds benefit for antibiotic treatment of simple skin wounds

A study today in the New England Journal of Medicine reports that the use of clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) in conjunction with incision and drainage, when compared with incision and drainage alone, improves short-term outcomes in patients who have uncomplicated skin abscesses.

The multicenter, prospective, double-blind trial involved 786 participants who had a skin abscess of 5 centimeters or smaller. Staphylococcus aureus was isolated from 527 participants, and methicillin-resistant S aureus (MRSA) was isolated from 388. After abscess incision and drainage, participants were randomly assigned to receive clindamycin, TMP-SMX, or placebo for 10 days. The primary outcome was clinical cure 7 to days after treatment.

The results showed that the cure rates for participants in the clindamycin group (83.1%) and the TMP-SMX group (81.7%) were significantly higher than in the placebo group (68.9%). The beneficial effects were limited to patients with S aureus infection. Among participants who were initially cured, new infections at 1 month follow-up were less common in the clindamycin group (6.8%) than in the TMP-SMX (13.5%) or the placebo group (12.4%), while adverse events were more frequent with clindamycin (21.9%) than with TMP-SMX (11.1%) or placebo (12.5%).

The authors say the benefits of adding treatment with clindamycin or TMP-SMX after incision and drainage of simple skin abscesses should be weighed against the known side-effect profiles of these antibiotics
Jun 29 N Engl J Med study

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