In response to a request for information from the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria that was published in the May 23 Federal Register(www.gpo.gov), the AAFP wrote a letter(4 page PDF) to Deputy Assistant Secretary for Health Bruce Gellin, M.D., M.P.H., explaining what the Academy and some of its sister organizations are doing to support this cause, as well as recommending further actions the council should consider.
Specifically, the advisory council asked for feedback on five questions about efforts to combat antibiotic resistance. In a June 22 letter, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., noted that during his time as AAFP president, he attended the White House Forum on Antibiotic Stewardship, where he was able to provide direct feedback on this topic.
During that meeting, said Wergin, both HHS Secretary Sylvia Burwell and Department of Agriculture Secretary Thomas Vilsack addressed how proper antibiotic use could help curb the rise in multidrug resistant bacteria and Clostridium difficile colitis. "This included the impact of 'shared classes of antibiotics,' which are those antibiotics used in both humans and animals," he noted.
- The Academy responded to a request for information from the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria in a letter to Deputy Assistant Secretary of Health Bruce Gellin, M.D., M.P.H.
- The advisory council asked for feedback on five questions related to efforts and strategies to combat antibiotic resistance.
- The Academy pointed to its policies on judicious use of these drugs, laid out its many CME activities and other resources, and offered suggestions for stepping up the fight against antibiotic resistance.
Wergin explained that the Academy's policy on antibiotics recognizes that inappropriate use of these drugs poses risks to personal and public health. As a strong proponent of evidence-based care, the AAFP encourages its members to be judicious with antibiotic prescribing, he said.
"For example, it would be inappropriate to prescribe antibiotics for the management of simple otitis media and sinusitis, as noted in the Choosing Wisely campaign recommendations," said the letter. "The AAFP acknowledges that all antibiotic prescribing should be based on evidence where possible and on best practices otherwise."
Furthermore, the AAFP's policy on antibiotic resistance in food production and human health advocates
- restricting antibiotic use in farm animals to treatment of established disease;
- requiring industry to provide proof of efficacy and a positive cost/benefit analysis for any antibiotics used in food production that takes into account the ultimate costs to human health -- not just economic costs, but morbidity and mortality, as well; and
- supporting federal legislation intended to accomplish these measures.
Addressing the advisory council's five questions individually, the AAFP first described how two of its sister organizations, the Association of Family Medicine Residency Directors and the Society of Teachers of Family Medicine, have offered specific curriculum modules(www.fammedrcr.com) that include information on appropriate antibiotic use. The residency curriculum resources are used by about 225 family medicine residency programs throughout the United States.
The letter also highlighted how the AAFP has addressed antibiotics and infection prevention in its CME programming, offering a robust list of CME activities on the topic. In the past four years alone, the AAFP CME Credit System has certified 23 activities covering these topics.
In response to HHS' request for suggestions on how to best educate and provide feedback to physicians about diagnostic testing for infectious diseases, optimal antibiotic prescribing and infection prevention, the Academy offered a number of recommendations, including
- offer better local surveillance and prevalence reports on antibiotic resistance patterns in communities, possibly delivered through a Department of Health app or email sent directly to physicians or their clinics;
- develop point-of-care diagnostics to differentiate viral and bacterial etiologies of infections seen in outpatient settings;
- develop and implement (and provide incentives for use of) electronic health record clinical decision support for select infections (e.g., upper respiratory infection, sinusitis or urinary tract infection); and
- build awareness of the BugDrug app(itunes.apple.com), which is a quick reference resource medical students and residents can use when prescribing antibiotics.
"Finally, we believe the appropriate use of antibiotics should be one of the main parameters of quality of care measures, and payments can and should be based on their appropriate use," the letter said.
Regarding examples of successful behavior change models that could be applied to preventive strategies for infection control and judicious antibiotic stewardship, the AAFP suggested that HHS
- develop and promote a campaign similar to the National Patient Safety Foundation's "Ask Me 3(www.npsf.org)" but specifically related to antibiotic use for patients;
- consider modifying, developing and validating behavioral change models such as the 5As (Assess, Advise, Agree, Assist, Arrange) for antibiotic use and prescribing; and
- continue the current oversight of antibiotic use in hospitals, as well as the monitoring that is being done in many accountable care organizations and medical homes, with feedback to physicians.
In conclusion, the Academy voiced its support for the One Health Initiative(www.onehealthinitiative.com), which aims to expand interdisciplinary collaboration and communication worldwide in all aspects of health care for humans, animals and the environment.
Related AAFP News Coverage
AAFP President Spotlights FP Role Against Antibiotic Resistance