The White House speaks out: Responsible antibiotic use

Some governmental agencies have recently spoken out on responsible antibiotic use, a growing threat Bacterial and viral infections are often clinically indistinguishable, leading to antibiotic overuse and contributing to the spread of antibiotic resistance, which the World Health Organization (WHO) says is approaching crisis proportions. (1)

Action from the White House
On June 2, 2015, the Obama administration held the White House Forum on Antibiotic Stewardship. (2) The purpose was to ensure the development, promotion, and implementation of activities to ensure the responsible use of antibiotics. The meeting built on a number of steps the Administration has taken to combat antibiotic resistance. (3) This includes things like administration of antibiotics to animals, to guidance and tools for nursing homes and other long-term care settings. This article will review the results of the Forum and how they affect oral health care.

On September 23, 2014 the Federal Register published Executive Order 13676, “Combating Antibiotic-Resistant Bacteria.” (4) The Executive Order created the Task Force for Combating Antibiotic-Resistant Bacteria:

“The Federal Government will work domestically and internationally to detect, prevent, and control illness and death related to antibiotic-resistant infections by implementing measures that reduce the emergence and spread of antibiotic-resistant bacteria and help ensure the continued availability of effective therapeutics for the treatment of bacterial infections.” (5)

The President’s Council of Advisors on Science and Technology (PCAST) released a report on September 18, 2014, “Combating Antibiotic Resistance.” The report was released concurrently with the “National Strategy on Combating Antibiotic Resistant Bacteria” as well as with the above mentioned Executive Order, emphasizing the importance of addressing this growing challenge. (6)

Action in the dental profession
The American Dental Association (ADA) participated in the White House Forum on Antibiotic Stewardship. ADA supports the responsible use of antibiotics, and they support decreased recommended prophylactic use of antibiotics in heart patients, as well as people who have had joint replacements. The ADA recommendations discuss the following topics: (7)

Prosthetic joint implants: An evidence-based clinical practice guideline for dental practitioners about antibiotics prior to dental work in patients who have joint replacements, published in the Journal of the American Dental Association, states that, in general, antibiotics are not recommended prior to dental procedures for patients with prosthetic joint implants. (2015) (8)
Heart health: Guidelines from the American Heart Association about prevention of infective endocarditis (PDF), approved by the ADA Council on Scientific Affairs as they relate to dentistry, published in JADA and the Journal of the American Heart Association. (2007) (9)
Assessing risk: Insights from the ADA’s Council on Scientific Affairs about combating antibiotic resistance, published in the Journal of the American Dental Association. It includes the statement: “Any perceived potential benefit of antibiotic prophylaxis must be weighed against … the development, selection and transmission of microbial resistance.” (2004) (9)

"Is it viral or bacterial?"
A company called MeMed developed a blood test, ImmunoXpert, that can distinguish between immune responses to bacterial or viral infections. The procedure is supposedly fast, taking only hours to complete when alternatives often require days. The study enrolled more than 1,000 patients and is published in the March 18, 2015 online edition of PLoS ONE. (10) Unlike most infectious disease diagnostics that rely on direct pathogen detection, MeMed's test decodes the body's immune response to precisely illustrate the cause of the infection. (11) The goal of the test is to improve patient management by providing physicians with information that enables them to reduce both the overuse and underuse of antibiotics.

Conclusion
Antibiotic misuse is a demanding public health problem, with overwhelming health-care and economic consequences. It is such a global problem that WHO developed the Global Action Plan on Antimicrobial Resistancein May 2015. (12)

The first World Antibiotic Awareness Week was held in November 2015. (13) The campaign’s goals were to increase awareness of global antibiotic resistance and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance.

Let’s do our part as oral healthcare professionals to educate ourselves, our colleagues, and our patients.

References
1. http://www.who.int/drugresistance/en/.
2. https://www.whitehouse.gov/sites/default/files/docs/060215_federal_govt_commitments_2.pdf.
3. www.gpo.gov/fdsys/pkg/FR-2014-09-23/pdf/2014-22805.pdf.
4. https://www.whitehouse.gov/blog/2014/09/18/pcast-releases-new-report-combating-antibiotic-resistance.
5. https://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria.
6. http://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis.
7. http://jada.ada.org/article/S0002-8177%2814%2900019-1/abstract.
8. http://jada.ada.org/article/S0002-8177%2814%2962745-8/pdf.
9. http://jada.ada.org/article/S0002-8177%2814%2961234-4/pdf.
10. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120012.
11. http://www.me-med.com/.
12. http://www.who.int/drugresistance/global_action_plan/en/.
13. http://www.who.int/mediacentre/events/2015/world-antibiotic-awareness-week/en/.
14. http://www.who.int/mediacentre/events/2015/world-antibiotic-awareness-week/infographics/en/.

Additional resources on antibiotic resistance

Laxminarayan R. et al. Antibiotic resistance--the need for global solutions. Lancet Infect Dis. 2013 (http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2813%2970318-9/abstract)
Threat Report 2013, Antimicrobial Resistance, CDC. http://www.cdc.gov/drugresistance/threat-report-2013/.
Fauci and Marston. The Perpetual Challenge of Antimicrobial Resistance. JAMA 2014 (http://jama.jamanetwork.com/article.aspx?articleid=1851734)

For more information on antibiotic underuse, see:

Craig JC, et al. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ. 2010 (http://www.bmj.com/content/340/bmj.c1594)
Houck PM. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004 (http://archinte.jamanetwork.com/article.aspx?articleid=216850