Over-the-counter antibiotic sales a ‘significant barrier’ to addressing antibiotic resistance

News brief

Pharmacy in Africa — Africanway / iStock

The results of a survey conducted among healthcare professionals in 37 countries suggest over-the-counter (OTC) antibiotic sales remain all too common, researchers reported last week in JAC-Antimicrobial Resistance.

The electronic survey, sent to members of the AMR Insights Ambassador Network by a team of international researchers, assessed demographic characteristics, the existence of national regulations regarding OTC antibiotic sales, and the availability of specific antibiotics for purchase without a prescription. Although research has shown that the use of OTC antibiotics remains ubiquitous in many countries, particularly in Asia and Africa, the researchers said the practice “remains inadequately described on a global scale.”

“The acquisition and use of antibiotics without a prescription remains a significant barrier to addressing the global burden of AMR [antimicrobial resistance],” they wrote. “While all antimicrobial use contributes to the development of resistance, such use when unwarranted can lead to significant harm to both the individual and society.”

Community pharmacies a primary point of sale

Of the 75 respondents, 49 (65.3%) said antibiotics could be bought OTC in their countries without a prescription and only eight (10.7%) said antibiotic sales were strictly limited to people with a valid medical prescription. Of the 64 who answered questions about points of sale for non-prescription antibiotics, 55 (85.9%) said community pharmacies were the primary point of sale, with retail stores, internet vendors, and grocery stores identified as other sources.

While all antimicrobial use contributes to the development of resistance, such use when unwarranted can lead to significant harm to both the individual and society.

Penicillins (86.7%) and tetracyclines (83.3%) were the most frequently reported antibiotic classes available without a prescription, but respondents reported that other critical antibiotic classes deemed critical by the World Health Organization (WHO) were also available, including carbapenems, cephalosporins, fluoroquinolones, and macrolides.

“The finding that antibiotics are readily available in 37 countries—representing nearly 19% of the 194 WHO Member States—is concerning and highlights a critical gap in global stewardship,” the authors wrote, adding that the availability of last-resort antibiotics like carbapenems is particularly concerning and indicates that countries need to do more to ensure appropriate antibiotic use.

“Impactful change demands robust governance, political accountability, and an understanding of the cultural and behavioural drivers of unwarranted use,” they wrote.

Hantavirus outbreak linked to cruise ship grows to 13 cases

News brief

Stephanie Soucheray, MA

doctor and patient — *Jacob Wackerhausen / iStock*

Over the past five days, two more cases of hantavirus have been confirmed among passengers and crew who were aboard the MV Hondius Dutch cruise ship in April and May.

The outbreak now has 13 cases, three of which were fatal.

Several passengers remain in isolation and quarantine in various countries, including 18 Americans who are staying in a biocontainment unit in Nebraska through the end of the month. Hantavirus can have a 42-day incubation period. The Andes strain causing the outbreak is the only known hantavirus capable of spreading from person to person.

The first new case identified late last week was in a Dutch crew member who had disembarked the ship in Spain and was being monitored for the virus.

WHO: 'Situation is stable’

“The situation is stable for now. We continue to remain vigilant and in close contact with all relevant governments,” Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), said on X on May 24. “All passengers and crew remain in quarantine and under close monitoring to ensure they receive care if needed.”

On May 25, Spain confirmed that a citizen who was aboard the MV Hondius and was isolated at a hospital in Madrid also tested positive for hantavirus.

So far, none of the cases have occurred in anyone who was not aboard the cruise ship.

Better prepandemic heart health may help prevent severe COVID

News brief

Mary Van Beusekom, MS

Two older women walking in park — *Paolo Gamba / Flickr cc*

Adults with healthier hearts before the pandemic were nearly half as likely to have severe COVID-19 than those with poorer heart health, suggests a study published in the Journal of the American Heart Association.

Researchers from the University of Vermont at Burlington led the study of nearly 30,000 participants without prepandemic cardiovascular disease from March 2020 to February 2023. The team fielded two questionnaires, conducted event surveillance, and tested blood samples to identify COVID-19 infections and evaluate associations between severe illness and the American Heart Association’s (AHA’s) Life Essential 8 (LE8) metrics.

The average participant age was 66.1 years, 61% were women, 35% were White, 34% were Hispanic, and 22% were Black.

“Cardiovascular disease is a risk factor for severe COVID‐19 (ie, hospitalization or death),” the study authors noted. “Whether better cardiovascular health (CVH) is associated with lower risk of severe COVID‐19 among adults without cardiovascular disease is unknown.”

Physical activity, healthy weight tied to lower risk

During the study period, 681 severe COVID-19 infections were reported. Adults with high LE8 scores (80 to 100, indicating robust CVH) were at 46% lower risk of COVID-19 hospitalization or death than those with low scores (less than 50). For every 14-point rise in LE8 score, the risk of a poor outcome was 20% lower.

Our results highlight that better heart health, which is something that individuals can work on, likely prepares you better for real-life stress tests such as infectious diseases like COVID-19.

Elizabeth Oelsner, MD, DrPH

Higher scores for the LE8 components of greater physical activity, healthier weight, optimal blood pressure, and good sleep patterns were each tied to a lower risk of severe infection.

“The findings suggest that having a healthy heart helps the body deal with the stress of a viral infection like COVID-19,” senior author Elizabeth Oelsner, MD, DrPH, of Columbia University, said in an AHA news release. “Our results highlight that better heart health, which is something that individuals can work on, likely prepares you better for real-life stress tests such as infectious diseases like COVID-19.”

But the authors cautioned that determining whether optimization of CVH could lower the risk of adverse outcomes from SARS-CoV-2 and other viruses requires further research.

Leptospirosis outbreak in dogs reveals large vaccination gaps

News brief

Mary Van Beusekom, MS

A leptospirosis outbreak involving more than 200 pet dogs in Los Angeles County, California, in 2021 highlights the importance of canine vaccination and discusses the public health risk, a team led by University of California at Davis (UC Davis) researchers write in the Journal of Clinical Microbiology.

The team investigated the outbreak in dogs diagnosed as having leptospirosis at two animal hospitals. They conducted serotyping and whole-genome sequencing (WGS) on samples from four dogs. When the outbreak was over, the team compared data on 59 infected dogs with data on 15,536 controls.

Leptospirosis is a potentially serious bacterial illness that can cause acute kidney injury and death in dogs. People also are susceptible to the disease through contact with contaminated water or animal urine, particularly that from rodents. In people, the disease often causes flu-like symptoms and can be treated with antibiotics.

Infection likely underdiagnosed in people

All isolates were identified as Leptospira interrogans serovar Canicola. Of 47 dogs with a leptospirosis vaccination history, none were completely vaccinated.

It might have been rodent problems in those facilities, or it might have just been really overcrowded facilities with lots of dogs in close contact with one another.

Jane Sykes, PhD

The outbreak was traced to dog daycare facilities, where close contact may have accelerated animal-to-animal spread, an unusual occurrence. “It might have been rodent problems in those facilities, or it might have just been really overcrowded facilities with lots of dogs in close contact with one another,” lead author Jane Sykes, PhD, of UC Davis, said in a university news release.

Real-time polymerase chain reaction blood and urine tests were positive for Leptospira in 15 of 56 (27%) and 49/54 (91%) of dogs, respectively. Serologic microscopic agglutination tests and point-of-care tests were positive in 22/29 (76%) and 27/35 (77%) of dogs, respectively. Of 59 dogs, 92% survived to hospital release.

No linked cases in people were identified, but the authors said leptospirosis is likely underdiagnosed in people.

The findings also underscore the importance of canine vaccination. “At the time, Los Angeles area veterinarians rarely offered leptospirosis vaccinations because the bacteria thrive in water from heavy rainfall and L.A. is an arid climate,” Sykes said. “It was considered a low risk.”

Quick takes: Upcoming VRBPAC meeting, Salmonella tied to moringa powder, Lyme surge in UK

News brief

Chris Dall, MA

The Food and Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) will meet tomorrow to discuss the composition of the COVID-19 vaccines for the 2026-27 viral respiratory season. The focus of the discussion will be whether the committee will advise vaccine manufacturers to use the LP.8.1 subvariant as the antigen in a monovalent vaccine, as the World Health Organization recently did, or consider two other JN.1 lineage subvariants—NB.1.8.1 and XFG—that have become dominant in the United States. The vaccines used for the 2025-26 season were based on LP.8.1. “Because of the continuing virus antigenic drift, a review and discussion regarding the need for a strain composition update for COVID-19 vaccines is warranted,” the FDA said in a briefing document.
The FDA and the Centers for Disease Control and Prevention are investigation another Salmonella outbreak linked to contaminated moringa leaf powder. The FDA said today that 18 people in 14 states have been sickened, and seven hospitalized, by the outbreak strain of Salmonella Typhimurium linked to Mogo brand Pure Moringa Oleifera capsules sold on Amazon, eBay, and the company’s website. Illness-onset dates range from February 3 to April 27. The FDA said the outbreak is new and the investigation separate from two previous Salmonella outbreaks linked to moringa powder. An investigation into one of those outbreaks was reopened today after 22 new cases were reported.
A report published last week by the United Kingdom Health Security Agency (UKHSA) shows that cases of Lyme disease rose by 22% last year. The One Health vector-borne disease surveillance report shows 1,168 lab-confirmed cases of Lyme disease were reported in 2025, up from 959 in 2024 but close to the 1,151 recorded in 2023. UKHSA officials say they’ve seen an increasing geographic distribution of the ticks that carry the Borrelia burgdorferi bacterium, which causes Lyme disease, across the United Kingdom in recent years, but they expect case rates to vary year by year depending on awareness, testing rates, and weather.