Skip to main content

Currently Skimming:

7 Strategies to Contain the Development and Consquences of Resistance
Pages 196-230

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 196...
... Various public agencies and private organizations already are putting parts of the action plan into practice. The FDA is using its regulatory responsibility to ensure that drugs and other chemical agents used in both humans and animals do not pose unacceptable health risks, including risks that may arise as a result of antimicrobial resistance.
From page 197...
... These strategies include preventing infections so as to directly reduce the need for antimicrobial exposure and the emergence and selection of resistant strains; diagnosing and treating infection properly, which will benefit patients and decrease the opportunity for development and selection of resistant microbes; using antimicrobials wisely, since optimal use will ensure proper patient care while avoiding overuse of broad-spectrum antimicrobials and unnecessary treatment; and preventing transmission of resistant organisms from one person to another. At the international level, the World Health Organization (WHO)
From page 198...
... Bell, M.D. Office of the Director, National Center for Infectious Diseases Centers for Disease Control and Prevention, Atlanta, GA The Public Health Action Plan to Combat Antimicrobial Resistance To provide a blueprint for federal actions to address the emerging threat of antimicrobial resistance (AR)
From page 199...
... In collaboration with state health departments and other partners, CDC monitors resistance for several pathogens of public health importance and collects limited data on antimicrobial drug prescribing. For example, resistance in invasive S
From page 200...
... Improving state, local, and health care system infrastructure to support development of local surveillance and enhance the capacity for electronic reporting. Reliable surveillance information as we Il as patient care and safetyrequires that front-line clinical laboratories detect emerging drug resistance accurately.
From page 201...
... (see Figure 7-3~. Initially focused primarily on pediatrics, the lIn the action plan, appropriate antimicrobial drug use is defined as use that maximizes therapeutic impact while minimizing toxicity and the development of resistance.
From page 202...
... 202 THE RESISTANCE PHENOMENON FIGURE 7-1 Example of a poster, used in public education campaigns, promoting appropriate use of antimicrobial drugs, developed by CDC in partnership with the American Society for Microbiology.
From page 203...
... CONTAINING THE DEVELOPMENT ~ CONSEQUENCES OF RESISTANCE 203 FIGURE 7-2 Example of a pamphlet, used in public education campaigns, promoting appropriate use of antimicrobial drugs, developed by CDC in partnership with the American Society for Microbiology.
From page 204...
... In health care settings, where infection with multi-drug-resistant organisms is a major patient safety issue, promoting appropriate antimicrobial drug prescribing is complicated by the higher stakes involved in treating sicker patients and the need to develop partnerships with a greater number of medical and surgical specialties involved in their care, as well as with other clinical staff and administrators. Prevent Antimicrobial Resistance, a campaign that emphasizes 12 evidence-based steps for diagnosis of infection, appropriate treatment, appropriate use of antibiotics, and preventing transmission, was launched by the CDC in March 2002, initially focusing on hospital care of adults.
From page 205...
... In 2001 CDC supported projects to evaluate the impact of pneumococcal conjugate vaccine in reducing infections with drugresistant pneumococci, demonstration programs evaluating comprehensive approaches to infection control in health care settings in Chicago and Pittsburgh, and infection prevention and control research and evaluation programs at seven university-based Centers of Excellence in Healthcare Epidemiology. Regional approaches are important, as illustrated by the early recognition and successful control of the spread of vancomycin-resistant enterococci (VRE)
From page 206...
... In summary, federal agencies now have a strategy and an action plan to address AR domestically and a similar plan is being developed to address global resistance. Progress to date is encouraging, indicating that additional investments can be expected to pay dividends in converting AR from an urgent to a routine problem that does not compromise the availability of safe and effective therapy for patients today and in future generations.
From page 207...
... These include our Subpart E and Subpart H regulations and fast track designation. These encourage early communication between FDA and firms, allow us to use data collected earlier in the drug development process as the basis for approval, and permit the use of surrogate markers to form the basis of approval.
From page 208...
... Beyond the above it is appropriate to consider how we can improve our ability to make inferences from clinical trials conducted for resistance claims. This would be of particular value for products whose primary emphasis is treatment of resistant infections.
From page 209...
... Implementing such a program would also be problematic for a drug that had demonstrated broad antimicrobial activity, including activity against resistant organisms, and for which a more substantial safety database was available. Antimicrobial therapy is used in a wide variety of clinical situations.
From page 210...
... As the use of ant~retroviral therapy increases throughout the world, issues of resistant HIV can be expected to become more widespread. THE CENTERS FOR DISEASE CONTROL AND PREVENTION'S CAMPAIGN TO PREVENT ANTIMICROBIAL RESISTANCE IN HEALTH CARE SETTINGS Julie L
From page 211...
... The campaign is a nationwide effort that targets front-line clinicians, patient care partners, health care organizations, purchasers, and patients. Its general goals include informing clinicians, patients, and other stakeholders about the escalating problem of antimicrobial resistance in health care settings: motivating interest in and acceptance ot ~ntervent~onai programs to prevent resistance; and providing clinicians with tools to support needed practice em , .
From page 212...
... Target the pathogen. Appropriate antimicrobial therapy saves lives.
From page 213...
... Infectious diseases expert input improves the outcome of serious infections. Infectious disease specialists are one important resource for providing input, but many other professionals, such as health care epidemiologists, clinical pharmacologists, and surgical infection experts, also can contribute to optimal care for patients with infections.
From page 214...
... Clinicians should recognize that fever in a patient with an intravenous catheter is not a routine indication for vancomycin. The CDC's Healthcare Infection Control Practices Advisory Committee has developed a set of guidelines that detail situations in which the use of vancomycin either is acceptable or should be discouraged (CDC, 1995~.
From page 215...
... ANTIMICROBIAL RESISTANCE CONTAINMENT STRATEGIES OF THE RATIONAL PHARMACEUTICAL MANAGEMENT PLUS PROGRAM Terry Green and Anthony Savelli Rational Pharmaceutical Management Plus (RPM Plus) Program Management Sciences for Health, Arlington, VA The use of antimicrobial agents has contributed to the significant decline in infectious diseases over the past half century.
From page 216...
... Similar concerns exist for the increased availability of TB and malaria drugs that will occur under the Global Fund to Fight AIDS, Tuberculosis and Malaria. The AMR containment strategies discussed below will increase awareness about this issue and provide opportunities to reduce the risks associated with the Global Fund.
From page 217...
... To improve the reach of the WHO global initiative, RPM Plus (and our partner the Alliance for Prudent Use of Antibiotics PAPUA]
From page 218...
... I Conduct Research to Fill Knowledge Gaps and Evaluate Interventions 1 Critical Mass of Activity to Contain AMR ~ \ \ Implement Advocacy Strategies Conduct multifocused advocacy directed toward: · Relevant stakeholders to stimulate and support evidence-based interventions · Policy makers to formulate AMR policies and strategies · General public and the media to increase awareness of AMR FIGURE 7-4 Outline of a systematic approach for containing antimicrobial resistance. Establishing and Strengthening Drug and Therapeutics Committees The DTC is a critical component of a health care organization's drug selection and use program.
From page 219...
... Managing adverse drug reactions Managing medication errors. RPM Plus DTC Training Courses DTCs are weak or non-existent in developing countries and irrational drug use is a common problem.
From page 220...
... RPM Plus will continue to hold DTC training courses while it monitors the work of past course participants. Promoting Infection Control Improvement Hospital-acquired infections are a major cause of preventable morbidity and mortality in developing countries worldwide, putting both patients
From page 221...
... In addition to the substantial impact on morbidity, mortality, and health care costs, there are other compelling reasons to focus on developing practical strategies for improving infection control and decreasing the emergence of AMR in hospitals: . Hospitals are major incubators for resistant bacteria, because antimicrobial agents are commonly prescribed Hospitals can amplify resistance, because resistant bacteria spread quickly among vulnerable patients in facilities that are understaffed, overcrowded, or lack basic infection control practices · Patients who acquire resistant infections in hospitals have the potential to disseminate these bacteria in their homes and communities RPM Plus is developing an infection-control quality improvement program (in collaboration with Harvard University)
From page 222...
... The RPM Plus portfolio also includes technical assistance activities for the Nepal national AMR program, which works to enhance AMR sentinel surveillance sites and improve drug management programs in the public and private sectors. Other AMR-related work includes support of INRUD activities including participation in Africa and Asia regional training courses on Promoting Rational Drug Use.
From page 223...
... Our goal, therefore, must be to slow down its emergence and continue to develop new antibiotics that will take the place of those drugs that become useless because of resistance. No one would disagree that the public health action plan is a significant effort among various groups and represents a comprehensive strategy to address antimicrobial resistance (U.S.
From page 224...
... in relation to the CDC and the National Institutes of Health is largely underfunded even though USDA provides the majority of funding for antimicrobial resistance research in agriculture. For example, USDA's Cooperative State Research Education and Extension Service funded $4 million in 1999 and $4.5 million in 2000.
From page 225...
... Research is needed to determine which dosage, treatment regimen, or drug might be the most important in the development of resistance. Two recent drug use surveys reported different results because of disagreements in the measurement of drug use (Animal Health Institute, 2000; Lipsitch et al., 2002)
From page 226...
... A significant effort in agriculture is toward alternative products such as competitive exclusion products, immune modulators, and vaccines. However, it is also important to concentrate on possible alternative management approaches.
From page 227...
... Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)
From page 228...
... System Report, Data Summary from January 1992-June 2001, issued August 2001. American Journal of Infection Control 29:404-421.
From page 229...
... 2000c. World Health Report on Infectious Diseases 2000: Overcoming Antimicrobial Resistance.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.