Pipeline or wipeout? The antibiotic era is at risk

Reaching an unsettling impasse in medicine

Wenzel RP. The antibiotic pipeline — challenges, costs, and values. New Engl J Med 2004; 351:523-526.

The author of this analysis observes cogently that the antibiotic era is threatened by the convergence of three adverse circumstances: high levels of antibiotic resistance among important pathogens, an uneven supply of novel classes of antibiotics, and a dramatic reduction in the number of pharmaceutical companies engaged in the discovery and development of anti-infective agents.

Consider the following facts: In U.S. communities, almost 50% of strains of pneumococci express high or intermediate levels of resistance to penicillin. In hospitals, 50% of S. aureus isolates are methicillin-resistant, and 30% of enterococci are vancomycin-resistant.

Of Pseudomonas aeruginosa strains, 20% express resistance to available quinolone drugs and 15% express resistance to imipenem.

In 2004, there are few antibacterial agents in the pipeline. A relatively unfavorable return on investment apparently is deterring large pharmaceutical companies from engaging in antibiotic-drug discovery, and the Infectious Diseases Society of America has suggested extending the life of drug patents as an incentive to industry.

Industry laments the costs related to the licensing process, citing bureaucratic barriers.

However, the Food and Drug Administration (FDA) has documented that anti-infective agents have had the highest approval rate of all therapeutic classes since 1964, as well as the shortest or second-shortest development time during each four-year period since 1982.

"With increasing levels of antibiotic resistance, an insecure pipeline, and a dwindling number of companies investing in anti-infective agents, we have reached an unsettling impasse in medicine," the author states.

"The public’s health, appropriate business incentives, and reasoned government regulations are all at risk. An urgent dialogue among committed advocates should begin and should be based on three accepted tenets. First, biologic explorations will eventually yield new targets. Second, society entrusts its safety to the FDA. And finally, good public companies need to be profitable and know the cost of disease, but great companies also aspire to serve and to know the value of health," he adds.

Child’s play: Finding Bacillus on Barney 

Toys bring pathogens into hospitals

Avila-Aguero ML, German G, Paris MM. Toys in a pediatric hospital: Are they a bacterial source? Am J Infect Control 2004; 32:281.

Toys brought into hospitals for pediatric patients can be contaminated with potentially dangerous bacteria and may provide unnecessary risks for nosocomial infection, the authors report.

In children’s hospitals, children commonly are provided with toys. Measures to guarantee the safety of these toys usually are not taken.

This study was conducted to determine whether toys were contaminated with potentially pathogenic bacteria when they arrived in the hospital, or if they were contaminated in the hospital.

The study was conducted during a three-month period. Children who were hospitalized for at least three days were chosen as study subjects. Once these children were identified, cultures from their toys were obtained within the first 48 hours of admission.

After this first culture, toys were cleaned with 4% chlorhexidine and water and were immediately re-cultured.

Following cultures were collected on days 5 to 7, 10 to 15, and every week thereafter until the owner-patient was discharged.

Seventy children’s toys were included in this study. Patients’ median age was 26 months (range: 1 day to 9 years). Respiratory infections (43%) and diarrhea (26%) were the most common causes of hospitalization.

Fifty-three (76%) toys were made of plastic, eight (11%) metallic, and nine (13%) other materials. Twenty-nine (41%) were brought from home, 38 (55%) were purchased from roving vendors, and three (4%) were purchased from toy stores.

All first cultures were positive for at least one pathogenic microorganism: 55 (78%) coagulase-negative Staphylococcus (CNS); 26 (37%) Bacillus spp; 13 (18%) Staphylococcus aureus; eight (11%) alpha-hemolytic Streptococcus; five (9%), Pseudomonas spp; two (3%) Stenotrophomonas maltophilia, and six (11%) other gram-negative organisms.

After toys were cleaned, subsequent cultures showed significant decreases in bacterial growth rates. Because some patients were discharged, additional cultures were obtained for only 31 toys.

Prepare your facility for influenza season

Flu season is right around the corner. Are you prepared? If an influenza pandemic hits, the entire U.S. population could be at risk. The annual impact of influenza is staggering — 10% to 20% of the U.S. population will get the flu. Some 36,000 people will die, and 114,000 will be hospitalized. Most of those who die will be older than 65, but children 2 and younger will be as likely to be hospitalized as the elderly.

Thomson American Health Consultants is offering an audio conference with information necessary to help you diagnose and treat patients with flu symptoms and prepare for an influenza pandemic. Get Ready For Influenza Season: What You Need to Know About the Threat, Diagnosis and Treatment will be held on Tuesday, Sept. 28, 2004, from 2:30-3:30 p.m., ET.

It will be presented by Benjamin Schwartz, MD, and Frederick Hayden, MD. Schwartz, who is with the National Vaccine Program Office and is spearheading the development of the National Pandemic Influenza Preparedness and Response Plan, will discuss the potential impact of an influenza pandemic.

Hayden, a professor of internal medicine and pathology at the University of Virginia School of Medicine in Charlottesville, will discuss current methods of diagnosis and the latest information on treatment with antivirals.

Your fee of $249 includes presentation materials, additional reading, and free continuing education.

For more information contact customer service at (800) 688-2421 or by e-mail at customerservice@ahcpub.com. When registering, reference code T04118-61332.