CRP-guided treatment may help in kids' respiratory infections
A trial by researchers from Switzerland and Tanzania demonstrated that use of an electronic decision algorithm that incorporated C-reactive protein (CRP) levels helped improve clinical outcomes in children with respiratory infections and reduce antibiotic prescribing. The study was published in Clinical Infectious Diseases.
In the randomized, controlled, noninferiority trial, which was conducted at nine primary care centers in Dar es Salaam, Tanzania, from December 2014 to February 2016, children aged 2 to 59 months with fever and cough received an antibiotic based on a CRP-informed strategy (a combination of CRP level of 80 milligrams per liter or higher plus age/temperature-corrected tachypnea and/or chest indrawing) or the current World Health Organization standard (respiratory rate of 50 or higher). The primary outcome of the study was clinical failure by day 7, and the secondary outcomes were antibiotic prescription at diagnosis, secondary hospitalization, or death by day 30.
Altogether, 1,726 children were included in the trial, with 868 in the CRP group and 858 in the control group; 0.4% were lost to follow-up. The proportion of clinical failure by day 7 was 2.9% (25/865) in the CRP arm versus 4.8% (41/854) in the control arm (risk difference -1.9%, -3.7% to -0.1%; risk ratio [RR], 0.60; 95% confidence interval [CI], 0.37 to 0.98). In the CRP group, 2.3% (20/865) of children received antibiotics, compared with 40.4% (345/854) of children in the control arm (RR, 0.06; 95% CI, 0.04 to 0.09). There were also fewer secondary hospitalizations and deaths in the CRP group: 0.5% (4/865) versus 1.5% (13/854) (RR, 0.30; 95% CI, 0.10 to 0.93).
The authors of the study conclude, "CRP testing using a high cut-off, combined with two respiratory signs into an electronic decision algorithm, was able to improve clinical outcome in children with respiratory infections while substantially reducing antibiotic prescription."
Feb 2 Clin Infect Dis abstract
Study: Formulary restriction policy effective in cutting restricted antibiotics
A formulary restriction and preauthorization (FRPA) program at an academic medical center was associated with declines in the use of restricted antibiotics in medical and pediatric units, according to a new study in the American Journal of Infection Control.
In the study, researchers with Virginia Commonwealth University (VCU) School of Medicine analyzed the longitudinal effectiveness of the FRPA program at VCU Health System by calculating the days of therapy for restricted and non-restricted drugs in the medical, surgical, and pediatric units over a 5-year period and then applying regression analysis to identify statistically significant time trends. Under FRPA, physicians must obtain approval from antibiotic stewardship program (ASP) staff before administering a restricted or non-formulary drug.
The results revealed a statistically significant downward trend in antibiotic use in 2 of 7 medical units, 0 of 4 surgical units, and 1 of 4 pediatric units, with 1 surgical unit showing a significant upward trend. In addition, no corresponding increase in prescribing of non-restricted antibiotics was found in the 2 medical units that saw declines in use of restricted antibiotics.
Though they note that their findings could be confounded by parallel ASP interventions, the authors of the study say the results show that that the FRPA program has been effective at limiting the use of restricted agents, especially in medical units, and that their unique methodology provides a simple, comprehensive review of FRPA performance.
Feb 2 Am J Infect Control study
CARB-X to fund Polyphor's novel class of gram-negative antibiotics
CARB-X announced today that it will award up to $2.6 million in funding to Swiss biopharmaceutical company Polyphor to develop a novel class of antibiotics to treat infections caused by gram-negative ESKAPE pathogens (Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species).
The funding will help support preclinical development of Polyphor's new class of outer membrane protein–targeting antibiotics (OMPTA), which have demonstrated in vitro and in vivo activity against ESKAPE pathogens, including multidrug-resistant and colistin-resistant isolates, with a favorable safety profile in animals. Polyphor could receive up to $3 million more if certain project milestones are met.
"We are delighted to have the support of CARB-X, which will enable us to accelerate and further advance our preclinical candidate targeting resistant gram-negative bacteria," Polyphor CEO Giacomo Di Nepi, MBA, MSC, said in a CARB-X press release.
Since it was established in 2016, CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) has awarded more than $103 million for the development of new antibiotics, diagnostics, and alternative therapies for drug-resistant infections. The OMPTA antibiotics are among the 11 novel classes of antibiotics in the CARB-X portfolio.
Feb 4 CARB-X press release