Stewardship / Resistance Scan for Jan 26, 2018

No antibiotics for sore throat
;
Old antibiotic shows promise
;
Antibiotic-free fast food

UK health officials advise against antibiotics for acute sore throat

New guidance today from the United Kingdom's National Institute for Health and Care Excellence (NICE) and Public Health England says general practitioners should not offer, and patients should not expect, antibiotics in most cases of acute sore throat.

The recommendations, aimed at limiting antibiotic use and reducing antimicrobial resistance, explain that acute sore throat (including pharyngitis and tonsillitis) is often self-limiting, most frequently triggered by a viral infection of the upper respiratory tract, and that most people will get better within a week without antibiotics. They advise physicians to explain to patients the usual course of acute sore throat and to recommend tips for management of symptoms. They also advise patients to seek medical help if symptoms worsen rapidly or don't improve after a week.

The guidance also lays out criteria for physicians to use when evaluating patients with acute sore throat. It recommends that patients who score low on clinical criteria scoring systems (0 or 1 points on FeverPAIN or 0,1, or 2 on Centor) should not receive an antibiotic and should be advised to drink adequate fluids and consider pain relievers and medicated lozenges. Patients with FeverPAIN scores of 2 or 3 should be given a back-up antibiotic prescription if their symptoms don't improve in 3 to 5 days. For patients most likely to benefit from an antibiotic (those with a FeverPAIN score or 4 or 5 or a Centor score of 3 or 4), the guidance calls for an immediate antibiotic, taking into account possible adverse effects and the unlikely event of complications if antibiotics are withheld.

"We are living in a world where bacteria are becoming more resistant to antibiotics," Gillian Leng, deputy chief executive at NICE, told the BBC. "It is vital these medicines are protected, and only used when they are effective."
Jan 26 NICE guidance on acute sore throat
Jan 26 BBC
story

 

Australian scientists find potential in a neglected class of antibiotics

Australian scientists report that a synthetic version of a neglected class of antibiotics showed efficacy against multidrug-resistant (MDR) bacteria in preclinical tests, according to a study today in Cell Chemical Biology.

In the study, scientists from the University of Queensland identified the biosynthetic pathway of octapeptins, a family of lipopeptide antibiotics that were discovered nearly four decades ago and are structurally related to the last-resort antibiotic colistin. Octapeptins displayed activity against gram-negative bacteria in several studies but were ultimately neglected due to a proliferation of other antibiotics.

In vitro testing against a panel of MDR bacteria revealed that one of the octapeptins identified, octapeptin C4, was more effective than colisitin against polymixin-resistant isolates of Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, but was not as effective against polymixin-resistant P aeruginosa in a mouse blood infection model, most likely due to high plasma protein binding. The scientists then designed a synthetic octapeptin with a similar structure to octapeptin C4 but reduced plasma protein binding that showed dramatically improved in vivo activity.

"Our in vitro and in vivo efficacy data indicate the significant potential of novel octapeptin-like lipopeptides as new antibiotics against polymyxin-resistant Gram-negative superbugs," the authors of the study write. They also note that octapeptins are potentially less toxic to the kidneys than colistin and polymixin B
Jan 26 Cell Chem Biol abstract

 

Consumer group urges McDonald's to detail an antibiotic-free-meat plan

As part of the launch of a national campaign, the consumer and public health advocacy group US PIRG Education Fund is calling on McDonald's Corp to commit to a specific timeline to phase out routine use of medically important antibiotics in its beef and pork supply chain, US PIRG (Public Interest Research Group) said in a news release yesterday.

The organization is spotlighting McDonald's because of its "outsized influence" as the largest US buyer of beef and has only a vague long-term antibiotics plan. Public health experts across the globe have warned that routine use of antibiotics in food animals helps spur antimicrobial resistance in a wide range of pathogens and poses a distinct threat to people.

"Protecting antibiotics requires action, not reaction. If we don't act now to preserve the effectiveness of these medicines, we'll face a world in which common infections once again kill," said Matthew Wellington, antibiotics program director for US PIRG Education Fund. "The Big Mac can make a big dent in stopping the misuse of antibiotics in our food system," he added, referring to McDonald's flagship hamburger.

As part of its "Hold the Antibiotics" campaign launch, US PIRG has had nearly 10,000 people sign a petition to support its efforts. The group's state affiliates also held events in front of McDonald's franchises across the country to educate people about the perils of antibiotic-resistant bacteria and the important role that McDonald's can play.

In August 2017, McDonald's announced that it will phase out use of highest-value human antibiotics in its global chicken supply, after having reached its US goal of serving broiler chickens raised without antibiotics in 2016. It has also signaled that it would take similar actions for its supply of beef, dairy cows, pork, and laying hens.
Jan 25 US PIRG news release
Aug 24, 2017, CIDRAP News story "McDonald's expands antibiotic-cutting steps globally"

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