Surviving Winter’s Ills Without Abusing Antibiotics

Credit CDC, FDA, HHS

 

 

# 7987

 

As mentioned yesterday (see The Lancet: Antibiotic Resistance - The Need For Global Solutions), today marks European Antibiotic Awareness day and kicks off the CDC’s Get Smart About Antibiotics Week.  With each year that passes, more and more bacterial strains are finding ways to evade our dwindling arsenal of antibiotics – and so public health officials are working hard to improve the stewardship of the ones that still remain effective.

 

To that end, this week agencies like the World Health Organization, the CDC, and the ECDC are working to educate the public on when antibiotics are appropriate treatments, and when they are not.  Since most winter respiratory illnesses are viral in nature, antibiotics simply don’t work – and using them inappropriately can lead to increased resistance.

 

So today, a quick tour of (and some excerpts from) the messaging coming from these organizations.

 

From the World Health Organization we get European Antibiotic Awareness Day 2013: everyone is responsible.

18-11-2013

Antibiotic resistance affects the entire WHO European Region, driven by the overuse, underuse and misuse of antibiotics. Although some efforts have been made to combat indiscriminate use, many countries have no national regulation or enforcement on antibiotic usage; healthy animals are given antibiotics to promote growth or prevent disease, and commercial companies promote antibiotics irresponsibly. In too many countries, members of the general public can buy antibiotics over the counter (without a prescription) and use them at will. Doctors often prescribe antibiotics easily or inappropriately, and people take them to treat viral infections such as influenza and the common cold, against which they do not work.

(Continue . . .)

 

While today Public Health England is in myth busting mode, explaining that:

 

Green phlegm and snot ‘not always a sign of an infection needing antibiotics

Advice on European Antibiotics Awareness Day (18 November) to raise awareness of the risks of inappropriate use of antibiotics.

Having green phlegm or snot is not always a sign of a bacterial infection that will require antibiotics to get better, says Public Health England (PHE) and the Royal College of General Practitioners (RCGP).

 

This advice is issued on European Antibiotics Awareness Day (18 November) which aims to raise awareness of the risks associated with the inappropriate use of antibiotics and how to use them responsibly.

Research by PHE’s Primary Care Unit has found that 40% of the general public believed that antibiotics would help a cough with green phlegm get better more quickly rather than clear phlegm (6%).

 

White blood cells are produced by the body to attack any foreign materials the body does not recognise such as pollutants, dirt, pollen or microbes, and are carried in your phlegm and snot. Some white blood cells contain a green substance (a protein) so if more of these cells are present the greener your phlegm or snot will be.

 

Phlegm therefore comes in a range of colours from white to mustard-yellow to varying shades of green. Coloured phlegm or snot does not mean you need antibiotics.

 

In most healthy people, phlegm or snot production with or without a cough will stop as your cold or flu-like illness clears up, although it may take up to 3 to 4 weeks.

 

And from the CDC, some advice on how to deal with the miseries of a winter illness without resorting to antibiotics.

 

How to Feel Better

What can I do to feel better if antibiotics won’t treat my illness because it’s caused by a virus?
For upper respiratory infections, such as sore throats, ear infections, sinus infections, colds, and bronchitis, try the following:

• Get plenty of rest
• Drink plenty of fluids
• Use a clean humidifier or cool mist vaporizer
• Avoid smoking, second-hand smoke, and other pollutants (airborne chemicals or irritants)
• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever (read about what is safe to give your child)

For children and adults, over-the-counter pain relievers, decongestants and saline nasal sprays may help relieve some symptoms. Remember, always use over-the-counter products as directed. Many over-the-counter products are not recommended for children younger than certain ages.

Over-the-counter medicines may help relieve symptoms such as runny nose, congestion, fever and aches, but they do not shorten the length of time you or your child is sick.

Learn more by reading below about over-the-counter medicines. Here are some helpful tips for how to feel better depending on how you or your child feels.

Sore Throat

• Soothe a sore throat with ice chips, sore throat spray, or lozenges (do not give lozenges to young children)
• Use a clean humidifier or cool mist vaporizer
• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever (read about what is safe to give your child)

Ear Pain

• Put a warm moist cloth over the ear that hurts
• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever (read about what is safe to give your child)

Runny Nose

• Use a decongestant or saline nasal spray to help relieve nasal symptoms (read about what is safe to give your child)

Sinus Pain/Pressure

• Put a warm compress over the nose and forehead to help relieve sinus pressure
• Use a decongestant or saline nasal spray
• Breathe in steam from a bowl of hot water or shower
• Take acetaminophen, ibuprofen or naproxen to relieve pain or fever (read about what is safe to give your child)

Cough

• Use a clean humidifier or cool mist vaporizer or breathe in steam from a bowl of hot water or shower (read about what is safe to give your child)

Over-the-Counter (OTC) Medicines

Questions and Answers for Parents about Over-the-Counter (OTC) Medicines

Related Materials

ECDC: Antibiotic Resistance In the EU – 2012

 

 

# 7980

 

 

Last September, in Referral: McKenna On CDC Antibiotic Resistance Report,  we looked at a new report from the CDC on the growing threat of antibiotic resistance – with  with Director Thomas Frieden warning, `“If we are not careful, we will soon be in a post-antibiotic era.”

 

This stark forecast echoed the sentiments that World Health Director-General Margaret Chan expressed a year ago (see Chan: World Faces A `Post-Antibiotic Era’).

 

On November 18th, the ECDC, Hong Kong’s CHP, and the United State’s CDC will kick off their antibiotic resistance awareness campaigns for 2013.  Here in the US, it signals the start of Get Smart About Antibiotics Week. 

 

Today, the ECDC has released a massive (218 pages) surveillance report report called Antimicrobial resistance surveillance in Europe 2012, along with a smaller (10 page) summary which will be easier to digest.

 

Highlights on antibiotic resistance

• Antibiotic resistance is a serious threat to public health in Europe, leading to increasing healthcare costs, prolonged hospital stays, treatment failures, and sometimes death.
•   
  Over the last four years (2009 to 2012), resistance to third-generation cephalosporins in K. pneumoniae and E. coli increased significantly at EU/EEA level. Combined resistance to third-generation cephalosporins and two other important antimicrobial groups (fluoroquinolones and aminoglycosides) also increased significantly at EU/EEA level for K. pneumoniae, but not for E. coli. 
• The increasing trend of combined resistance in K. pneumoniae means that only a few therapeutic options (e.g., carbapenems) remain available for treatment of infected patients. 
• Carbapenems form a major last-line class of antibiotics to treat infections with multidrug-resistant Gram-negative bacteria such as K. pneumoniae and E. coli, both common causes of pneumonia, urinary tract infections and bloodstream infections. However, the percentage of carbapenem-resistant K. pneumoniae is already high and increasing in some countries in the EU.
• Antimicrobial resistance data for Acinetobacter spp. are available in EARS-Net for the first time. Data for 2012 show large inter-country variations in Europe, and high levels of resistance (>25%) to carbapenems in nearly half of the reporting countries. 
• In contrast, in the past few years, the percentage of meticillin-resistant Staphylococcus aureus (MRSA) has shown a significant decreasing trend at EU/EEA level, and either a continuous decrease or a stabilising trend was observed in most EU/EEA countries during the last four years. Nevertheless, MRSA remains above 25% in almost one fourth of the reporting countries, mainly in southern and eastern Europe. 
• Prudent antibiotic use and comprehensive infection control strategies targeting all healthcare sectors (acute care hospitals, long-term care facilities and ambulatory care) are the cornerstones of effective interventions that aim to prevent selection and transmission of antibiotic-resistant bacteria.

 

Also released today is an ECDC Technical Report called Carbapenemase-producing bacteria in Europe which provides Interim results from the European survey on carbapenemase-producing Enterobacteriaceae (EuSCAPE) project 2013.

Bacteria resistant to the Carbapenem class of antibiotics (a class that includes imipenem, meropenem, doripenem, and ertapenem) – are called carbapenemases –  are of particular concern since Carbapenems are often the drug of last resort for treating difficult bacterial infections.

 

Short of seeing an extremely high mortality influenza pandemic, I can think of no looming medical crisis more dire than the growing threat of antimicrobial resistance. The World Health Organization, the ECDC, and the CDC all consider the spread of antibiotic resistant organisms to be an extremely urgent public health concern.

 

So I expect I’ll be devoting a good deal of blog space to this topic over the next couple of weeks.

Get Smart About Antibiotics Week

 

 

# 5966

 

 

Short of seeing a Category 5 pandemic, I can think of no health threat that has a greater potential to threaten the general public than does the global rise in antibiotic resistant bacteria.

 

As Maryn McKenna so eloquently explained in her book Superbug: The Fatal Menace Of MRSA, not only are many of our older antibiotics losing their effectiveness, the number of replacement antibiotics under development is distressingly limited.

 

While it may sound alarmist, there are many scientists who fear that one day we may find ourselves facing a post-antibiotic world, where many of the infections we can treat today will no longer respond to the antibiotics we have remaining.

 

In April of this year, Margaret Chan – Director General of the World Health Organization – in a speech for World Health Day 2011, issued this stark warning:

 

In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.

 

 

Since much of this resistance has come about from inappropriate use of antibiotics (in humans, and on the farm), the immediate focus is on ways to curb their improper use.

 

This week the CDC is promoting their GET SMART about antibiotics campaign, while countries across Europe are promoting European Antibiotic Awareness Day tomorrow, November 18th.

 

 

Today, a round up of some antibiotic resistance resources for you to explore.

 

 

First stop, a short video from the CDC on the appropriate use of antibiotics.

 

 

The CDC has also introduced a number of new fact sheets and other promotional material for 2011 on antibiotic resistance.

 

Fact Sheets New 2011

• Antibiotics: Will they work when you really need them? [412 KB, 2 ages]

                                                                 

• Delivering safe care for patients: all healthcare providers play a role [503 KB, 2 pages]
  
• Antibiotic stewardship – the ultimate return on investment [460 KB, 2 pages]
  
• Preserving antibiotics for the future [420 KB, 2 pages]
  
• Resistance anywhere is resistance everywhere [475 KB, 2 pages]
  
• Antibiotic use in long-term care facilities [600 KB, 2 pages]
  

 

Across the pond, the ECDC has posted a short (8 minute) documentary on antibiotic resistance, and some short PSA announcements which can be viewed at this link.

 

You’ll find additional European initiatives and information on the European Antibiotics Awareness Day website.

 

In support of the CDC & ECDC awareness campaigns, Clinical Infectious Diseases  and The Journal of Infectious Diseases  have made a number of recent articles on antibiotic resistance freely available for the month of November.

 

Clinical Infectious Diseases articles:

Editorial commentary: Outpatient Antibiotic Use in the United States: Time to "Get Smarter"

Behavior Change Strategies to Influence Antimicrobial Prescribing in Acute Care: A Systematic Review

The Interface Between Antibiotic Resistance and Virulence in Staphylococcus aureusand Its Impact Upon Clinical Outcomes

Rapid Diagnostics and Appropriate Antibiotic Use

Strategies for Reduction in Duration of Antibiotic Use in Hospitalized Patients

The Journal of Infectious Diseases articles:

Editor's Choice: Antibiotic Choice May Not Explain Poorer Outcomes in Patients With Staphylococcus aureus Bacteremia and High Vancomycin Minimum Inhibitory Concentrations

Editorial commentary: At What Cost Echinocandin Resistance?

Acinetobacter baumannii Resistant to Colistin Alters Its Antibiotic Resistance Profile: A Case Report From Spain

The Combination of a Tumor Necrosis Factor Inhibitor and Antibiotic Alleviates Staphylococcal Arthritis and Sepsis in Mice

Divergent Mechanisms for Passive Pneumococcal Resistance to &szlig-Lactam Antibiotics in the Presence of Haemophilus influenza

 

 

And for good measure, a sampling of some of my antibiotic resistance essays from the past year.

 

India: The NDM-1 Story Continues

CDDEP: Mapping Resistance

NDM-1: One Year Later

ECDC/EMEA: Joint Report On Resistant Bacteria

Carbapenemases Rising

ECDC/EMEA: Joint Report On Resistant Bacteria

 

 

 

# 5064

 

Just as the CDC on this side of the pond is promoting their GET SMART about antibiotics campaign, countries across Europe each year promote European Antibiotic Awareness Day during the week of November 18th.

 

This year the European campaign is promoting the prudent use of antibiotics in hospitals; meaning that antibiotics are only used when they are needed, with the correct dose, dosage intervals and duration of the course.

 

To coincide with this campaign, the ECDC and EMEA have released a 54 page joint technical report called:

 

The Bacterial Challenge: Time To React

 

 

The main findings from the executive summary include:

Executive summary

Main findings:

• There is a gap between the burden of infections due to multidrug-resistant bacteria and the development of new antibiotics to tackle the problem.
• Resistance to antibiotics is high among Gram-positive and Gram-negative bacteria that cause serious infections in humans and reaches 25% or more in several EU Member States.
• Resistance is increasing in the EU among certain Gram-negative bacteria such as recently observed for Escherichia coli.
• Each year, about 25 000 patients die in the EU from an infection with the selected multidrug-resistant bacteria.
• Infections due to these selected multidrug-resistant bacteria in the EU result in extra healthcare costs and productivity losses of at least EUR 1.5 billion each year.
• Fifteen systemically administered antibacterial agents with a new mechanism of action or directed against a new bacterial target were identified as being under development with a potential to meet the challenge of  multidrug resistance. Most of these were in early phases of development and were primarily developed against bacteria for which treatment options are already available.
• There is a particular lack of new agents with new targets or mechanisms of action against multidrug-resistant Gram-negative bacteria. Two such agents with new or possibly new targets and documented activity were identified, both in early phases of development.
• A European and global strategy to address this gap is urgently needed.

 

The ECDC posted the following press release on their website, regarding this awareness campaign, and release of information.

 

Multidrug resistant bacteria remain a public health issue in Europe

Brussels, 16 November 2010

On the occasion of the European Antibiotic Awareness Day, ECDC is releasing new European-wide surveillance data on antibiotic resistance from the European Antimicrobial Resistance Surveillance Network (EARS-Net).

 

With annually up to 400,000 patients [1]reported to suffer from infections resistant to multiple antibiotics, the data show that antibiotic resistance remains a public health problem across the European Union. In Klebsiella pneumoniae, a common cause of infection amongst hospital patients, an emerging trend is the proportion of resistance to powerful last-line antibiotics, such as carbapenems.

 

Proportions of resistance range from less than 1% to more than 25%. Without effective last-line antibiotics, doctors face the dilemma of not having any treatment options left.

 

Speaking today at the launch event for European Antibiotic Awareness Day in the European Parliament, ECDC Director, Marc Sprenger, said:
“Antibiotic resistance remains a serious threat to patient safety, reducing options for treatment and increasing lengths of hospital stay, as well as patient morbidity and mortality.

 

However the news is not all gloomy. European-wide surveillance data from EARS-Net – a network coordinated by ECDC – show that a significant number of countries have reported decreasing trends for MRSA for the second consecutive year.

 

Notwithstanding, we are seeing increasing multi-drug resistance and the emergence of resistance to last-line antibiotics in European hospitals which we must take urgent action to address.”

(Continue . . . )

 

Reuters has a good report today on all of this, including an interview with Dominique Monnet of the ECDC who expressed deep concern over the spread of NDM-1 (New Delhi metallo-beta-lactamase) and other resistant bacteria.

 

He is quoted as saying, "I know people are calling this NDM-1 a superbug, but for me NDM-1 and bacteria like it are more than superbugs. We're talking about super superbugs."

 

"Super superbug" NDM-1 spreads in Europe

By Kate Kelland, Health and Science Correspondent

LONDON | Wed Nov 17, 2010 6:27pm IST

 

The concern over these resistant bugs was palpable and increasing practically every day - even before NDM-1 appeared on the scene.

Now, with many of these new resistance genes residing on a plasmid — a snippet DNA  that has the potential to jump to other strains of bacteria – concerns are escalating even faster than before.

 

You can read my recent report on KPC and NDM-1 in Carbapenemases Rising.

 

For more on the CDC’s  GET SMART program, visit their website at http://www.cdc.gov/getsmart/.

 

CDC: Get Smart About Antibiotics Week

 

 

 

# 5044

 

 

Next week (Nov 15th-21st) the CDC will launch its yearly awareness campaign for the appropriate use of antibiotics.

 

With the steady rise in MRSA, and other antimicrobial resistant strains of bacteria (including the newly identified NDM-1 gene), concerns over the misuse of antibiotics are at an all time high.

 

 

 

About the Get Smart Campaign

On This Page

• Why CDC has an appropriate antibiotic use campaign
• Campaign objectives
• Focusing on upper respiratory infections
• Target audiences of the campaign
• Campaign activities
• Campaign staff
• Awards the campaign has won
• Getting involved in the campaign

Why CDC has an appropriate antibiotic use campaign

Antimicrobial resistance among respiratory pathogens has become a common clinical problem, and the association of resistance with the use of antimicrobial drugs has been documented in both inpatient and outpatient settings. The Institute of Medicine has identified antibiotic resistance as one of the key microbial threats to health in the United States and has listed decreasing the inappropriate use of antimicrobials as a primary solution to address this threat. For this reason, antibiotic resistance is among CDC's top concerns.

Campaign objectives

CDC launched the National Campaign for Appropriate Antibiotic Use in the Community in 1995. In 2003, this program was renamed Get Smart: Know When Antibiotics Work in conjunction with the launch of a national media campaign. This campaign aims to reduce the rate of rise of antibiotic resistance by:

1. promoting adherence to appropriate prescribing guidelines among providers,
2. decreasing demand for antibiotics for viral upper respiratory infections among healthy adults and parents of young children, and
3. increasing adherence to prescribed antibiotics for upper respiratory infections.

(Continue . . . )

 

The target audience for these messages are primarily healthcare providers and parents of small children, who generally have an expectation of getting antibiotics for their children whenever they are seen for common (often viral) infections. 

 

Admittedly, not all doctors are in complete agreement with what the CDC considers to be the `appropriate use’ of antibiotics. 

 

Which is one of the reasons why the CDC is targeting clinicians as well in this campaign.

 

You’ll find a variety of podcasts available on the CDC’s Get Smart Campaign Online Materials webpage.

 

Podcasts

Antibiotics, When and When Not to Use Them

Listen To This Podcast (2:00 minutes)

In this episode of Medical Discovery News, medical experts talk about when and how to use antibiotics the right way.
Date Released: 10/3/2009

Too Much of a Good Thing (A Cup of Health with CDC)

Listen To This Podcast... (4:14)

In this podcast, a CDC expert discusses the dangers of overusing antibiotics.
Date Released: 10/1/2009

 

Too Much of a Good Thing (A Minute of Health with CDC)

Listen To This Podcast... (0:59)

This podcast discusses how the use of antibiotics has increased significantly for many infections and how many common conditions can be overcome by simply treating the symptoms and letting the illness run its course.
Date Released: 10/1/2009

 

 

Next week, I’ll have more on this campaign.  In the meantime, you can get more information at these sites.

 

Related Links

• CDC Antibiotic / Antimicrobial Resistance Website
• Antimicrobial Resistance in Healthcare Settings
• Get Smart: Know When Antibiotics Work on the Farm
• National MRSA Education Initiative