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To coordinate the federal response to this growing public health threat, the Department of Health and Human Services (HHS) joined other federal agencies in 1999 to create a federal Interagency Task Force on Antimicrobial Resistance. In January, the task force issued an action plan designed to build on existing efforts with a comprehensive approach to combat antimicrobial resistance. The plan provides a blueprint with 84 action items divided into four major categories - surveillance, prevention and control, research, and product development. The action plan is available on the Web at www.cdc.gov/drugresistance/.

Background

While antimicrobial drugs have revolutionized the treatment of many diseases caused by bacteria and other germs, their widespread use and misuse has reduced their effectiveness. Many of the germs once treated effectively by penicillin and other antibiotic drugs have developed a resistance to specific medications.

Antimicrobial resistance occurs when microbes adapt to survive the use of medications meant to kill or weaken them - making the infection more difficult or even impossible to treat. Someone infected with a germ that is resistant to a certain medicine can pass on that resistant microbe to others, allowing a hard-to-treat illness to spread from person to person. It is the germ itself - not the person who is infected - that develops a resistance to specific drugs.

In the United States and around the world, antimicrobial resistance adds to the burden of infectious diseases including bacterial, fungal, parasitic and viral diseases. Resistant strains have developed in virtually all microbes once considered easily treatable, including protozoa that cause malaria, mycobacteria that cause tuberculosis, and bacteria that cause pneumonia, ear infections and meningitis; skin, bone, lung and blood infections; and foodborne infections.

Many factors contribute to the spread of antimicrobial resistance. In some cases, doctors prescribe antibiotics too frequently or inappropriately. Sometimes patients do not complete the prescribed course of an antibiotic, making it more likely that surviving microbes will develop resistance. In addition, antibiotics used to prevent infections in livestock may contribute to the emergence of resistant germs that can infect people. Through international trade and travel, resistant microbes can spread quickly worldwide.

People infected with drug-resistant organisms are more likely to require hospitalization, to remain in the hospital for a longer time or are more likely die. Today, there are increasingly limited options to treat many common infections. Even when alternative drugs are available, these drugs may be less effective, more toxic, more expensive or more difficult to administer. A 1995 Office of Technology Assessment report estimated that antimicrobial resistance among six common bacteria costs at least $661 million per year more in additional direct hospital charges.

Interagency Task Force on Antimicrobial Resistance

The rapid spread of resistance requires aggressive response domestically and globally. Data suggest that antibiotic prescribing practices can be improved. Effective partnerships involving clinicians, researchers, public health officials and patients can prolong the effectiveness of currently available antimicrobial drugs. Cooperative efforts also can accelerate the development of needed new tools, including rapid diagnostic tests, new antimicrobial agents, and new or improved vaccines.

In 1999, HHS joined other federal agencies to form an interagency task force to better coordinate public health efforts to address antimicrobial resistance. The Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) co-chair the interagency task force, whose members also include HHS' Agency for Healthcare Research and Quality (AHRQ), the Health Care Financing Administration (HCFA) and the Health Resources and Services Administration (HRSA). The task force also includes representatives from the Departments of Agriculture, Defense and Veterans Affairs, and the Environmental Protection Agency. In 2001, the U.S. Agency for International Development joined the task force to more specifically address global antimicrobial resistance issues.

Public Health Action Plan

In 2001, the task force published an action plan to address the antimicrobial resistance threat. The action plan provides a blueprint for specific, coordinated federal actions to address the emerging threat of antimicrobial resistance. It reflects a broad-based consensus of federal agencies, which was reached with input from consultants from state and local health agencies, universities, professional societies, pharmaceutical companies, health care delivery organizations, agricultural producers, consumer groups, and other members of the public. Implementation will require close collaboration with all of these partners. The task force will continue to monitor and coordinate implementation of the action plan.

The plan has four major components: surveillance, prevention and control, research, and product development. The plan includes a total of 84 action items, including 13 priority items considered essential to addressing antimicrobial resistance. Highlights of the action plan include:

Surveillance. Information and statistics about the emergence and spread of resistant microbes and the use of antimicrobial drugs can help experts interpret trends and identify strategies to prevent or control antimicrobial resistance. CDC is working with state health departments and other task force members to design and implement a strategy to coordinate national, regional, state and local surveillance efforts. In addition, FDA, CDC and the Department of Agriculture are developing systems to monitor patterns of antimicrobial drug use in human medicine, in agriculture and in consumer products.

Prevention and control. Research shows that the appropriate use of antibiotics can help reduce the incidence of antimicrobial resistance. HHS is developing a national campaign to improve physicians' prescribing practices and to educate the public about the proper use of antibiotics. In partnership with doctors and other medical professionals, CDC is already developing clinical guidelines for health professionals on how best to use antimicrobials. FDA has proposed regulations for labeling antibiotics regarding their appropriate use for infections caused by bacteria, not viruses. FDA also is working on an education program to encourage appropriate use of antibiotics. CDC also supports pilot projects to identify effective strategies to promote appropriate antimicrobial drug use. In addition, FDA is working to refine its proposed framework for assessing the human health impact of antimicrobials that may be used in food-producing animals.

Research. The action plan promotes expanding existing research in antimicrobial resistance and related fields in an effort to improve treatments and outcomes. NIH is leading a team of agencies to provide the research community with new information and technologies, including genetic blueprints for various microbes, to identify targets for desperately needed new diagnostics, treatments and vaccines to combat the emergence and spread of resistant pathogens. NIH will support clinical studies to test new antimicrobials and novel approaches to treating and preventing infections caused by resistant pathogens. NIH also continues to support and evaluate the development of new rapid diagnostic methods related to antimicrobial resistance. In addition, AHRQ funds various studies on the use of antimicrobial drugs and antimicrobial resistance, including ongoing research on reducing unnecessary antimicrobial prescribing in children.

Product development. As antimicrobial drugs lose their effectiveness, new products must be developed to prevent, rapidly diagnose and treat infections. To identify and publicize priority health needs for new products that prevent resistance or treat resistant infections, HHS is creating an Interagency Antimicrobial Product Development Working Group. This group also will consult with stakeholders and economic consultants to identify incentives that encourage this kind of product development. FDA continues to hold public forums to address product development in the area of antibiotic resistance. The agency is working both to facilitate product development for resistant organisms and to preserve the usefulness of existing antimicrobials. FDA recently approved Zyvox, Levaquin, Synercid and Malarone for the treatment of resistant organisms, and the Zyvox labeling encourages use that would preserve this drug for serious diseases. In addition, FDA is working to streamline the approval and regulatory process for veterinary antimicrobial products that are unlikely to result in the transfer or resistance to humans.

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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.