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Obama administration releases National Action Plan to combat antibiotic-resistant bacteria

Thursday, April 2, 2015

The White House has released a comprehensive plan that identifies critical actions to be taken by key Federal departments and agencies to combat the rise of antibiotic-resistant bacteria. The National Action Plan for Combating Antibiotic-Resistant Bacteria, which was developed by the interagency Task Force for Combating Antibiotic-Resistant Bacteria in response to Executive Order 13676: Combating Antibiotic-Resistant Bacteria, outlines steps for implementing the plan.

To provide advice, information and recommendations regarding programs and policies intended to support and evaluate the implementation of the plan, the secretary of HHS established the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria. HHS currently is seeking nominations of individuals who are interested in being considered for appointment to the advisory council. 

The action plan is organized around five goals for collaborative action by the U.S. Government, in partnership with foreign governments, individuals and organizations aiming to strengthen healthcare, public health, veterinary medicine, agriculture, food safety and research and manufacturing. Aggressive action will move the nation towards major reductions in the incidence of urgent and serious drug-resistant threats.

These goals are:

  • Slow the emergence of resistant bacteria and prevent the spread of resistant infections
  • Strengthen national One-Health surveillance efforts to combat resistance
  • Advance development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria
  • Accelerate basic and applied R&D for new antibiotics, other therapeutics and vaccines
  • Improve international collaboration and capacities for antibiotic resistance prevention, surveillance, control and antibiotic R&D.

Judicious use of antibiotics in healthcare and agricultural settings is essential to slow the emergence of resistance and extend the useful lifetime of effective antibiotics. The CDC estimates that up to half of all human antibiotic use is unnecessary or inappropriate. The action plan includes activities to foster improvements in the appropriate use of antibiotics (i.e., antibiotic stewardship) by improving prescribing practices across all healthcare settings, preventing the spread of drug-resistant threats in healthcare facilities and communities and continuing to eliminate the use of medically-important antibiotics for growth promotion in animals.

By 2020, significant outcomes in this area will include:

  • Establishment of antimicrobial stewardship programs in all acute care hospitals and improved antimicrobial stewardship across all healthcare settings
  • Reduction of inappropriate antibiotic use by 50% in outpatient settings and by 20% in inpatient settings
  • Establishment of State Antibiotic Resistance (AR) Prevention (Protect) Programs in all 50 states to monitor regionally important multi-drug resistant organisms and provide feedback and technical assistance to health care facilities
  • Elimination of the use of medically-important antibiotics for growth promotion in food-producing animals.

The One-Health approach to disease surveillance for human and animal pathogens is critical to combat antibiotic resistance. Improved detection and control of antibiotic resistance in human and animal pathogens will be achieved through a One-Health approach to disease surveillance that integrates data from multiple monitoring networks. This approach significantly will increase the currently very limited data and provide high-quality information, including detailed genomic data, necessary to track resistant bacteria in diverse settings in a timely fashion.

By 2020, significant outcomes in this area will include:

  • Creation of a regional public health network—the Detect Network of AR Regional Laboratories—for resistance testing, a specimen repository for resistant bacterial strains, and a National Sequence Database of Resistant Pathogens
  • Routine reporting of antibiotic use and resistance data to National Health Safety Network (NHSN) by 95% of Medicare-eligible hospitals, as well as by Department of Defense and Veterans Affairs healthcare facilities
  • Routine testing of zoonotic and animal pathogens for antibiotic susceptibility at ten to twenty National Animal Health Laboratory Network (NAHLN) and Veterinary Laboratory Investigation and Response Network (Vet-LIRN) member laboratories, using standardized testing methods and data sharing practices.

With the support of funding agencies such as the NIH, researchers are taking advantage of new technologies to develop rapid point-of-need diagnostic tests that can be used during a healthcare visit to distinguish between viral and bacterial infections and identify bacterial drug susceptibilities—an innovation that could significantly reduce unnecessary antibiotic use. The availability of new rapid diagnostic tests, combined with ongoing use of culture-based assays to identify new resistance mechanisms, will advance the detection and control of resistant bacteria.

By 2020, significant outcomes in this area will include:

  • Development and dissemination of authorized point-of-need diagnostic tests that rapidly distinguish between bacterial and viral infections
  • Validation of diagnostic tests that rapidly determine the antibiotic resistance profiles of bacteria of public health concern.

Antibiotics that lose their effectiveness for treating human disease through antibiotic resistance must be replaced with new drugs; alternatives to antibiotics also are needed in veterinary medicine. The action plan will boost basic scientific research, attract greater private investment, and facilitate clinical trials in order to advance the discovery and development of new antibiotics and alternative therapies to combat resistance.

By 2020, significant outcomes in this area will include:

  • Characterization of the gut microbiome—the communities of microorganisms that live within the gastrointestinal tract—of at least one animal species raised for food.  This outcome will help us understand how antibiotic treatments disrupt normal gut bacteria and how animal growth might be promoted—and bacterial diseases might be treated—without using antibiotics
  • Advancement of at least two new antibiotic drug candidates, non-traditional therapeutics, and/or vaccines from preclinical testing to clinical trials for treatment or prevention of human disease
  • Development of at least three new drug candidates or probiotic treatments as alternatives to antibiotics for promoting growth or preventing disease in animals
  • Creation of a biopharmaceutical incubator—a consortium of academic, biotechnology and pharmaceutical industry partners—to promote innovation and increase the number of antibiotics and antibodies in the drug-development pipeline.

Antibiotic resistance is a global problem that requires global solutions. The U.S. will engage with international ministries and institutions to strengthen national and international capacities to detect, monitor, analyze, and report antibiotic resistance; provide resources and incentives to spur the development of therapeutics and diagnostics for use in humans and animals; and strengthen regional networks and global partnerships that help prevent and control the emergence and spread of resistance.

By 2020, significant outcomes in this area will include:

  • Elevation of antibiotic resistance as an international priority for global health and security
  • Enhanced capacity to identify antimicrobial resistant pathogens in more than 15 partner countries
  • Establishment of a common U.S.-E.U. system for sharing and analyzing bacterial resistance patterns for priority pathogens
  • Development of a global database to collect harmonized quantitative data on the use of antibacterial agents in animals
  • Development of national plans to combat antibiotic resistance and improve antibiotic stewardship in low- and middle-income countries
  • Strengthened regulatory and supply chain systems that assure the quality, safety and efficacy of antibiotics used in low- and middle-income countries.

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