July 10, 2015
A roundup of news on drug resistance and other topics in global health.
Fast-tracking approval of new antibiotics won’t solve the problem of antibiotic resistance if new antibiotics are marketed as aggressively as in the past—and funding for antibiotic stewardship needs to rise dramatically, according to CDDEP Director Ramanan Laxminarayan at the 2015 Latsis Symposium on Drug Resistance and the Future of Disease Control. Laxminarayan challenged the narrative of an empty antibiotic pipeline and contended that antibiotic stewardship, in the broadest sense, is more important than a raft of new antibiotics. Slides from the presentation, including graphics on animal antibiotic use, drug development and antibiotic stewardship, are now available online. [CDDEP, Latsis Symposium]
A new Consumer Reports special investigation focuses on antibiotic resistance and what patients can do to address the issue. CDDEP Director Ramanan Laxminarayan, interviewed for the story, highlighted the complex nature of antibiotic resistance and remarked that coping with it requires a community effort, including patients and consumers in addition to physicians, policymakers, farmers and pharmaceutical companies. [Consumer Reports]
Invasive Salmonella disease affects millions worldwide, with concentrations in sub-Saharan Africa and south Asia, much of it multi-drug resistant (MDR). Global Antibiotic Resistance Partnership (GARP)-Kenya chair Samuel Kariuki led a review of antibiotic resistance and invasive Salmonella infections, published in Vaccine, including typhoid and non-typhoidal Salmonella (NTS), a major cause of pediatric bacteremia. Kariuki and his colleagues call for “improved sanitation [and] the wider introduction of WHO recommended typhoid vaccines and the acceleration of trials for novel typhoid, paratyphoid and iNTS vaccines.“ [Vaccine]
The Oxford University Clinical Research Unit (OUCRU) in Hanoi, secretariat of the GARP-Vietnam working group, signed an Aide Memoire on antibiotic resistance with the Vietnamese Government. The Ministries of Health, Agriculture and Rural Development, Industry and Trade, Natural Resources and Environment joined other development partners in recognizing the growing global threat of antibiotic resistance and committing to take steps to control it. [WHO Western Pacific Region]
The U.S. House of Representatives passed the 21st Century Cures Act with a vote of 344-77 today. The bill, which must also be considered by the Senate before it can be signed into law by the President, would expedite the FDA approval process for drugs and medical devices. The legislation garnered rare bipartisan support in the House, but its critics, which include several nonprofit health research organizations and the editor of JAMA Internal Medicine, contend that lowered clinical trial standards intended to shorten the approval process could put patients at risk, without rigorous evidence of benefit from the new therapies. [Library of Congress, Washington Post]
“[I]f charging patients drives people to poorer-quality care, that should alarm public health officials—especially if it’s encouraging antibiotic resistance.” Stanford researchers analyzed data from 47 countries, reported in the recent WHO report on global antibiotic resistance, and found that in low- and middle-income countries, public sector drug co-pays are strongly correlated with increased antimicrobial resistance. They surmised that high co-pays cause patients to seek lower-cost—and lower-quality—drugs in the private sector, where antibiotics are available without prescription. The authors write, “While the causes of antimicrobial resistance are complex, our analysis supports an increasing role of the public sector in regulating and subsidizing the distribution of antimicrobial agents.” [Bloomberg Business, Lancet Infectious Diseases]
A low-cost cholera vaccine offers significant protection against the disease and may be key to reducing the burden of cholera in low- and middle-income countries. In a randomized trial of more than 270,000 individuals in Bangladesh, the vaccine offered more than 50 percent protection against cholera for five years and “reduced life-threatening episodes of the infection by about 40 percent.” The positive results surprised many experienced public health experts, as the vaccine was more effective than supplying chlorine to sanitize water and soap for hand-washing. The ongoing cholera epidemic in Haiti has killed over 10,000 people, and other outbreaks have occurred recently in Burundi, South Sudan and Nigeria. [The New York Times, The Lancet]
An imbalance in the human microbiota can promote the development of allergies—and new research may finally suggest why. The research, published in Science, found that a loss of bacterial symbionts can trigger an exaggerated response from certain immune cells that would normally fight large parasites, but instead trigger allergic responses. The mechanism may help explain the “hygiene hypothesis,” which links an increase in allergies with improved public hygiene. [Science, Infection Control Today]
Paper rupee notes in India carry a wide variety of pathogens—some of which are resistant to antibiotics. A study published in PLOS One analyzed swabs of Rs10, Rs20 and Rs100 currency notes collected from shops in Delhi and identified the presence of 78 bacterial pathogens, including Staphylococcus aureus and Enterococcus faecalis. They also found 78 antibiotic-resistanc genes on the rupees, 18 of them on every note analyzed. [Quartz, PLOS One]
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Image via Consumer Reports.
