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Study: Flu Symptoms Boost Antibiotic Use, Antibiotic Resistance During Winter Months

Aug 7, 2012, 2:25 PM

Although a June study in Pediatrics noted a recent drop in antibiotics prescribed for infants, children and adolescents relative to past years, prescriptions continue to be high in winter months and may lead to increased antibiotic resistance, according to a new study in Clinical Infectious Diseases.  Research on the link between flu and a rise in antibiotic prescribing in the winter was conducted by Extending the Cure, which is funded by the Robert Wood Johnson Foundation Pioneer Portfolio, to research and examine solutions to antibiotic resistance.

The Clinical Infectious Diseases study found that increases in prescription sales for two popular groups of antibiotics during flu season led to a rapid increase, one month later, in resistant Escherichia coli (E. coli) in hospitals, as well as a rise in methicillin-resistant Staphylococcus aureas (MRSA), linked to the seasonal increase in antibiotic prescriptions.

In a recent op-ed published in Modern Healthcare, Ramanan Laxminarayan, study author and director of Extending the Cure, offered recommendations to help decease use of antibiotics and antibiotic resistance, such as giving all healthy people age 6 months and up the flu shot—because if fewer people experience flu symptoms, fewer people will receive unnecessary antibiotic prescriptions.

“It’s time to start viewing antibiotics as a natural resource that can be depleted with overuse, much like oil or other natural resources, and which must be conserved so these resources are there for us when we need them,” says Laxminarayan.

>>Read a related Q&A with Ramanan Laxminarayan, executive director of Extending the Cure, where he talks about the need for a shift in social norms around parents asking for antibiotics for their children when it may not be needed.

>>Bonus Link:  Read a policy brief from Extending the Cure about strategies to reduce doctor’s over-prescribing of antibiotics including education programs, incentives and mandating appropriate prescribing.  

>>New Study:  A new study in the Annals of Internal Medicine finds that adding data on circulating infections to electronic health records helps reduce antibiotic overuse by giving doctors real-time data to inform diagnosis on viral or bacterial infections. 

This commentary originally appeared on the RWJF New Public Health blog.

A Doctor Delivers Multiple Acts of Human Kindness to Homeless Women

Aug 3, 2012, 11:55 AM, Posted by Roseanna Means

Roseanna H. Means, MD, is the founder of Women of Means, which provides free medical care to homeless women in the Boston area, a clinical associate professor at Harvard Medical School, and an internist on the attending staff at Brigham and Women’s Hospital in Boston.  She is a 2010 Robert Wood Johnson Foundation Community Health Leader.


The prolonged recession of the last four years has hit many people hard.  My work is taking care of homeless women, which I have done for the past 20 years.  I lead a team of volunteer physicians and part-time paid nurses who provide free walk-in care to women and children in Boston’s shelters.  We fill in the gaps left by larger, more bureaucratically rigid systems that put unrealistic and unattainable expectations on those who are disabled by extreme poverty, mental illness, trauma, and cognitive dysfunction.

I designed a program of “gap” care that brings health care to them. We act as the communication and advocacy bridge between the shelter/street world and the hospitals and health centers.  Gap care is part of a continuum that I feel has an important role to play in health care access for vulnerable populations.

Here is a glimpse of our work.

Walking into one of the women’s shelters on a recent morning, I see a woman standing glumly in line for coffee, her hands chapped and shaky, her face pale and dry, a blanket heaped around her shoulder, pouring hot liquid into her body before staking out a cot where she can sleep for a few hours, let her guard down, away from the doorway where she was prey to drunk men who jumped her, raped her and stole her stuff.

She is hungover.  She drank to escape the horror of having been attacked.  She has been on and off the wagon so many times we have all lost count.  She’s also been raped and stabbed more times than any of us can remember.  She doesn’t go to the police any more.  She’s just one more homeless woman who has been raped, a “nobody”; just more paperwork.  I give her a hug and remind her that I love her no matter what.  I know that she has a library of negative and self-loathing messages in her head.  Mine is the one that can break through that chatter and give her a shred of self-respect.

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Afternoon Public Health News Update: June 18

Jun 18, 2012, 6:35 PM, Posted by NewPublicHealth

Study: Antibiotics Down, ADHD Drugs Up Among Kids

Fewer antibiotic prescriptions were dispensed by pharmacies for kids 17 and younger but prescriptions for ADHD drugs were up, according to a study by Food and Drug Administration researchers and published in Pediatrics. The researchers reviewed outpatient retail prescription databases. In addition to decreases in antibiotic prescriptions for children, the study also found decreases in allergy, pain and depression drugs as well as a 42 percent drop in cough and cold medicines for kids. The FDA issued an advisory in 2008 against using cough and cold drugs in very young kids.

In addition to increases in ADHD drugs, the study found higher rates of asthma drugs and contraceptives. Read more on prescription drugs.

Delaying Infant Vaccines Triples in Portland, Oregon

A new study in Pediatrics looks at the practice of delaying infant vaccinations, which experts say can increase the risk of communicable disease outbreaks. The study found that in 2009, about 9.5 percent of parents in the Portland, Ore., area did not consistently follow the recommended vaccine schedule for infants and children up to nine months old, up from 2.5 percent in 2006. Children whose parents delayed shots had more visits to providers for shots, fewer total shots, and did not generally catch up later with the recommended vaccination schedule.

The researchers say negative media attention about vaccine safety likely contributed to the increase in parents delaying or limiting the number of immunizations, and say there are no known benefits to delaying vaccines in infants. Read more on vaccines.

This commentary originally appeared on the RWJF New Public Health blog.

Positive Deviance Research Continues to Impact Health Care System

Mar 23, 2012, 9:53 AM, Posted by Pioneer Blog Team

We are proud to see that an earlier grant supporting research into how positive deviance can be applied to methicillin-resistant Staphylococcus aureus (MRSA) prevention in hospitals continues to influence the way health care systems approach and solve challenges.

An article in last week’s Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report profiles the AtlantiCare Regional Medical Center, which participated in the CDC Hemodialysis BSI Prevention Collaborative to reduce bloodstream infections (BSIs). The medical center implemented the positive deviance method, identifying individuals within an organization who have overcome seemingly intractable problems and spreading their solutions throughout, to engage staff members in BSI prevention interventions. For example, a nurse developed a mnemonic device to meet the hand hygiene compliance that she then shared with other nurses. The program found that collaborative interventions and the use of positive deviance were associated with significant reduction in BSIs. 

Curt Lindberg, project director on a 2006 Pioneer grant to Plexus Institute to study the effect of using positive deviance to prevent hospital-acquired infections, recently served as a positive deviance coach at AtlanticCare. In his earlier research, Lindberg and other investigators developed a pilot program at six hospitals to control and reduce the rate of MRSA, one of the most virulent hospital-acquired infections in the United States. The study showed that MRSA infections rates declined by 73 percent in four of the six pilot units.

Read more about the results of the grant and learn about Pioneer’s work researching the growing problem of antibiotic resistance.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

New Data Reveals High Death Rates From Clostridium Difficile (C. diff)

Mar 8, 2012, 11:35 AM, Posted by Pioneer Blog Team

A new Vital Signs report issued March 6 by the Centers for Disease Control and Prevention shows rates of infection with Clostridium difficile (C. diff) are at historic highs and must be curtailed. C. diff can cause cramps, severe diarrhea and, in some cases, death.

Also on March 6, Extending the Cure—a project funded by the Pioneer Portfolio that studies antibiotic resistance—released a new analysis showing high C. diff death rates in parts of New England. In fact, the Extending the Cure analysis shows that as of 2007 Rhode Island, Maine, and Connecticut had the highest death rates for C. diff in the nation.

These top three states had death rates that were more than double the national average of 2.15 deaths per 100,000 people.  The trend is visualized using the interactive mapping platform of ResistanceMap, Extending the Cure’s online tool that tracks antibiotic use and drug resistance in North America and in Europe.

At the same time, the mapshows that most Southern and Western states had death rates from C. diff that were below the national average. For example, Georgia, Colorado, and Idaho reported less than one death per 100,000 people from these infections in 2007. “The geographical variation points to the need for additional research to better understand the epidemiology of C. diff infections and highlight the most effective ways of preventing their spread,” says Ramanan Laxminarayan, director of Extending the Cure, the D.C-based research project funded in part by the Robert Wood Johnson Foundation’s Pioneer Portfolio.

While C. diff has long been linked to hospitals, the CDC report finds that patients can acquire the infection in all medical settings, including nursing homes and outpatient clinics. Those most at risk are patients who take antibiotics, which can wipe out the good bacteria living in the gut, allowing C. diff to thrive.

C. diff infections can be reduced by judicious use of antibiotics, according to the CDC, which notes that about 50 percent of all antibiotics prescribed are not necessary. Reducing unnecessary antibiotic use will not only help prevent C. diff infections, but also curtail the growing problem of antibiotic resistance.

Addressing the rising rates of C. diff infections will require a multifaceted approach.  In addition to promoting antibiotic stewardship, health officials must work towards better infection control and early diagnosis at hospitals and other facilities where C. diff and other health care-associated infections can spread from patient to patient or from one facility to the next.

 In addition, policymakers, researchers, and others can use visualizations, like the map from Extending the Cure, to identify regions of the country with the most serious problems and look for targeted solutions to the rising tide of C. diff and other disease-causing bacterial pathogens.

Check out the new data and let us know what you think: Do you have a story to tell about a solution to the problem with C. diff?

Follow @ExtendgtheCure on Twitter to track coverage of this study.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Shorter Antibiotic Regimens Might Counter Antibiotic Resistance

Jan 12, 2012, 9:05 AM, Posted by Pioneer Blog Team

Antibiotics on the shelf today are increasingly losing their potency against resistant microbes or “superbugs” like the potentially lethal methicillin-resistant Staphylococcus aureus, or MRSA.

Extending the Cure researchers published an analysis this week that questions the conventional wisdom regarding antibiotic dosing practices and suggests rethinking the guidelines to minimize the growing public health crisis posed by antibiotic resistance. Ramanan Laxminarayan, director of Extending the Cure, and his colleagues, used mathematical models to study antibiotic treatment guidelines, the regimens physicians follow for the standard dose and duration of antibiotic treatment for common infections.

While antibiotic dosing regimens have typically been designed to cure bacterial infections, rarely have these guidelines taken antibiotic resistance into account.  All antibiotic use contributes to the development of antibiotic resistance, and the new research suggests dosing guidelines could be optimized to both treat infections and limit the spread of resistant microbes. The analysis, published January 11 in the online scientific journal PLoS ONE, indicates that in many cases, a shorter regimen of antibiotic treatment could work just as well as a longer course yet still reduce the risk of resistance.

Dosing strategies for antibiotics are not set in stone.  For example, many physicians have switched from the traditional 10-day course of antibiotics and now effectively prescribe a three-day regimen to treat otitis media, or middle ear infections. In some cases, the authors argue, shorter dosing regimens like this one could limit the selection pressure for resistant bacteria and thus reduce the threat of resistance.

Extending the Cure, a project of the Center for Disease Dynamics, Economics & Policy sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio, is working to change how we think about antibiotics, a resource that can be depleted with overuse. This study suggests that shorter treatment regimens, in some cases, may help us preserve the power of the antibiotics we still have left.

Let us know what you think:  Are there any risks to shortening current treatment regimens? Are there any other benefits? Leave a comment here or tweet at @ExtendgTheCure and @PioneerRWJF #SaveAbx to tell us what you think.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Public Health Stories to Watch in 2012: Recommended Reading

Jan 4, 2012, 5:45 PM, Posted by NewPublicHealth

In the grand tradition of spending the first half of each January predicting what's new and noteworthy in the coming year, TIME Healthland has identified eight major health stories to watch in 2012. Many of the issues have been brewing over the course of 2011. Take a look at some of the highlights, and related NewPublicHealth stories, below:

  • Sports-related head injuries: In 2011, NewPublicHealth looked at some of the public health challenges of preventing, identifying and creating effective legislation around sports-related head injuries. We also reported on dramatic new data around these injuries in youth, and spoke with public health lawyers on the status of law to prevent youth sports concussions.
  • Prescription drug overdose epidemic: In 2011, we found out that drug overdose deaths, particularly from prescription drugs, exceeded deaths from car crashes for the first time. We also spoke with the executive director of Extending the Cure about another danger of prescription drugs: antibiotic resistance.
  • E. coli outbreaks: From sprouts to contaminated cantaloupe, 2011 was a tough year for food safety. We looked at the riskiest foods and pathogens for public health, and delved into potential food safety issues at fairs and festivals as well as farmers' markets.
  • Graphic cigarette warning labels: In 2011, we spoke with Surgeon General Regina Benjamin and Danny McGoldrick of the Campaign for Tobacco-Free kids on the public health potential for new, graphic cigarette warning labels that the U.S. Food and Drug Administration intended to have printed on all cigarette packaging to make the health consequences of tobacco clear and unavoidable. Legal action late in the year put the new warning labels on hold, after a case filed by several cigarette manufacturers that challenged their constitutionality.

Read the full TIME story here.

>>Now that you've had a look ahead at 2012, take a look back at 2011 with our top NewPublicHealth posts of the year.

This commentary originally appeared on the RWJF New Public Health blog.

@Choo: Can Twitter Track The Flu?

Dec 19, 2011, 10:15 AM

Now that flu season is upon us, more and more Americans will be tweeting about aches and pains and other symptoms that could signal the onset of the flu.

Pioneer grantee Philip Polgreen and his colleagues at the University of Iowa in Iowa City suggests that social media tools such as Twitter and Foursquare could one day be used to track flu activity—and give public health officials a heads up if activity takes a turn for the worse.

Polgreen and his colleagues published a study last May in the scientific journal PLoS One that tracked millions of tweets during the 2009 swine flu pandemic. They discovered that many Americans used Twitter to express concerns about the flu or talk about early symptoms such as a fever. The researchers collected tweets that used the words “flu,” “fever,” and  other related terms and analyzed them—finding that Twitter data could be used to estimate the incidence of the flu in real time.

Currently, the system the CDC uses to track reported cases of influenza has a time lag of several weeks, giving the flu a chance to spread. Polgreen and his colleagues believe that Twitter might help speed up that process by alerting public health officials about an increase in flu symptoms in real time. The early warning might provide officials the time they need to curtail the spread of the flu or to urge more people to line up for flu shots.

And what about getting a head start on information about where the flu is spreading? The Iowa team recently analyzed data from FourSquare, a social media application that permits users to “check in” and record their current location in exchange for incentives, like coupons.

The information could also be used, the team says, to track the location of individuals infected with the flu or some other contagious disease—and then send alerts to public health officials trying to contain an emerging disease threat.

The team presented the early findings from the study at the International Society for Disease Surveillance meeting held in Atlanta on December 7-8.

Polgreen also says that the Twitter stream might be used to look for public misinformation about the flu—like the mistaken belief that antibiotics can combat it. Twitter reveals all kinds of fears, concerns and behaviors and might give public health officials insight into the myths they should address in public education campaigns.

Such real-time information could also inform the CDC about overuse of antibiotics. On November 14, the CDC launched an annual campaign to curtail the unnecessary use of antibiotics given the estimate that about 50 percent of all antibiotic use is unnecessary. Furthermore, research by Polgreen and colleagues published last July in Infection Control and Hospital Epidemiology suggests that antibiotic use goes way up during flu season.

Antibiotics, however, do nothing to combat the flu or other viral infections. Think about that—or better yet tweet about it—the next time you get an ache or pain that signals the flu.

Let us know what you think: When you feel sick this flu season, will you tweet about your experience?

You can also vote for "The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. During the Influenza A H1N1 Pandemic," published in PLoS ONE in May, as one of RWJF's Most Influential Research Articles of 2011.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Why We Have to Start Cutting Back on Antibiotic Use

Nov 18, 2011, 1:51 AM

Up to one million antibiotics are prescribed unnecessarily every year, often for colds and other viral infections that they can’t even cure.  This overuse is a serious public health threat because it significantly reduces antibiotics’ effectiveness to combat all sorts of infections, including life-threatening ones caused by microbes like MRSA and E. coli.

As part of a national effort to reduce improper use of antibiotics, the Centers for Disease Control and Prevention (CDC) and its partners are promoting Get Smart About Antibiotics Week, a campaign to educate consumers and health care providers about appropriate antibiotic use in hospitals and throughout the community.

Pioneer grantee Extending the Cure (ETC), a partner in CDC’s campaign, also released new data this week on antibiotic use trends.  These findings are the focus of a guest blog post on CDC’s Safe Healthcare blog, where Ramanan Laxminarayan, ETC director, describes a pattern of high antibiotic consumption in the Southeastern United States, particularly in West Virginia and Kentucky.  USA Today ran a story about the new research on Wednesday.

Laxminarayan also authored an op-ed in the McClatchy Tribune, calling on public health officials to put in place strategies that address these worrisome trends, such as broader flu vaccination. The new research comes to us from ResistanceMap, an online mapping tool developed by ETC that illustrates the growing problem of antibiotic resistance. This new map provides a look at antibiotic use across the U.S. 

Also this week, ETC released a paper describing a new “Drug Resistance Index” that allows policymakers and hospitals to track changes in antibiotic effectiveness over time using a single measure.  The index, similar in concept to the consumer price index, appeared in Monday’s edition of the British Medical Journal Open.

Extending the Cure is working to change how we as a society think about antibiotics, encouraging us to think about these drugs as a shared resource—just like water, trees or oil reserves—that we rely on and should preserve so they maintain their effectiveness. 

Let us know what you think:  Do we, as a society, use antibiotics too often?  What strategies should we use to ensure a future with plenty of powerful antibiotics?  Leave a comment here or tweet @PioneerRWJF #SaveAbx and @CDDEP to tell us what you think.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Get Smart About Antibiotics: NewPublicHealth Q&A With Ramanan Laxminarayan

Nov 17, 2011, 2:12 PM, Posted by NewPublicHealth

RamananLaxminarayan Ramanan Laxminarayan, Extending the Cure

Get Smart about Antibiotics Week is an annual effort to coordinate efforts from the Centers for Disease Control and Prevention, state public health agencies and other partners on the importance of appropriate antibiotic use.

NewPublicHealth spoke with Ramanan Laxminarayan, executive director of the Robert Wood Johnson Foundation-funded program Extending the Cure, about this week's annual campaign and about new tools for better tracking of antibiotic use and resistance. Extending the Cure released new data today revealing a pattern of antibiotic overuse in parts of the U.S., particularly the Southeast. The five states with the highest antibiotic use in the nation are West Virginia, Kentucky, Tennessee, Louisiana and Alabama, but the maps show high antibiotic use in other parts of the country as well.

NewPublicHealth: A study was published in Pediatrics last week that found that there are perhaps ten million unnecessary pediatric antibiotic prescriptions written each year. Is that number surprising?

Ramanan Laxminarayan: I’m not surprised by the large number, but the good news is that the situation may be getting better. The antibiotic prescription for otitis media [ear infection], which is the single most common condition for which antibiotics are prescribed in the U.S., has dropped. So that’s the good news. Much more could be done to reduce antibiotic use, and one reason why it is has not gone forward with the same pace as it could have is because the CDC is woefully underfunded to carry out this task. But what they did do is to get the Get Smart campaign in full force, and they’ve had a tremendous impact. You couldn’t go to a pediatrician’s office without seeing one of those pamphlets saying don’t ask for antibiotics from the provider and at least some people got the message. What is missing right now is a sustained education message letting people know that antibiotics are a precious resource and we need to use them carefully.

NPH: What else might be keeping us from having a more dramatic decline in inappropriate antibiotics use in the outpatient setting?

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