Obama Unveils Plan to Tackle Antibiotic Resistance

From the WebMD Archives

March 27, 2015 -- The Obama administration is pledging to end the widespread practice of using antibiotics to boost the growth of animals that are raised for food in the U.S.

“The National Action Plan for Combating Antibiotic-Resistant Bacteria” also directs the FDA to make meat producers get a veterinarian’s okay in order to buy the drugs for other reasons in animals.

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The FDA had recommended those measures before, but it didn't require livestock producers to comply.

The new report gives the agency a year to set final changes to the labels of “medically important” antibiotics sold for animals being raised for food. The changes will make it illegal to sell these antibiotics without a vet’s prescription.

The plan also includes new proposals intended to stem the spread of antibiotic-resistant bacteria and speed new tests and treatments to people:

  • The creation of new DNA databanks of bacteria that are resistant to antibiotics. These will serve as reference libraries to help disease detectives trace the sources of resistant infections. They'll help scientists develop new treatments, too.
  • Changes to the designs of clinical trials, so that new drugs could be tested on patients even when outbreaks of these infections are sporadic and affect relatively small numbers of people.
  • New requirements for hospitals to track and report their antibiotic use.
  • Prize money to spur the development of tests that could help doctors quickly tell if an infection is caused by bacteria or viruses -- and if it is caused by bacteria, which drugs would work to kill them.

An infectious disease expert says the new requirements for hospitals were particularly important.

“We have really poor national systems for tracking antibiotic use and antibiotic resistance,” says Trevor Van Schooneveld, MD, an assistant professor of internal medicine at the University of Nebraska Medical Center in Omaha.

“There’s never been a requirement for hospitals to track their antibiotic use, except in California,” he says. “This is the first step, and the real question is: How do you turn this information into something meaningful that really improves antibiotic use? But this puts it on the radar of every facility in the U.S.”

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President Speaks Out

In an interview with WebMD, President Barack Obama calls antibiotic resistance a pressing public health issue that is vital to our national security.

“They [antibiotics] save the lives of service members wounded in battle. They prevent infections in one community from spreading far and wide. They’re also a critical defense against bio-terrorism. They are, quite simply, essential to the health of our people and people everywhere,” he says.

He calls on Congress to help fund the plan, but says the administration will act where it can to implement parts on its own. The plan will nearly double the amount of money spent on fighting antibiotic resistance to more than $1.2 billion.

In a press call on Friday, senior administration officials said that $77 million would fund efforts to combat resistance at the Department of Agriculture, $85 million is slated to the Department of Veterans Affairs, and $75 million is slotted to the Department of Defense.

“We realize this is an area of active discussion in Congress, and we want to make sure Congress knows they have the ability to save lives by implementing the funding that is needed to start these significant steps in the action plan,” one official said.

The president also says the new plan would help to revitalize the pipeline for antibiotics that work in new ways. Right now, there are about 741 new antibiotics in development, according to a recent market report from GBI Research, but most are identical or similar to drugs already on the market.

Only four completely new kinds of antibiotics have been approved in the U.S. and Europe since 2000, but Obama says he hopes his plan will change that.

“A lot of drug development comes down to market signals. Pharmaceutical companies want to know that if they spend the time and money to develop new drugs, those drugs will sell,” he says.

“This National Action Plan is a huge market signal. The federal government is making a long-term commitment to fighting drug resistance. That doesn’t just mean producing one batch of new antibiotics. It means creating a stronger drug pipeline, so American drug companies will keep producing new antibiotics well into the future,” he says.

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More Reactions

An expert who reviewed the report says some of the most significant changes affect the ways antibiotics would be used in animals.

Many of the antibiotics used to treat human infections can be bought over the counter and in bulk by farmers, who add the drugs to animal feed to boost growth and prevent illness.

A report released in 2013 by the Center for Science in the Public Interest (CSPI) shows that about 80% of the antibiotics sold in the U.S. are used in animals that are raised for food. About three-quarters of those drugs are antibiotics that are also used for human health.

There's growing concern that the use of these drugs in livestock is contributing to the problem of antibiotic resistance, where bacteria that cause human infections can no longer be killed by drugs available to treat them.

Earlier this month, fast food giant McDonald’s joined other major chains, like Chick-fil-A and Chipotle Mexican Grill, that have agreed to stop selling meat raised with antibiotics.

“These are very important antibiotics to preserve for human medicine, but they’re being squandered by excess use on the farm,” says Caroline Smith DeWaal, director of Food Safety at CSPI.

DeWaal praises the proposed new restrictions and another pledge in the report to collect more info on the sales and use of antibiotics in animals. But the plan still has to be put into action, she cautions.

“This is certainly an important new document, but the real proof will be when the administration releases meaningful policy changes that address the overuse of antibiotics on the farm,” she says.

Other experts say the report doesn’t go far enough to curb antibiotic use in animals, since the drugs could still be used for low doses over long periods of time in healthy animals to prevent disease.

“Many times, a ‘disease prevention’ benefit is that [the animals] continue to grow well,” says Steven Roach, a senior analyst for Keep Antibiotics Working, a network of advocacy groups that are working to curb the overuse of the drugs.

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“In terms of their [the administration's] approach on the animal side, it’s incredibly disappointing,” Roach says. “It also reveals that they just didn’t consider enough input from stakeholders besides [livestock] industry stakeholders.”

The administration says it aims to slash the number of infections caused by antibiotic-resistant “superbug” bacteria by the year 2020 -- including a 50% decrease in the number of new cases of Clostridium difficile, or C. diff, and a 60% drop in the number of infections caused by carbapenem-resistant Enterobacteriaceae, or CRE. CRE was the germ that sickened and killed patients at two California hospitals earlier this year, when they contaminated hard-to-clean surgical instruments.

The plan also calls for closer tracking of where and when antibiotics are being used.

“Ideally, we’d be able to see in real-time where the cases of drug resistance are being reported, so we can take swift action,” Obama says. “The same goes for rates of antibiotic use. If we can see where these drugs are being over-prescribed, we can target our interventions where they’re needed most."

WebMD Health News Reviewed by Hansa D. Bhargava, MD on March 26, 2015

Sources

SOURCES:

The White House: “National Action Plan for Combating Antibiotic-Resistant Bacteria.”

Caroline Smith DeWaal, director of Food Safety, Center for Science in the Public Interest, Washington, D.C.

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