Experts advise new measures to combat antimicrobial resistance

By Dr. Ananya Mandal, MDSep 22 2017

An expert panel was formed in the United States to advise the government on how to deal with the problem of antimicrobial resistance (AMR), a growing menace. This panel has now come up with a set of recommendations that could help reduce AMR in humans and animals. Recommendations include development of new vaccines against infections, development of better diagnostic tools to detect the infections early and also new therapies to handle the infections.

Image Credit: Jarun Ontakrai / Shutterstock

The draft report of the Presidential Advisory Council came in last week. The meeting was termed Combating Antibiotic Resistant Bacteria (PACCARB). The panel spoke on the hurdles to development of new antibiotics or vaccines against the infections to deal with AMR. The panel recommends that more public and private funding should come in for research and development by the pharmaceutical and biotech companies to develop therapies and vaccines to combat this problem. Further they also urged more efforts in easing regulatory pathways for these innovative therapies and preventive measures and patients’, clinicians’, and veterinarians’ education regarding AMR. The PACCARB was established in 2014 to provide the Department of Health and Human Services recommendations regarding federal programs and issues regarding AMR.

The report says that the major problem faced by the industry is lack of funds and initiatives. It says in the report that on an average, the cost of development of a vaccine is between “$300 million to more than $1 billion” and the time taken is up to 12 years. This is huge investment to make. Unless more funding and incentives are provided, it is difficult to bridge this gap they explain.

The panel also spoke about developing diagnostic tests. They say that these could guide appropriate antibiotic prescribing which could be a game changer in reducing AMR. Appropriate prescribing can also reduce the length of stay in the hospitals. They write, “The cost of development, lack of clinical implementation of approved tests, inadequate reimbursement, and an expensive and complex regulatory process pose barriers to development.” They suggest that a part of the funding should go into development of rapid antibiotic susceptibility tests for an antibiotic. A part of the funding used for development of an antibiotic could be used for this purpose they explain. There should be a sustained funding for development of new, cost-effective diagnostic tests they suggest.

Government agencies that deal with AMR also need support and this include financial and technical support for agencies such as –

• The Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X)
• The Biomedical Advanced Research and Development Authority (BARDA)
• The National Institutes of Health (NIH), and the National Institute of Allergy and Infectious Diseases (NIAID)

Another area that has not been given its due importance is reducing AMR in animals the council writes. They explain, “As recognized by many, AMR epitomizes the concept of One Health, as the genes that confer resistance to antibiotics…” All humans and animals carrying the microbes could “enhance the evolution, spread, and persistence of these genes” in the microbes that give rise to AMR. The council's recommendations for animal health are not very specific because of the lack of funding in this area.
The main recommendation made by the council is to prepare a National Policy on Innovation for Food Animal Disease Interventions. This would be a charter for the proposed Innovation Institute. This institute would be a body within the US Department of Agriculture wherein the researchers along with the industry representatives could get access to various resources to advance their products.

The World Health Organization (WHO) describes antimicrobial resistance as “a global health emergency”.

Ear infections do not need antibiotics

Kids with ear infections need not be given antibiotics says a latest draft guidance from the National Institute for Health and Care Excellence (Nice). Only treatment should be with paracetamol or ibuprofen. Centres for Disease Control and Prevention also warned parents a few days ago that antibiotics should not be administered for common infections.

The Nice guidance says that there is evidence that around 60% of children will show signs of improvement within 24 hours even without antibiotics. There will be marked reduction in ear pain. Children with discharge from the ear that is due to a ruptured ear drum however need antibiotics immediately they say.

Source: https://www.hhs.gov/sites/default/files/draft-incentives-report-september-2017.pdf and http://www.cidrap.umn.edu/news-perspective/2017/09/us-panel-advises-amr-reduction-humans-animals