Tuesday, July 2, 2019

PAC CARB Posts Draft US 5 Year Plan for Antibiotic Resistance; Calendars Meeting

In 2015, the Obama administration announced an organized five-year plan for fighting antibiotic resistance.   It also created a President's Advisory Council on antibiotic resistance. 

The Trump administration is now in the midst of publishing a new five-year plan for 2020-2025.

On July 10-11, 2019, the PAC CARB will hold a public meeting.   On the first day, PAC CARB will discuss and take comments on the draft 5-year plan, recently released on its website.   On the second day, I was intrigued to see that most of the day is devoted to provider behavior issues, which are indeed pivotal to the overuse of antibiotics.

Organizations like the United Nations have been emphasizing the antibiotics public health crisis, and it was recently featured as the cover of Newsweek.   A recent publication in Mayo Clinic Proceedings referred to antibiotics overuse as "a slow motion catastrophe." 

PAC CARB is taking comments on the five-year plan through July 2 midnight, in preparation for the July 10 meeting.  However, they are also taking public comments at the meeting and I believe they will consider comments after July 2, they just won't have time to publish them for the panelists meeting book.

As in 2015-2020, Goal 3 of the five year plan is entirely focused on antibiotics.  Reimbursement issues are noted; PAMA is noted in a footnote.

  • PAC CARB home page here.
  • PAC CARB website for July 10-11 here.
  • Draft five-year action plan here (92pp).
    • S. Bill 1379, here, this reauthorizes PAC CARB (part 505) but also includes extensive information and funding lines for many antibiotics and biodefense issues (e.g. find BARDA funding here).
  • April 2019 U.N. announcements here.
  • Mayo Clinic Proceedings, Lesho & Laguio-Vila, antimicrobial resistance as "slow motion catastrophe," open access, here.
In the 2015-2020 plan, CMS was supposed to institute Antibiotic Stewardship Program rules for both long term care and acute care (hospital) settings.  The hospital rule was delayed and nearly expired, but CMS just gave itself another year to complete the hospital rulemaking (here).  PAC CARB's expert panel had unanimously petitioned HHS for this action in April 2019.  CDC, IDSA, and Pew Foundation are all very active in antibiotic stewardship issues so it is nice to see CMS making an effort to keep up.

As part of World Antibiotic Awareness Week 2018, Biomerieux published an interesting roadmap of the pathway of care and where diagnostics help intervene wisely.  While this is specific to Biomerieux product lines, the concept is an interesting one.  It's designed in the pattern of a subway map.


Further Reading.

See Chastain et al. (2019), A Baker's Dozen Top ASP Intervention Publications in 2017, open access, here.    For one of the best articles on hospital decision making anywhere (it's a hospital MBA-in-a-box), see Spellberg et al., 2016, Pitching ASP to the C-Suite, here.