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Source: https://www.cidrap.umn.edu/news-pers...an-mar-11-2021
News Scan for Mar 11, 2021
Nursing home prescribing during COVID; Antibiotics in the pipeline; New Saudi MERS cases; Avian flu in 2 countries
Filed Under:
Antimicrobial Stewardship; MERS-CoV; Avian Influenza (Bird Flu)
Higher nursing home use of certain antibiotics, COVID therapies noted
US nursing homes saw an increase in prescribing of antibiotics commonly used for respiratory infections during the pandemic, and large number of residents were prescribed drugs being evaluated for COVID-19 treatment, according to a study yesterday in Clinical Infectious Diseases.
For the study, researchers with the Centers for Disease Control and Prevention looked at long-term care pharmacy data from 1,944 nursing homes in 48 states, assessing two categories of drugs: antibiotics and drugs that were being investigated for COVID-19 treatment, including hydroxychloroquine, famotidine, and dexamethasone. To account for seasonal variability in antibiotic prescribing and decreased nursing home occupancy during the pandemic, the researchers calculated the monthly prevalence of residents with a prescription dispensed per 1,000 residents from January to October 2020, then calculated the monthly relative percent change from 2019 to 2020.
From March to October 2020, prescribing of azithromycin and hydroxychloroquine per 1,000 residents was higher than 2019, most notably in April, when hydroxychloroquine prescribing was 563% higher (prevalence ratio [PR], 6.63; 95% confidence interval [CI], 5.87 to 7.48) and azithromycin prescribing was 150% higher (PR, 2.50; 95% CI, 2.37 to 2.63). Prescribing of these drugs declined in May 2020, but was still significantly higher than 2019 from July through October 2020. Prescribing of famotidine was 59% higher in April 2020 compared with 2019, while dexamethasone was 303% higher by July 2020.
In addition to azithromycin, prescribing of ceftriaxone was 43% higher in April 2020 versus 2019 and prescribing of doxycycline was 6% higher. Ceftriaxone use remained significantly elevated from May (+22%) through October 2020 (+11%) compared with 2019. But total antibiotic prescribing among nursing home residents was lower from May (-5%) through October 2020 (-4%) compared with 2019.
The study authors say the increases in prescribing of these drugs to nursing home residents without clear benefits are concerning, as they could put residents at greater risk for adverse events. They say further studies linking prescribing data to diagnoses and outcomes are needed to determine how appropriate these prescriptions were and what health impacts they had.
Mar 10 Clin Infect Dis abstract
Pew analysis shows antibiotic development pipeline remains thin
The latest analysis of the antibiotic development pipeline by the Pew Charitable Trusts shows there are still too few antibiotics in development to meet current and anticipated needs.
The analysis shows 43 antibiotics with the potential to treat serious bacterial infections were in clinical development as of December 2020, with 15 in phase 1 clinical trials, 13 in phase 2, 13 in phase 3, and 2 with new drug applications submitted to the Food and Drug Administration (FDA). Historically, only 1 in 5 infectious disease drugs that reach phase 1 studies will receive FDA approval, and roughly 60% of those that reach phase 3 will be approved.
At least 19 of the drugs in clinical development have the potential to treat gram-negative ESKAPE pathogens, which is a critical area of unmet need, and at least 15 have the potential activity against carbapenem-resistant/extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa, which are considered high priority threats by the World Health Organization (WHO). At least 10 of the antibiotics, if approved, could address infections caused by drug-resistant Neisseria gonorrhea and Clostridioides difficile.
Only 10 drugs in the pipeline represent a novel antibiotic class or mechanism of action, according to Pew, and none are active against gram-negative ESKAPE pathogens or WHO critical-threat bacteria.
The analysis also found that only two of the companies with antibiotics in development rank among the top 50 pharmaceutical companies by sales, which is further indication that large pharmaceutical companies are abandoning antibiotic development.
Mar 9 Pew antibiotic pipeline analysis
MERS sickens 2 more in Saudi Arabia
Saudi Arabia's Ministry of Health (MOH) today reported two more MERS-CoV cases, both involving people from Riyadh.
One is a 57-year-old man who had contact with camels, and the other is a 56-year-old woman who didn't have contact with camels or others known to be infected with MERS-CoV (Middle East respiratory syndrome coronavirus). Neither was a healthcare worker.
The cases lift the country's total so far this year to seven.
In its last overview of MERS-CoV, the World Health Organization (WHO) said there have been 2,566 human cases reported since 2012, at least 882 of them fatal.
Mar 11 Saudi MOH update
Avian flu outbreaks strike poultry in Niger and Sweden
In the latest avian flu outbreak developments in poultry, two countries reported highly pathogenic events involving different strains: Niger with H5N1 and Sweden with H5N5, according to notifications from the World Organization for Animal Health (OIE).
In Niger, animal health officials reported H5N1 outbreaks at two locations near the capital of Niamey, one housing exotic Brahma hens and the other a layer farm. The events began on Feb 17 and Feb 25, respectively, and taken together, the virus killed 220 of 28,040 susceptible birds. The outbreaks mark the first appearance of H5N1 in Niger since 2017.
Meanwhile, Sweden reported an H5N5 outbreak at a poultry farm in Trelleborg in the far south. The outbreak began on Mar 2 at a layer farm, killing 3,000 of 18,000 susceptible birds. The country's last H5N5 outbreak in poultry was reported in November.
Mar 10 OIE report on H5N1 in Niger
Mar 10 OIE report on H5N5 in Sweden
News Scan for Mar 11, 2021
Nursing home prescribing during COVID; Antibiotics in the pipeline; New Saudi MERS cases; Avian flu in 2 countries
Filed Under:
Antimicrobial Stewardship; MERS-CoV; Avian Influenza (Bird Flu)
Higher nursing home use of certain antibiotics, COVID therapies noted
US nursing homes saw an increase in prescribing of antibiotics commonly used for respiratory infections during the pandemic, and large number of residents were prescribed drugs being evaluated for COVID-19 treatment, according to a study yesterday in Clinical Infectious Diseases.
For the study, researchers with the Centers for Disease Control and Prevention looked at long-term care pharmacy data from 1,944 nursing homes in 48 states, assessing two categories of drugs: antibiotics and drugs that were being investigated for COVID-19 treatment, including hydroxychloroquine, famotidine, and dexamethasone. To account for seasonal variability in antibiotic prescribing and decreased nursing home occupancy during the pandemic, the researchers calculated the monthly prevalence of residents with a prescription dispensed per 1,000 residents from January to October 2020, then calculated the monthly relative percent change from 2019 to 2020.
From March to October 2020, prescribing of azithromycin and hydroxychloroquine per 1,000 residents was higher than 2019, most notably in April, when hydroxychloroquine prescribing was 563% higher (prevalence ratio [PR], 6.63; 95% confidence interval [CI], 5.87 to 7.48) and azithromycin prescribing was 150% higher (PR, 2.50; 95% CI, 2.37 to 2.63). Prescribing of these drugs declined in May 2020, but was still significantly higher than 2019 from July through October 2020. Prescribing of famotidine was 59% higher in April 2020 compared with 2019, while dexamethasone was 303% higher by July 2020.
In addition to azithromycin, prescribing of ceftriaxone was 43% higher in April 2020 versus 2019 and prescribing of doxycycline was 6% higher. Ceftriaxone use remained significantly elevated from May (+22%) through October 2020 (+11%) compared with 2019. But total antibiotic prescribing among nursing home residents was lower from May (-5%) through October 2020 (-4%) compared with 2019.
The study authors say the increases in prescribing of these drugs to nursing home residents without clear benefits are concerning, as they could put residents at greater risk for adverse events. They say further studies linking prescribing data to diagnoses and outcomes are needed to determine how appropriate these prescriptions were and what health impacts they had.
Mar 10 Clin Infect Dis abstract
Pew analysis shows antibiotic development pipeline remains thin
The latest analysis of the antibiotic development pipeline by the Pew Charitable Trusts shows there are still too few antibiotics in development to meet current and anticipated needs.
The analysis shows 43 antibiotics with the potential to treat serious bacterial infections were in clinical development as of December 2020, with 15 in phase 1 clinical trials, 13 in phase 2, 13 in phase 3, and 2 with new drug applications submitted to the Food and Drug Administration (FDA). Historically, only 1 in 5 infectious disease drugs that reach phase 1 studies will receive FDA approval, and roughly 60% of those that reach phase 3 will be approved.
At least 19 of the drugs in clinical development have the potential to treat gram-negative ESKAPE pathogens, which is a critical area of unmet need, and at least 15 have the potential activity against carbapenem-resistant/extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa, which are considered high priority threats by the World Health Organization (WHO). At least 10 of the antibiotics, if approved, could address infections caused by drug-resistant Neisseria gonorrhea and Clostridioides difficile.
Only 10 drugs in the pipeline represent a novel antibiotic class or mechanism of action, according to Pew, and none are active against gram-negative ESKAPE pathogens or WHO critical-threat bacteria.
The analysis also found that only two of the companies with antibiotics in development rank among the top 50 pharmaceutical companies by sales, which is further indication that large pharmaceutical companies are abandoning antibiotic development.
Mar 9 Pew antibiotic pipeline analysis
MERS sickens 2 more in Saudi Arabia
Saudi Arabia's Ministry of Health (MOH) today reported two more MERS-CoV cases, both involving people from Riyadh.
One is a 57-year-old man who had contact with camels, and the other is a 56-year-old woman who didn't have contact with camels or others known to be infected with MERS-CoV (Middle East respiratory syndrome coronavirus). Neither was a healthcare worker.
The cases lift the country's total so far this year to seven.
In its last overview of MERS-CoV, the World Health Organization (WHO) said there have been 2,566 human cases reported since 2012, at least 882 of them fatal.
Mar 11 Saudi MOH update
Avian flu outbreaks strike poultry in Niger and Sweden
In the latest avian flu outbreak developments in poultry, two countries reported highly pathogenic events involving different strains: Niger with H5N1 and Sweden with H5N5, according to notifications from the World Organization for Animal Health (OIE).
In Niger, animal health officials reported H5N1 outbreaks at two locations near the capital of Niamey, one housing exotic Brahma hens and the other a layer farm. The events began on Feb 17 and Feb 25, respectively, and taken together, the virus killed 220 of 28,040 susceptible birds. The outbreaks mark the first appearance of H5N1 in Niger since 2017.
Meanwhile, Sweden reported an H5N5 outbreak at a poultry farm in Trelleborg in the far south. The outbreak began on Mar 2 at a layer farm, killing 3,000 of 18,000 susceptible birds. The country's last H5N5 outbreak in poultry was reported in November.
Mar 10 OIE report on H5N1 in Niger
Mar 10 OIE report on H5N5 in Sweden