Today’s digest features a roundup of the major work and research CDDEP has completed in the last year, from on-the-ground successes with the Global Antibiotic Resistance Partnership to studies published in leading journals, including The Lancet and Proceedings of the National Academy of Sciences.
Physician competition may drive up antibiotic prescriptions, according to study by CDDEP researchers published in the Journal of Antimicrobial Chemotherapy in January. Changes in the healthcare landscape—particularly the expansion of urgent care and retail clinics in wealthier areas—increase physician competition and result in increased outpatient antibiotic prescription rates. Lead author and CDDEP fellow Eili Klein and CDDEP Director Ramanan Laxminarayan discuss the research in The Conversation US. [Journal of Antimicrobial Chemotherapy, The Conversation US]
Global livestock antibiotic use is expected to increase 67 percent by 2030, according to a CDDEP analysis published in the Proceedings of the National Academy of Sciences.  CDDEP researchers conducted the first broad assessment of global antibiotic consumption in livestock and found that use is expected to grow by two-thirds between 2010 and 2030. About two-thirds of the growth is due to an increase in the number of animals raised for food production, while the remaining third is attributable to changing farming practices. [PNAS, CDDEP]
CDDEP’s Global Antibiotic Resistance Partnership (GARP) had a successful 2015. Four GARP countries—Tanzania, Nepal, Mozambique and Uganda—published situation analyses on antibiotic use and resistance that can be used to ground new national antibiotic policies. Several GARP countries held events for the first annual World Antibiotic Awareness Week, including the third annual Antibiotic Awareness Week in Kenya and a cycling rally in Nepal to raise awareness about antibiotic resistance. In 2015, CDDEP also launched GARPNet News, a bimonthly newsletter focusing on GARP and global antibiotic resistance news. The November issue of GARPNet News, and information about how to sign up for the newsletter, is available online. [GARP, GARPNet News]
In September, CDDEP released the first State of the World’s Antibiotics: 2015 report. The report provides the most complete picture to date on the status of antibiotic use and resistance around the globe. CDDEP authors challenge the prevailing argument that the biggest obstacle facing antibiotic resistance is a lack of new drugs in the “antibiotic pipeline.” New antibiotics are part of the solution, but only when coupled with conservation: strong antibiotic stewardship in its broadest sense, which involves limiting overuse of antibiotics in humans and livestock. CDDEP’s Global Antibiotic Resistance Partnership (GARP) provided both data and insight into meeting the challenges in low- and middle-income countries. The report received significant media coverage, including a video on BBC News, articles in Nature News and NPR and was cited in an Observer editorial about fighting antibiotic resistance worldwide. [CDDEP]
A redesigned, updated and expanded ResistanceMap was launched alongside the State of the World’s Antibiotics: 2015. ResistanceMap (ResMap) is a web-based collection of data visualization tools that allows interactive exploration of antimicrobial resistance (AMR) and antibiotic use trends, now available for 69 countries across the world. Its new iteration, for which the site was completely redesigned and updated, includes never-before-published data on antibiotic resistance in low- and middle-income countries (LMICs), including India, Kenya, Vietnam, South Africa and Thailand. ResMap continues to grow, with new sites added regularly. ResMap received media attention from WIRED, Quartz,  and National Geographic. [ResistanceMap]
India’s Safe Motherhood Scheme (JSY), one of the largest conditional cash transfer programs for pregnant women in the world, may have resulted in a 2.5–3.5 percentage point rise in the probability of childbirth or pregnancy in some states. CDDEP researchers Arindam Nandi and Ramanan Laxminarayan assessed possible unintended effects of JSY in a study in the Journal of Population Economics. JSY began in India in 2005 and offers cash incentives for socioeconomically disadvantaged women to give birth to children in healthcare facilities. Nandi and Laxminarayan found that the program may have increased the probability of childbirth or pregnancy by 2.7 percentage points (equivalent to a 7% rise from baseline) among women who are either poor or belong to socioeconomically disadvantaged caste groups. [Journal of Population Economics]
President Obama made combating antibiotic resistance in the United States a priority in 2015, with advisory support from CDDEP. In March, the White House President’s Council of Advisors on Science and Technology (PCAST) released its National Action Plan on Combating Antibiotic Resistance (CARB), and in June it held a Forum on Antibiotic Stewardship, which CDDEP joined. In September, CDDEP Director Ramanan Laxminarayan was chosen to serve on the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, which will work with U.S. federal agencies to implement the National Action Plan. On the Council, Laxminarayan co-chairs a subcommittee on international efforts to combat resistance. [National Action Plan on CARB, White House Forum, Presidential Advisory Council]
Declining antibiotic efficacy in surgical and blood cancer chemotherapy prophylaxis could lead to 120,000 more infections in the United States annually. In a first-of-its-kind analysis published in October in The Lancet Infectious Diseases, CDDEP researchers estimated the increase in infections and infection-related deaths that reduced antibiotic efficacy could have on prophylactic antibiotic use for blood cancer chemotherapy and the ten most common surgical procedures performed in the U.S. each year. CDDEP Associate Director Hellen Gelband put the study in perspective on the CDDEP blog, “From Boilerplate to Lives Lost: Surgery, Cancer and Antibiotics.” [The Lancet Infectious Diseases, CDDEP]
Cancer, volume 3 in the Disease Control Priorities, 3rd edition, was released in Marrakech, Morocco at AORTIC—the African Organisation for Research and Training in Cancer. CDDEP Associate Director Hellen Gelband, the lead editor, was joined by co-editors and authors in a symposium at the Pan-African conference on November 18. The volume provides a basis for low- and middle-income countries (LMICs) to develop national cancer plans that include interventions that are effective, cost-effective, feasible and affordable, and address significant portions of their cancer burdens. According to the volume, most of the expected increase in cancer incidence is in cancer types that are not preventable with current knowledge, so it is critical that the capacity to treat curable cancers be greatly increased and that resources not be squandered on ineffective measures. Eighty-seven experts from around the world contributed to chapters on globally important cancers, treatment modalities and economics. A post by Gelband on the World Bank’s Investing in Health blog accompanied the release. Key findings and recommendations from the volume appeared in The Lancet (11 November). In an accompanying Lancet podcast, Gelband explained, “The package has to be tailored by each country to its own conditions, and what we suggest is a way of getting there and a starting point.” [The Lancet, The Lancet Audio, AORTIC, World Bank, DCP-3]
Globally, more children die from pneumonia, sepsis and other infections because they get no treatment than die from antibiotic-resistant infections. That is a central message of the lead article, by CDDEP Director Ramanan Laxminarayan and collaborators, in the Lancet series Antimicrobials: access and sustainable effectiveness. The article focused on the dual challenge of increased antibiotic resistance and the still serious lack of access to antibiotics in many countries. In a comment in the series, Ministers of Health and their representatives in India, Kenya, South Africa and Mozambique note their progress and challenges in creating effective national antibiotic policies that consider both access and resistance and look to fresh approaches inspired by the series papers. [The Lancet, The Lancet]
Other 2015 CDDEP Publications:
·  Ardal, C., Outterson, K., Hoffman, S. J., et al. (includes R. Laxminarayan). International cooperation to improve access to and sustain effectiveness of antimicrobials. Lancet.
·  Gelband, H. & Laxminarayan, R. Tackling antibiotic resistance at global and local scales. Trends in Microbiology.
·  Klein, E. Y., Smith, D. L., Cohen, J.M., Laminarayan, RBioeconomic analysis of child-targeted subsidies for artemisinin combination therapies: a cost-effectiveness analysis. Journal of the Royal Society Interface.
·  Laxminarayan, R., Van Boeckel, T. P. & Teillant A. The Economic Costs of Withdrawing Antimicrobial Growth Promoters from the Livestock Sector. OECD Food, Agriculture and Fisheries Papers.
·  Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT, and the DCP3 Essential Surgery Author Group (includes A. Nandi and R. Laxminarayan). Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet.
·  Nandi, A. Holtzman, E. P., Malani, A., Laxminarayan, R. The need for better evidence to evaluate the health & economic benefits of India’s Rashtriya Swasthya Bima Yojana. Indian Journal of Medical Research.
·  Pramanik, S., Muthusamy, N., Gera, R., Laxminarayan, R. Vaccination coverage in India: a small area estimation approachVaccine.·  Renschler, J. P., Walters, K. M., Newton, P. N., Laxminarayan, R. Estimated Under-Five Deaths Associated with Poor-Quality Antimalarials in Sub-Saharan Africa. American Journal of Tropical Medicine and Hygiene.
·  Wattal, C., Goel, N., Khanna, S., Byotra, S. P., Laxminarayan, R., Easton, A. Impact of informational feedback to clinicians on antibiotic prescribing rates in a tertiary care hospital in Delhi. Indian Journal of Medical Microbiology.
The digest will resume its regular reporting next week.