Stewardship / Resistance Scan for Aug 28, 2018

New antibiotic for intra-abdominal infections
Web training for antibiotic stewardship
Chest x-ray and pneumonia

Internet training tied to fewer antibiotic for respiratory tract infections

A new study in the Journal of Antimicrobial Chemotherapy shows that Internet-based communication training might be a cost-effective way to limit primary care antibiotic prescriptions when compared with C-reactive protein (CRP) testing.

Yesterday's study, conducted by UK & Belgian scientists, measured the cost-effectiveness of interventions among primary care clinicians treating patients who had respiratory tract infections in five European countries over a 28-day period. The clinicians were either trained in the use of CRP testing, trained in Internet-based communication skills, or trained in both CRP testing and communication skills, all as a way to reduce the number of written antibiotic prescriptions.

During the month-long study, approximately 59% of participants in the usual care arm had an antibiotic prescribed, compared with 34% in the combined intervention arm. Under cost-saving analysis, Internet-based communication training was the most cost-sparring way to reduce antibiotic prescribing.

"In terms of cost per percentage reduction in antibiotic prescribing, overall, communication skills was the most cost-effective intervention," the authors conclude.
Aug 27 J Antimicrob Chemother


Study: Chest x-ray can rule out pneumonia in kids and save antibiotics

Using chest radiography (CXR) to rule out pneumonia in kids allows for the safe observation of children without the initiation of antibiotic use, according to a study today in Pediatrics.

CXR has long been used in the diagnosis of pneumonia, but it can result in false-negatives if performed early in the illness or if a child is dehydrated. This prospective study took place over a 2-year period and included 683 children ages 3 months to 18 years, with a median age of 3 years.

In total, 16.5% of children had positive, 10.7% had equivocal, and 72.8% had negative CXRs. Of the 156 children with clinically diagnosed pneumonia, 78% had positive or equivocal CXRs and 22% had negative CXRs. Forty-four children (8.9%) were clinically diagnosed with pneumonia at the emergency department despite the negative radiographic findings.

Of the 411 children with negative CXRs who were not prescribed an antibiotic, only 5 (1.2%) were diagnosed as having pneumonia during a 2-week follow-up period. The negative predictive value of CXR was 98.8% (95% confidence interval, 97.0%-99.6%).

"Among children with negative CXRs who were not treated with or prescribed antibiotics, only 1.2% were subsequently diagnosed with pneumonia within 2 weeks of the ED visit," the authors said. "Our findings reveal that most children with negative results will recover fully without antibiotic use."

But in a commentary in the same journal, Matthew D. Garber, MD, and Ricardo A. Quinonez, MD, pediatricians who were not involved in the research, write that the study overemphasizes the provenance of bacterial pneumonia in children, and thus attributes too much diagnostic power to CRXs. They suggest that children who have a low clinical suspicion of pneumonia could also avoid CRX, further decreasing radiation, cost, and unnecessary antibiotics.
Aug 28 Pediatrics
Aug 28 Pediatrics


FDA approves antibiotic for treating complicated intra-abdominal infections

Tetraphase Pharmaceuticals announced yesterday that the US Food and Drug Administration (FDA) has approved its novel antibiotic eravacycline (Xerava) for treating complicated intra-abdominal infections (cIAI) in patients age 18 and older.

In a statement, the company, based in Watertown, Mass., said clinical trials have shown that the drug was well tolerated and achieved high cure rates in patients with cIAI and was statistically noninferior to two widely used drugs, ertapenem and meropenem. To reduce the development of drug-resistant bacteria and maintain eravacycline's effectiveness—and that of other drugs—it should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria.

Philip Barrie, MD, MBA, professor of surgery and public health at Weill Cornell Medicine, said in the statement that cIAIs are the second most prevalent infection site in intensive care units and are the second leading cause of infection-related mortality in ICUs. "With the growing crisis of antibiotic resistance, treatment options for these polymicrobial infections are limited following surgery or percutaneous drainage, and the causative pathogens may be multi-drug resistant," he said, adding that current empiric treatments for cIAIs all have limitations, creating a need for new and novel treatments. "Eravacycline has a broad spectrum of antibacterial activity and a clinical profile that addresses this unmet medical need," Barrie said.

Eravacycline dosage doesn't need to be adjusted for patients who have renal impairment, and the drug can be used in those who are allergic to penicillin, he said.

The company said it expects the drug to launch commercially in the fourth quarter of 2018.

The Biomedical Advanced Research and Development Authority (BARDA), part of the US Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR), has provided support for the drug's development since 2012. Rick Bright, PhD, BARDA's director, said the FDA's approval of eravacycline provides a new weapon in the battle against antibiotic resistance and addresses an unmet need for patients suffering from multidrug-resistant and other serious infections.

In an ASPR blog post yesterday, two BARDA officials said the novel, fully synthetic tetracycline antibiotic can also be used against serious gram-negative infections, including ones caused by multi-drug resistant organisms considered urgent public health threats by the Centers for Disease Control and Prevention and the World Health Organization.

They also wrote that Tetraphase conducted BARDA-supported studies needed for the FDA to consider eravacycline for emergency use authorization for treating anthrax or tularemia.
Aug 27 Tetraphase press release
Aug 27 ASPR
blog post

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