May 20, 1998 As early as 1945, scientists discovered a pathogen that had developed resistance to penicillin. Since that time, antibiotic resistance has risen dramatically, posing a threat to public health, increasing medical costs, and fueling a resurgence in pathogens that were considered under control.
Fighting the problem of antibiotic resistance will require a better, more coordinated system of surveillance, as well as an increased effort to prolong the effectiveness of existing antibiotics and to develop new drugs, says a new report from the Institute of Medicine's (IOM) Forum on Emerging Infections. The report summarizes the findings and opinions of participants at a recent workshop, and outlines options that policy-makers, pharmaceutical industry leaders, health officials, clinicians, researchers, and others may consider to combat this problem.
Though health officials have long argued the need for better surveillance, no country has developed a reliable, comprehensive system for tracking drug resistance, the report says. Efforts to understand its full impact are stifled by uncoordinated efforts to track across local, national, and international jurisdictions, as well as a lack of common standards among laboratories and health organizations for collecting data. An effective national surveillance program should allow broad access to information and data gathered from all parties, integrate information from participating laboratories into a national database, and distinguish cases of drug resistance occurring in hospitals from those found in the local community. On an international scale, policy-makers need to evaluate whether it is desirable to give more authority to the United Nations' World Health Organization or to the U.S. Centers for Disease Control and Prevention to lead a global surveillance effort.
Widespread, inappropriate use of antibiotics has led to premature emergence of resistance. Increasing the life of antibiotics will require changes in attitude and behavior among health care providers, patients, parents, managed-care organizations, the pharmaceutical industry, and others. Since no adequate enforcement mechanisms exist to ensure proper antibiotic use, current efforts consist primarily of trying to educate people about the hazards of antimicrobial overuse or misuse. Professional societies should collaborate to develop uniform guidelines that encourage better practices, the report says.
More research is needed to examine the impact of antibiotic overuse and misuse on humans; on finding new ways to define a drug's effectiveness; and on the benefits and risks of reducing antimicrobial dose and duration of therapy. Research also is needed on the human health effects of widespread agricultural use of antibiotics. A separate study on the use of antibiotics in chicken, cattle, and other food animals and products, and their potential impact on human health, will be completed by the National Research Council later this year.
In addition to preserving the effectiveness of the current groups of antibiotics, incentives are needed to develop new drugs. Pharmaceutical industry representatives at the workshop felt that efforts need to be directed towards promoting and fostering joint ventures that meet the scientific, legal, and regulatory concerns of industry and academic institutions alike.
The IOM's Forum on Emerging Infections was created in response to a request from the Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases. It brings together representatives from academia, industry, government, and professional and interest groups to examine and discuss scientific and policy issues related to emerging infections. The Institute of Medicine is a private, non-profit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences.
This project is funded by Abbott Laboratories; the American Society for Microbiology; Applied Microbiology Inc.; Bristol Myers Squibb; the Burroughs Wellcome Fund; the Centers for Disease Control and Prevention; Eli Lilly & Co.; F. Hoffmann-La Roche; the Food and Drug Administration; Glaxo Wellcome; Merck and Co. Inc.; the National Institute of Allergy and Infectious Diseases; Pfizer Inc.; SmithKline Beecham Corp.; the U.S. Department of State; the U.S. Department of Veterans Affairs; and Wyeth-Ayerst.
Copies of Antimicrobial Resistance: Issues and Options are available from the National Academy Press for $25.00 (prepaid) plus shipping charges of $4.00 for the first copy and $.50 for each additional copy; tel. (202) 334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
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