Stewardship / Resistance Scan for Jan 30, 2019

Proposed UN AMR guidance
European antibiotic use survey
Antibiotic use in nursing homes
Novel antibiotic vs C diff

UN committee publishes AMR recommendations, seeks input

An ad hoc expert panel convened by the UN secretary-general in March 2017 yesterday published guidelines on antimicrobial resistance (AMR) and is seeking public input, the World Health Organization (WHO) announced.

The Interagency Coordination Group (IACG) on Antimicrobial Resistance has a mandate "to provide practical guidance for approaches needed to ensure sustained effective global action to address antimicrobial resistance," the WHO said. "The terms of reference for the IACG include to promote, plan and facilitate collaborative action, to align activities so gaps are closed, and resources are optimally utilized, to explore the feasibility of developing global goals and targets related to antimicrobial resistance." The report and IACG's recommendations will be submitted to the UN secretary-general in April.

The report is divided into five main areas, each with its own recommendations: (1) accelerate progress in countries, (2) innovate to secure the future, (3) collaborate for more effective action, (4) invest for a sustainable response, and (5) strengthen accountability and global governance.

The deadline for submitting feedback is Feb 19, and an email address is provided in the WHO announcement.
Jan 29 WHO announcement
Full IACG report


ECDC launches survey of healthcare workers and antibiotics

Earlier this week, Public Health England (PHE) and the European Centre for Disease Prevention and Control (ECDC) launched a Europe-wide survey to gauge health worker perceptions about antibiotic use and antibiotic resistance.

"ECDC and PHE are aiming for a return of at least 10,000 responses with representation from healthcare workers, including doctors, nurses, pharmacists and hospital managers, as well as clinical scientists, physiotherapists, nursing assistants, dental/pharmacy technicians, public health teams and health students," ECDC said in a news release yesterday.

The online survey takes 5 to 10 minutes to complete and is open until Feb 14.

ECDC said the results will be used to guide communication aimed at healthcare workers and to see what, if any, gaps exist in the current education around antibiotic use.
Jan 29 ECDC press release


Study: Half of UK residents long-term care residents receive antibiotics

Half of all residents in long-term care (LTC) facilities received at least one antibiotic in the previous year, according to a retrospective cohort study from the United Kingdom published yesterday in the Journal of Antimicrobial Chemotherapy.

To conduct the study, researchers extracted from a national pharmacy chain database antibiotic prescriptions written for LTC residents from November 2016 to October 2017. In total they analyzed 544,796 antibiotic prescriptions dispensed for 167,002 residents in England, Northern Ireland, Scotland, and Wales.

During the study period, 56.6% of LTC residents in Northern Ireland, 53.2% in Scotland, 48.5% in England, and 45.0% in Wales received at least one antibiotic prescription. Amoxicillin, trimethoprim, nitrofurantoin, and flucloxacillin accounted for 66.4% of all antibiotic prescribing. LTC residents were frequently rates for respiratory infections, urinary tract infections, and skin infections.

"Half of the residents (52.1%) were dispensed one antibiotic drug over the 12 month period, a quarter (27.5%) were dispensed two different antibiotics, 12.9% were dispensed three, and 5.1% were dispensed four (the remaining 2.4% were dispensed between 5 and 10 different antibiotics)," the study authors wrote.

This was the largest study to examine antibiotic prescribing among LTC residents in the UK, and the authors said the information can help both clinicians and pharmacists support antibiotic stewardship efforts.
Jan 29 J Antimicrob Chemother study


Novel antibiotic cadazolid underperforms in two phase 3 C difficile trials

Cadazolid, a novel quinoxolidinone antibiotic developed by Actelion Pharmaceuticals, was safe and well tolerated but was shown inferior to vancomycin for the clinical cure of Clostridioidis difficile infection (CDI) in one of two identical phase 3 trials, making its future uncertain, an international team reported yesterday in The Lancet Infectious Diseases.

The study highlights the results of IMPACT 1 and IMPACT 2, two identically designed multicenter, double-blind, placebo-controlled, randomized trials. IMPACT 1 was conducted in Australia, Brazil, Canada, France, Germany, Italy, the Netherlands, Peru, Poland, Romania, Spain, and the United States. IMPACT 2 was done in Argentina, Belgium, Brazil, Canada, Chile, Croatia, Czech Republic, Greece, Hungary, Israel, Romania, Slovakia, South Korea, the United Kingdom, and the United States. Adults with mild to severe CDI were randomized 1:1 to either the same daily dosage of oral cadazolid or oral vancomycin, with a placebo disguised as the other drug.

In the intention-to-treat arm of the study, cure rates for cadazolid were 84% in IMPACT 1 and 81% in IMPACT 2, versus 85% and 86% for vancomycin, respectively. In the per-protocol patients, cure rates were 88% and 87% for cadazolid, respectively, and 92% for vancomycin in both IMPACT 1 and 2. That means the data revealed non-inferiority for cadazolid in IMPACT 1 but not in IMPACT 2. Safety and tolerability was the same for both antibiotics in both trials.

The authors concluded, "Further commercial development of cadazolid for C difficile infection is unlikely." The study was funded by Actelion.

In an accompanying commentary, Benoit Guery, MD, PhD, with the University of Lausanne in Switzerland, wrote, "IMPACT 1 and 2 do not provide a strong basis for the implementation of cadazolid in treatment of C difficile infection, but they do underline the need for strong and uniform definitions and the development of new tools to assess the response to treatment."
Jan 29 Lancet Infect Dis study
Jan 29 Lancet Infect Dis commentary

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