Stewardship initiative linked to lower outpatient prescribing in NYC clinics
An effort to reduce inappropriate antibiotic prescribing in New York City hospitals was associated with a modest decrease in prescribing for acute respiratory infections (ARIs), according to a study today in Infection Control and Hospital Epidemiology.
The intervention was the second stage of two-stage initiative from the United Hospital Fund to evaluate outpatient antibiotic stewardship in hospital-owned clinics in New York City. In stage 1, investigators found few clinics with outpatient stewardship activities, significant variation in prescribing practices, common prescribing of macrolides, and an interest among providers in learning more about appropriate prescribing. In stage 2, clinics implemented from 3 to 13 interventions based on the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship recommendations, including augmented patient and provider education, clinical decision support, provider audit and feedback, and communication skills training.
The investigators reviewed 991 visits for ARI pre-intervention and 902 post-intervention. They found that antibiotic prescribing declined from 30.6% of ARI visits pre-intervention to 25.5% (P = .016) post-intervention. Prescribing for patients with "bronchitis, not specified" decreased from 62.0% to 43.4% (P = .01) and, although not statistically significant, prescribing for patients with acute sinusitis decreased from 77.6% to 68.0% (P = .27).
Declines in ARI prescribing were also observed among patients 40 to 59 years of age (31.8% to 22.7%, P = .007), Medicaid patients (30.3% to 14.1%, P < .0001), and Spanish-speaking patients (25.6% to 11.1%, P = .004). The proportion of macrolide and fluoroquinolone prescriptions decreased from 55.1% to 46.5% (P = .05) and from 12.2% to 7.0% (P = .038), respectively. But prescriptions of amoxicillin/clavulanic acid increased from 18.8% to 27% (P = .028), and substantial variation in system-level prescribing remained (10% to 65%, P <.0001).
The authors of the study note that although they were not able to ascertain which interventions were most effective, their observations suggest that targeting both providers and patients works best.
Jul 26 Infect Control Hosp Epidemiol abstract
BARDA to help fund new antibiotic for MDR pathogens, bioterror threats
The Department of Health and Human Services (HHS) announced this week that it will partner with the Department of Defense (DoD) and drug maker VenatoRx Pharmaceuticals on a novel combination antibiotic to treat multidrug-resistant gram-negative infections.
Under the partnership, VenatoRx, of Malvern, Pennsylvania, will receive up to $20.7 million over 2 years from the Biomedical Advanced Research and Development Authority (BARDA)—part of the HHS Office of the Assistant Secretary for Preparedness and Response—to develop cefepime/VRNX-5133, which combines a currently marketed fourth-generation cephalosporin with a novel beta-lactamase inhibitor. The drug, which has completed phase 1 clinical trials, has the potential to treat infections caused by carbapenem-resistant Enterobacteriaceae, as well as pathogens that can be engineered for bioterrorism, such as Burkholderia spp.
"Developing new antibiotics that represent an improvement over standard of care antibiotics is essential to national health security and global health efforts to combat antibiotic-resistant infections," BARDA Director Rick Bright, PhD, said in an HHS press release. "This unique public-private partnership will focus on adding a new tool to healthcare providers' toolkits and to help them save lives in an incident involving some of the serious bioterrorism threats our country faces."
BARDA and VenatoRx will share the costs of all studies needed to bring the drug to market. DoD's Threat Reduction Agency will provide up to $10 million to fund studies to test the efficacy of cefepime/VRNX-5133 against bioterror threats.
Jul 22 HHS press release