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The Lancet releases series on antimicrobial access and resistance during World Antibiotic Awareness Week
During World Antibiotic Awareness Week, The Lancet published a series entitled “Antimicrobials: access and sustainable effectiveness” on November 18th. The series reframes the challenges of antibiotic access and resistance as issues of sustainability, with a particular focus on targeting policy domains to improve international collaboration on ensuring long-term antibiotic effectiveness. The first two papers in the series focus on the problems and challenges associated with antibiotic access and antimicrobial resistance, while the last three papers examine potential policy intervention points for improving issues of access and sustainability. According to an article authored by the Center for Disease Dynamics and Economic Policy (CDDEP), which delved into both human and animal use of antibiotics, improved access to antibiotics is estimated to prevent the deaths due to pneumonia of greater than 75 percent of children under five each year across 101 countries. Researchers find that instead of using antibiotics to treat pneumonia in this age group, the scale-up of vaccines against pneumococcus and Haemophilus influenzae type b could prevent up to 11.4 million days on antibiotics per year, a 47 percent reduction in 75 countries. This would conserve antibiotics through preventing the development of resistance. Given these findings, they argue for prioritization of antibiotic access for children and neonates. The study also finds that although human antibiotic consumption is increasingly globally, restrictions to access to antibiotics have caused greater mortality than antibiotic resistance. Finally, researchers also project that worldwide antimicrobial consumption will rise by 67 percent in 2030 with the rise in demand for livestock. They also suggest that a ban on antimicrobials used for growth promotion would only to moderate production losses worldwide and that there continues to be a high correlation between antibiotic use and antibiotic resistance in food animals.
Another piece by Christine Årdal of the Norwegian Institute of Public Health and colleagues including Anna Zorzet of ReAct Europe calls for urgent, collective global action against antimicrobial resistance based on current evidence, while recognizing the need for more robust evidence to understand transmission of resistance from animals to humans. Coordinated global collaboration is specifically needed to address antimicrobial resistance across three policy areas - innovation, responsible use, and universal access. These areas must be integrated such that interventions to increase innovation and access to antimicrobial drugs should also include responsible use provisions in order to ensure drug effectiveness and prevent further resistance. The authors also call for delinkage of the payments of these drugs from the volumes sold in order to mitigate inappropriate incentives to waste antimicrobials. Additionally, as the challenge of antimicrobial resistance is multisectoral, spanning across the health, agricultural, and veterinary sectors, global collaboration through a One Health strategy is necessary. The authors call for a combination of “quick wins” and long-term solutions in multiple policy areas - surveillance, universal access, infection prevention and control, responsible use, and innovation. These solutions would also need to be coupled with better global coordination and financing. The authors put forth two possibilities at the intergovernmental level - namely, an international treaty with strong enforcement provisions as well as a UN-level coordinating body.
Osman Dar of Public Health England and colleagues including Anthony So of ReAct North America and Jasper Littman of ReAct Europe address the challenges of combatting antimicrobial resistance in low- and middle-income countries (LMICs). Moreover, the authors state there is an inadequate evidence base to inform policymakers of the effectiveness including generalizability and cost-effectiveness of antimicrobial policies, specifically in the areas of responsible use, surveillance, and infection control and prevention. The authors examine policies across these three areas, providing assessments of their effectiveness and generalizability. In particular, they find that there is a lack of evidence around cost-effectiveness of interventions such as surveillance and infection control across LMICs. Additionally, within these countries, they also call for a specific focus towards monitoring drug quality and counterfeit drugs. From this examination of antimicrobial resistance policies across different areas, the authors conclude that standardized policy assessments should measure cost-effectiveness and adaptability to the local context with a comprehensive political, regulatory, and technical landscape analysis. The authors also call for a One Health approach that would allow for the development of policies that can be tailored to the sector involved and adaptable to the specific country or regional context.
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Gaps remain in public knowledge about antibiotic resistance
A team of researchers from Queensland, Australia recently published a systematic review of public perceptions and beliefs regarding antibiotic resistance (ABR). The review surveyed 54 studies comprising interviews and questionnaires of 55,225 people from Europe, North America, and Asia. The researchers found that many people (70%) had heard of antibiotic resistance and believed that it was a problem. However, most people (88%) didn’t fully understand how resistance develops and also believed that the ABR threat is not something over which individuals have control or responsibility. Survey participants tended to attribute ABR development to the actions of others and believed that clinicians should take on the full responsibility of decreasing excessive antibiotic use. However, clinicians have a very different view of their role in combatting antibiotic resistance. In another systematic review published this past summer, the same researchers reviewed a combined 57 studies that surveyed 11,593 medical professionals’ perceptions of ABR. While the vast majority of surveyed clinicians believed that ABR is a serious global health problem, less than 70% thought it was a problem related to their own practice. Causal attributions for ABR development also differed from those of the general public. Instead of viewing clinician practices as the main driver of resistance, most of the surveyed health professionals believed that patient non-adherence and excessive antibiotic use were the main culprits.
Taken together, these findings on public and clinician perceptions of ABR can guide interventions for tackling overuse and misuse in clinical and household settings. The authors noted that their research highlights the need for public education on why antibiotic resistance is “everyone’s problem,” and how “it is individuals who have the power to minimize use and halt antibiotic resistance.” From a clinical standpoint, health professionals have the ability to ensure that patients understand the implications of antibiotic overuse and are aware of available alternatives for common infections. The authors also noted the role that international organizations and policymakers can play in controlling ABR, through improved resistance surveillance, regulating antibiotics in agriculture, infection prevention, and incentivizing innovative drug development.
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Chipotle's faces shortage in US of antibiotic-free meat, turns to UK supplier
Restaurant chain Chipotle has recently faced a shortage of pork produced in the US that meets its "Responsibly Raised" standards that require animals to never receive antibiotics. This shortage comes as a result of a failure to adhere to these standards by one of Chipotle's existing suppliers. For this reason, Chipotle has now begun supplying pork from the UK-based supplier Karro Food, which follows European antibiotic standards that do allow the therapeutic use of antibiotics under veterinary supervision. This stands in contrast with Chipotle's publicly strict policy to source meat from animals raised without antibiotics. The company emphasized, however, that their meat would continue to be free of antibiotic residues since animals treated with antibiotics from Karro would be subject to the withdrawal period mandated both in the US and Europe. As reported by NPR, veterinarian Gail Hansen, who previously worked for the Pew Charitable Trusts, suggested that it is not always feasible never to give antibiotics to animals, and she voiced her approval of Chipotle's transparency about possible therapeutic use by Karro Food. This is not the first shortage in antibiotic-free meat that Chipotle has faced. In 2014, the chain served chicken and beef in which non-therapeutic antibiotics were used in some locations during shortages of antibiotic-free chicken and beef. That year, Chipotle also began sourcing grass-fed beef from Australia because the US supply of antibiotic-free meat could not keep pace with the demand for Chipotle's products.
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Noodles & Company makes commitment to remove antibiotics from supply chain by 2017
Noodles & Company, a restaurant chain, announced in early October a commitment to source by 2017 meat and poultry from animals that have never been given antibiotics or hormones. The commitment comes as a part of the chain's rebranding that will also lead to the removal of "artificial colors, flavors, preservatives and sweeteners from its core menu." The company began serving antibiotic-free pulled pork in 2012 and has introduced antibiotic-free bacon this past month. Noodles & Company plans to remove antibiotics from its steak and meatball options by "mid to late 2016" and from chicken by early 2017. Like Chipotle, Noodles & Company is a "fast-casual" restaurant chain with 470 locations in the US.
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