ATLANTA—In response to a growing public health problem, the federal government recently released an action plan to battle antimicrobial resistance in the United States. The plan was developed by a task force of 10 government agencies and departments led by the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and the Food and Drug Administration.[1] The task force was created in 1999.

“The action plan is intended as a blueprint or federal agencies in coordinating their efforts against antimicrobial resistance,” said David Bell, MD, a task force cochair and the Antimicrobial Resistance Coordinator at the CDC. “Several items will assist physicians in prescribing antibiotics (including access to better surveillance data on drug resistance, improved diagnostic tests, and computerized decision support) and improving public awareness of the benefits and limitations of antibiotics.”

This is the first part of a global approach to antimicrobial resistance by federal agencies in the United States. Part II of the plan, to be developed in collaboration with the World Health Organization, will identify federal actions to combat antimicrobial resistance on the international front.

There are four major components to part I—surveillance, prevention and control, research, and product development. Each requires collaboration between the appropriate federal agencies and entities outside the federal government, such as state and local health agencies, universities, pharmaceutical companies, and insurers.

THE NEED FOR SURVEILLANCE

The domestic plan contains 84 interventions, 13 of which are top priority. Seven of the top-priority interventions are already under way, and the remaining six will be implemented within the next year or two.

A top-priority intervention still in the works is a coordinated national surveillance program, which will enable detection of resistant microbes as they emerge. Other vital surveillance activities include ensuring access to reliable antimicrobial susceptibility data; monitoring antimicrobial drug use; and providing timely dissemination of surveillance data to clinicians, public health officials, and others who need it.

Besides spotting new pockets of antimicrobial resistance, national surveillance will make it possible to monitor changes in existing resistance patterns, identify interventions for preventing resistance, and anticipate gaps in antimicrobial availability. “It will also help in making physicians aware of local resistance patterns that may affect their prescribing decisions,” said Dr. Bell in an interview with PULMONARY REVIEWS.

PREVENTION AND CONTROL

Public education about appropriate antimicrobial use will be a mainstay of efforts to prevent and control antimicrobial resistance. “We often hear that it is hard to explain to patients why an antibiotic will not help a cold,” commented Dr. Bell. “Public education should help with this problem.”

Reducing inappropriate antimicrobial prescribing is a top priority, too, and will be accomplished through interventions that educate clinicians. Among the possibilities are clinical guidelines, computer-assisted decision support, regulatory changes regarding antimicrobial use, and culturally appropriate teaching materials that help physicians inform patients about the benefits and limitations of antimicrobials.

Community-based public health campaigns will help to prevent the spread of resistant microbes in the general population by promoting appropriate antimicrobial use, vaccination, and hygienic practices, such as hand washing and safe food handling. To enhance these efforts, health care providers must find novel ways to increase administration of pneumococcal and other vaccines useful in preventing drug-resistant infections, such as offering them to patients at hospital discharge.

To improve infection control in health care settings, it will be necessary to develop better diagnostic tests, increase understanding of factors that promote cross-infection, and find alternatives to invasive medical procedures that raise infection risk. Infection-control education for health care workers who have contact with patients is important at all stages of training and practice.

To promote the incorporation of effective antimicrobial resistance prevention and control programs into routine practice, the action plan task force will be implementing model programs in federal health care systems. It will also push to have prevention and control activities included in quality assurance and accreditation standards for health care delivery nationwide.

TOP RESEARCH PRIORITIES

Basic and clinical research will provide the fundamental knowledge needed to respond appropriately to antimicrobial resistance. A top priority in this area is to provide researchers with advanced technologies, such as microbe genomics, that permit the development of new diagnostic, preventive, and therapeutic interventions.

Clinical studies of new therapies will be conducted in collaboration with academia and the private sector. There will also be efforts to develop new rapid diagnostic methods, with an emphasis on accuracy, affordability, and ease of use in clinical settings. These new methods may include tests for resistant microbes (including nonculture specimens) and resistance genes. Point-of-care tests for resistant microbes may be created for use in those patients who have been diagnosed with respiratory conditions.

Vaccines will be developed to combat antimicrobial resistance directly by preventing infection with enterococci, staphylococci, and other resistant organisms. These vaccines will work indirectly, too, reducing antibacterial use by preventing common bacterial infections (such as those caused by Streptococcus pneumoniae), as well as influenza and other viral infections that predispose to bacterial infection or are often mistaken for bacterial infections.

PRODUCT DEVELOPMENT LAGGING

The need is increasing for new antimicrobials and other products that address the resistance problem, but these products are not being developed rapidly enough. “New antibiotics are a particular problem,” said Dr. Bell. “Drug companies may hesitate to develop and test them if sales are going to be hurt by policies that limit use.”

To encourage product development, an interagency working group will be formed to identify urgent public health needs for targeted-spectrum antibiotics, disinfectants, and other new products that address antimicrobial resistance. The working group will find ways to promote the development and appropriate use of these products (eg, offering financial incentives when profitability is a concern). It will also report current and projected gaps in product availability to researchers and manufacturers, and identify potential markets for urgently needed new products.

There is major emphasis on speeding approval for antimicrobials and other new products while ensuring their safety and efficacy. Approaches for antimicrobials may include expedited approval in accordance with the Investigational New Drug regulations and finding easier ways to measure a drug’s effectiveness, an option allowed in the New Drug Application regulations. To speed approval of anti-infective medical devices, resistance concerns will be addressed during the pre- and post-licensing review.

—Timothy Begany

A printable, full-text PDF version of A Public Health Action Plan to Combat Antimicrobial Resistance is available online at www.cdc.gov/drugresistance/actionplan/html/index.htm. The action plan can also be ordered online; by mail through the Office of Health Communication, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop C-14, 1600 Clifton Road, Atlanta, GA 30333; or by fax at (404) 371-5489

Reference
1. Interagency Task Force on Antimicrobial Resistance. A public health action plan to combat antimicrobial resistance. Available at: http://www.cdc.gov/drugresistance/actionplan/html/index.htm. Accessed April 3, 2001.