Greater training sought to combat resistant bacteria

A national health organization is calling for increased physician education on proper use of antimicrobials in light of escalating resistance to the drugs. (See correction)

The Infectious Diseases Society of America issued the recommendation April 7 in a report that detailed how to address resistant bacteria as development of new medications to treat the superbugs has stalled. The IDSA also suggests that antimicrobial stewardship programs be implemented across all health care settings, including private practices. Such programs focus on teaching doctors to prescribe the drugs appropriately.

"The way we've managed our antibiotics for the past 70 years has failed," said IDSA President James M. Hughes, MD. "Antibiotics are a precious resource -- and we have a moral obligation to ensure they are available for future generations."

The society issued the call to action on World Health Day, which marks the founding of the World Health Organization on April 7, 1948.

Each year the WHO selects a key issue and encourages health professionals around the globe to address it. This year's subject is antimicrobial resistance.

"The world is heading towards a post-antibiotic era in which many common infections will no longer have a cure and, once again, kill unabated," said Dr. Margaret Chan, WHO director-general.

In the United States, hospital-acquired infections kill about 90,000 people a year, according to the National Institute of Allergy and Infectious Diseases. That figure is up from about 13,300 deaths in 1992. More than 70% of the bacteria that cause these infections are resistant to at least one of the antibiotics used to treat them.

Contributing to resistance problems are patients who do not take antibiotics as prescribed by their physicians and health professionals who misuse the medication, according to the IDSA. Such misuse is due in part to a lack of physician training on conserving antimicrobials, experts said. Antibiotics also are added to livestock feed to prevent infections and increase animal growth rates. Using the drugs in such a way can transfer antibiotic-resistant bacteria from animals to consumers when they eat the meat products.

Developing drugs

But even if approaches are improved, resistance will continue because microorganisms constantly evolve and grow resilient to medications, said Margaret A. Hamburg, MD, commissioner of the Food and Drug Administration. That means "no matter what, we need to develop new drugs," she said.

During the past three decades, the number of new antibacterials approved by the FDA has declined steadily. Twenty-nine such drugs were licensed between 1980 and 1989, according to the FDA. The number fell to 23 in the 1990s and dropped to nine between 2000 and 2009.

Even more troubling to experts is the limited number of potentially new antibiotics in research and development. Contributing to the slowdown is that antibiotic development is not as profitable as manufacturing other medications, such as those for chronic diseases like diabetes and hypertension, said Paul Miller, PhD, vice president and chief scientific officer of Pfizer Inc.

He said health professionals use antibiotics judiciously to prevent resistance, and the drugs are prescribed for short periods of time. In contrast, medications for chronic diseases often are used throughout a patient's life.

Dr. Hamburg said the FDA is working with infectious diseases experts and manufacturers to find solutions. Those could include offering economic incentives for manufacturers to encourage new antibiotic development and streamlining the FDA's drug approval process to expedite the review of new antimicrobials.

Last year, the IDSA called on manufacturers to develop 10 new, safe and effective antibiotics by 2020. Several bills before Congress seek to bolster antibiotic development.

"We need to enter a paradigm shift with how society deals with antibiotics, and we have to do so urgently because antibiotic resistance is only going to get worse," said Brad Spellberg, MD, an associate professor of medicine at the David Geffen School of Medicine at UCLA.