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How Foundations Are Working to Prevent Antibiotic Overuse and Resistance



December 6th, 2011

Overuse of antibiotics and antibiotic resistance are serious problems that many people seem unaware of. Witness those who go into a physician’s office with a bad cold and insist upon being prescribed an antibiotic. A cold is caused by a virus, and antibiotics are ineffective on viruses. In today’s post, GrantWatch Blog looks at some foundation-supported efforts to ameliorate these problems and advocate for appropriate use of these drugs.

In a post titled “Get Smart about Antibiotics: NewPublicHealth Q & A with Ramanan Laxminarayan” (Nov. 17), this Robert Wood Johnson Foundation (RWJF) blog interviews the executive director of the Extending the Cure program. Funded in part by the RWJF, this organization (a project of the Center for Disease Dynamics, Economics, and Policy) conducts policy research and does consulting work related to reducing antibiotic resistance and extending antibiotic effectiveness.

In November, Extending the Cure released data indicating a pattern of antibiotic overuse in certain areas of the United States. States with the highest use of antibiotics (measured by outpatient dispensing, per capita) in 2006–2007 were West Virginia, Kentucky, Tennessee, Louisiana, and Alabama, but the group says those states are not alone in having high usage of the drugs. Alaska, interestingly, had the lowest use of antibiotics. Overall, however, from 1999 to 2007, antibiotic use actually went down, according to an Extending the Cure press release.

In the interview, Laxminarayan called for changing the social norm in the United States in which parents go into a doctor’s office and request (or even demand) that their child be prescribed an antibiotic for a condition for which it will be ineffective. He notes that in Scandinavia, such a routine with parents requesting and physicians complying is not “okay.” It will be a challenge to change norms in the United States, Laxminarayan maintains, but it “can be overcome.”

NewPublicHealth, a relatively new blog (launched in March 2011), asks Laxminarayan about a recent article in the journal Pediatrics that found that “perhaps ten million unnecessary pediatric antibiotic prescriptions [are] written each year.” He says that he was not surprised by that stat, but that things may be improving because antibiotic prescriptions are down for ear infections—the most common condition for which they are prescribed.

He commends the Centers for Disease Control and Prevention’s (CDC’s) Get Smart: Know What Antibiotics Work campaign. Much more could be done to reduce use of antibiotics—for example, if the CDC were better funded.

When asked what could done at the policy level to address antibiotic resistance, he mentions reducing hospital infections and strongly pushing seasonal flu vaccines to the public and health care providers. Read why he suggests these policy solutions.

The post contains a good amount of information on Extending the Cure’s web-based ResistanceMap, which aims to accurately depict the spread of antibiotic resistance. Also, it now shows data on use for 1999–2007. With new interactive maps, you can even specify use by state and by class of antibiotics. ResistanceMap also recently announced a Drug Resistance Index, a composite measure of various bugs and drugs. The index, among other things, will be able to show where drug research and development should be focused, based on need. The index was the subject of a recent article in the British Medical Journal Open.

Laxminarayan explains in the RWJF blog post that one can “look at trends in resistance [versus] trends in antibiotic use and infer how these might be correlated, which is critical because an important driver of resistance is . . . antibiotic use.”

The Pew Campaign on Human Health and Industrial Farming

The Pew Charitable Trusts’ campaign has an excellent, easily understandable description of the problematic ways that antibiotics are used for humans, as well as animals, in the United States. As Pew notes, “certain industrial farming practices lead to overuse of antibiotics.”

Antibiotic-Free Chicken for Chicago School Kids

In early November, Pew announced that the Chicago Public Schools began serving local chicken raised without antibiotics to students in nearly 475 schools in the district. The chicken comes from an Amish poultry company in Indiana. Chartwells-Thompson Hospitality, the food service company that works with the Chicago school system, made this decision because of the research and consulting services provided by the Pew campaign and School Food FOCUS (Food Options for Children in the United States). School Food FOCUS is funded by the W.K. Kellogg Foundation, the Kresge Foundation, and others. Whole Foods Market also helped with the effort.

According to a press release from School Food FOCUS, “No other [school] district in the nation is serving this kind of poultry regularly at such a scale.” Laura Rogers, who directs the Pew campaign, explained in the release, “The routine feeding of antibiotics to livestock that are not sick is undermining the effectiveness of these life-saving [antibiotics], which leaves children especially vulnerable.” The release acknowledges that conventionally produced chicken, though, “is just as safe and wholesome to eat” as antibiotic-free chicken.

School Food FOCUS and the Pew campaign have developed purchasing guidelines for other school districts interested in replicating this work in their local areas.

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Pew and others, including the American Academy of Pediatrics and the American Public Health Association, collaborated on a one-page, four-color ad, “The Facts are Clear” (that it is not a good idea to feed low doses of antibiotics to healthy farm animals), which was released in September.

Related resources:

Alliance for the Prudent Use of Antibiotics (APUA). This group has chapters in more than sixty-five countries, according to its website. Its partners and collaborators list includes the Bill & Melinda Gates Foundation and Pew.

“Fighting Antibiotic Resistance: Marrying New Financial Incentives to Meeting Public Health Goals,” Aaron S. Kesselheim and Kevin Outterson, Health Affairs, September 2010.

Keep Antibiotics Working has 11 million supporters and is based in Chicago. The coalition includes agricultural, consumer, environmental, health, humane, and other advocacy groups. Numerous foundations, including the Jenifer Altman, George Gund, and Joyce Foundations, the Jessie B. Cox Charitable Trust, and the New York Community Trust, have provided funding to the coalition over the years. For a full list of supporters, click here.

“Large Veterans Health Administration Study Shows ‘Last Resort’ Antibiotics Use on the Rise,” Society for Healthcare Epidemiology of America, April 4, 2011, press release. The multiyear study described here, which was conducted by Makoto Jones and colleagues, found a dramatic increase in the use of antibiotics called carbapenems. This increase “is alarming because carbapenem-resistant bacteria are becoming more common.”

“When Food Kills,” Nicholas D. Kristof, New York Times, June 11, 2011, op-ed piece.

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