Apr 30 2013

Extending the Cure Releases Antibiotic Resistance Research

In recent years many bacteria have become resistant to drugs that commonly vanquished them, depleting a natural resource—antibiotics—that has saved millions of lives around the globe. Using these drugs only when necessary, and using the right drug for the right infection will help ensure that the medications are available and effective when they’re needed.

>>Watch a new, three-minute animated video that tells the story of how antibiotic-resistant “superbug” bacteria have become a serious public health threat that affects everyone. The video frames the problem uniquely: We must treat antibiotics as a natural resource that can be depleted with overuse, just like water, trees, and other resources on which we all depend. The video lays out specific steps that everyone – including doctors, hospitals, and consumers – can take to tackle the problem.

Ramanan Laxminarayan Ramanan Laxminarayan, Extending the Cure

Extending the Cure (ETC), a project of the Center for Disease Dynamics, Economics & Policy based in Washington, D.C., and New Delhi, released the Superbugs video this week, along with a new report on trends in antibiotic resistance.

Last year, the organization also released research showing that certain types of bacteria responsible for causing urinary tract infections (UTIs) are becoming more difficult to treat with current antibiotics. ETC released the research via its online ResistanceMap, an online tool created to track changes in antibiotic drug use and resistance. A new, added feature of the ResistanceMap is ETC’s Drug Resistance Index, a way for non-experts to track changes in antibiotic effectiveness.

This research was funded by the Robert Wood Johnson Foundation. Urinary tract infections account for about 8.6 million visits to health care providers each year, according to the Centers for Disease Control and Prevention. More than half of U.S. women will get a UTI in their lifetime.

“Without proper antibiotic treatment, UTIs can turn into bloodstream infections, which are much more serious and can be life-threatening,” said Ramanan Laxminarayan, director of Extending the Cure (ETC). “These findings are especially disturbing because there are few new antibiotics to replace the ones that are becoming less effective,” says Laxminarayan. 

Read a previous NewPublicHealth interview with Ramanan Laxminarayan about ETC’s research and Drug Resistance Index.

NewPublicHealth: Extending the Cure focuses on antibiotic resistance and has produced some critical research. What are your most recent findings?

Ramanan Laxminarayan: We have had the ResistanceMap for about two and a half years now, and the updated version looks at trends in antibiotics prescribing from 1999 to 2010. The map looks primarily at antibiotic resistance rates by U.S. census region, but we also capture data on antibiotic prescribing across different states. And what we are finding is a pattern that is fairly consistent with what we have seen in the past. There is a small set of states in the Southeast—Kentucky, West Virginia, Tennessee, Mississippi, Louisiana, and Alabama—which have the highest rates of prescribing in the country. And these are also the states that have high rates of antibiotics resistance. Their rates of antibiotic consumption are almost two and a half times that of states in the West like California, Hawaii or Arkansas. States that have consumed a lot of antibiotics typically have also not made as much progress in reducing prescribing over this 11 year period. The states that were doing better to begin with have seen a decrease in prescribing and the ones that weren’t doing so well to begin with have stayed relatively flat.

However, overall the good news is that antibiotic prescribing is falling across the country from about 966 prescriptions per 1,000 people down to about 801 prescriptions per 1,000 people between 1999 and 2010. However, much of that reduction in prescribing has come from relatively common antibiotics. The reduction in prescribing has not been as strong in the most powerful antibiotics like penicillin, though there is a greater need to save those drugs for the hardest to treat infections.

NPH: The current research focuses on UTIs. Why are those infections especially concerning?

Ramanan Laxminarayan: It’s important because UTIs are a very common infection. UTIs account for a quarter of all infections. There are about seven or eight million office visits due to UTIs and about a million emergency room visits. It is an infection that you can get from the ambulatory setting [outside of hospitals and clinics] or can be acquired while hospitalized, often from catheterization.

NPH: Why have you introduced the Drug Resistance Index?  

Ramanan Laxminarayan: The Drug Resistance Index, in very simple terms, is essentially what the Dow Jones Index is to individual stock prices. If I tell you about just one bug and one drug, that is not very meaningful to the general public. However, if we talked about resistance in UTI infections which are caused by a number of different pathogens and a number of different antibiotics used to treat them, that composite weighted average of resistance is much more meaningful. It gives you a complete picture of the overall trends in antibiotic resistance.

NPH: Your recent research also shows geographic disparity in prescribing rates. Do you know why that is or is that still being investigated?

Ramanan Laxminarayan: We are still looking for better evidence in what is determining this. What’s challenging about the whole thing is that higher antibiotic prescribing tends to happen in areas that have other poor public health outcomes as well, like high rates of obesity. We hope to find out more in the months to come. The next step is to look at what determines prescribing in these states. What sort of socioeconomic factors are important and what health factors underlay these regional disparities and antibiotic use?

NPH: What is next for Extending the Cure?

Ramanan Laxminarayan: We are working on some recommendations that we think would be helpful in the U.S. to make sure that our antibiotics remain effective. These recommendations will likely be launched in late January. We will also have updates to the resistance map. And we are also working to form a coalition of organizations because combatting antibiotic resistance is not within the domain of a single organization or group, and there needs to be a much bigger awareness about how we see these problems and the urgency about doing something about it. That is what we are aiming for with our consensus statement that we recently launched with the Centers for Disease Control and Prevention and more than 30 other organizations. 

Tags: Infectious disease, Public and Community Health, Q&A