Impacts of antibiotic-resistant bacteria : Thanks to penicillin-- He will come home! PDF
Preview Impacts of antibiotic-resistant bacteria : Thanks to penicillin-- He will come home!
or p a c t s id i fw V w 1KSJ JHrii ~E^i^ tLwBL 1 J Jt^g *$|nBr|kgmW?/y/» ^ ’-jC i* \wy N^Vs^^ \ W' fVll y^togBBL. "^Wkm ilJli i v^^PH u ^yyfjMr fZik^^wV \ 1 ISF' <" Technology Assessment Board of the 103d Congress* EDWARD M. KENNEDY, Massachusetts, Chairman DON SUNDQUIST, Tennessee, Vice Chairman SENATE HOUSE ERNEST F. HOLLINGS, South Carolina GEORGE E. BROWN, JR., California CLAIBORNE PELL, Rhode Island JOHN D. DINGELL, Michigan ORRIN G. HATCH, Utah JIM McDERMOTT, Washington CHARLES E. GRASSLEY, Iowa AMO HOUGHTON, New York DAVE DURENBERGER, Minnesota MICHAEL G. OXLEY, Ohio ROGER HERDMAN C. (Nonvoting) Technology Assessment Advisory Council JAMES C. HUNT, Chairman JOSHUA LEDERBERG Distinguished Professor, Health Sciences Center Professor, Rockefeller University University of Tennessee New York, New York Memphis, Tennessee DANIEL MULHOLLAN MAX LENNON, Vice Chairman Director, Congressional Research Service President and CEO The Library ofCongress Washington, D.C. Eastern Foods, Inc. Atlanta, Georgia THOMAS PERKINS J. CHARLES BOWSHER General Partner A. Comptroller General of the United States Kleiner, Perkins, Caufield and Byers Washington, D.C. San Francisco, California LEWIS M. BRANSCOMB JOHN F.M. SIMS Director, Science, Technology & Public Vice President, Marketing Policy Program, Harvard University Usibelli Coal Mine, Inc. Cambridge, Massachusetts Fairbanks, Alaska HERBERT (TED) DOAN L. DOUGLAS SMOOT President (Ret.), The Dow Chemical Company Dean, College of Engineering & Technology Midland, Michigan Brigham Young University Salt Lake City, Utah NEIL E. HARL MARINA v.N. WHITMAN Charles F. Curtiss Distinguished Professor Iowa State University Professor, Institute of Public Policy Studies Ames, Iowa University of Michigan Ann Arbor, Michigan *TheTABforthe 104thCongresshasnotyetbeenappointed. TheTechnologyAssessmentBoardapprovesthereleaseofthisreport.Theviewsexpressedinthisreport arenotnecessarilythoseoftheBoard,OTAAdvisoryCouncil,orindividualmembersthereof. national 996 CENTER DR. 20892-1150 (MTIBIOTIORCSISTflllT BACTERIA Office of Technology Assessment Congress of the United States Recommended Citation: U.S. Congress, Office of Technology Assessment, Impacts of Antibiotic-Resistant Bacteria, OTA-H-629 (Washington, DC: U.S. Government Printing Office, September 1995). ForsalebytheU.S.GovernmentPrintingOffice SuperintendentofDocuments,MailStop:SSOP,Washington,DC 20402-9328 ISBN 0-16-048338-7 Penicillin, the first antibiotic, and the more than 100 other anti- biotics now available to physicians are the primary weapons in mankind's battle against bacterial diseases. They revolu- tionized medicine, providing cures for formerly life-threaten- ing diseases and preventing many previously inevitable deaths from infected wounds. They still do, but within a short time of each antibi- otic's introduction into medicine, some bacteria became resistant to it, and the antibiotic lost its effectiveness against some diseases. Cur- rently, few bacteria are resistant to all antibiotics, but many more are resistant to all but one or all but a few antibiotics, and the expectation is that resistant bacteria will continue to emerge and spread. The fear is that many bacteria will become resistant to all antibiotics, plunging humanity back into the conditions that existed in the pre-antibiotic age. OTA's report discusses what is known about the emergence and spread of antibiotic-resistant bacteria and describes research and development aimed at controlling those organisms. It concludes that efforts are necessary both to preserve the effectiveness of currently available antibiotics and to develop new antibiotics. It discusses issues that arise in these activities, and it presents options for taking action. This report was requested by the House Committee on Energy and Commerce in the 103d Congress (now the House Committee on Com- merce). The Senate Committee on Labor and Human Resources in the same Congress endorsed the request for the study. OTA was assisted in this study by an advisory panel of scientists and physicians from academia, industry, and state government chaired by Gail Cassell, Ph.D., of the University of Alabama at Birmingham. OTA gratefully acknowledges the contribution of each advisory panel member as well as that of many other experts who supplied informa- tion for the report and participated in reviews of the report as it was prepared. As with all OTA reports, the final responsibility for the con- tent ofthe assessment rests with OTA. ROGER HERDMAN C. Director Advisory Panel Gail Cassell, Ph.D. Prabhavathi B. Fernandes, Stuart Levy, M.D. Professorand Chairman Ph.D. Professor ofMedicine and of Department ofMicrobiology Vice President, Drug Molecular Biology and University ofAlabama at Discovery Microbiology Birmingham/University BiomolecularScreening Tufts University Medical Station Bristol-Myers Squibb School Birmingham, AL 35294 PO Box 4000 136 Harrison Ave. MA Princeton, NJ 08543-4000 Boston, 02111-1800 Anne Bolmstrom President Winston Frederick, M.D. Robert C. Moellering, Jr., AB Biodisk Infectious Disease Research M.D. Pyramidvagon 7 Howard University Hospital Physician-In-Chiefand S-17136 Solna 2041 Georgia Ave., NW, Chairman Sweden Room 5C-43 New England Deaconess Washington, DC 20060 Hospital Robert J. Bywater, Ph.D. DepartmentofMedicine/Room Director, Anti-Infective Joshua Lederberg, Ph.D. 6A Assessment Professor 110 Francis Street MA SmithKline Beecham Animal The Rockefeller University Boston, 02215-5553 Health New York, NY 10021-6399 Walton Oaks Barbara Murray, M.D. Dorking Road Stephen Lerner, M.D. Professor ofMedicine and of Tadworth Professor ofMedicine Microbiology and Molecular Surrey KT20 7NT Wayne State University School Genetics UK ofMedicine Infectious Diseases Harper Hospital/Division of University ofTexas Medical Barry Eisenstein, M.D. Infectious Diseases School at Houston Vice President, Lilly Research 3990 John R 6431 Fannin Labs Detroit, MI 48201 Houston, TX 77030 Lilly Corporate Center, 0434 Indianapolis, IN 46285 iv Tom O'Brien, M.D. AlexanderTomasz, Ph.D. Craig Townsend, Ph.D. Medical Director ProfessorandHead/Laboratory Chairman, Department of Microbiology Laboratory ofMicrobiology Chemistry Brigham and Women's The Rockefeller University The Johns Hopkins University Hospital 230 York Ave., Box 52 Charles and 34th Streets 1 1 75 Francis Street New York, NY 10021-6399 Baltimore, MD 21218 MA Boston, 02115 Richard Wenzel, M.D., M.Sc. Michael Zasloff, M.D., Ph.D. Lone Simonsen, Ph.D. Associate Chairman President, Magainin Research 926 Waverly Way, Apt. A Department ofInternal Institute Atlanta, GA 30307 Medicine 5110 Campus Drive The University of Iowa Plymouth Meeting, PA 19462 Harry Taber, Ph.D. Iowa City, IA 52242 Acting Director, Division of Infectious Diseases NY State Department of Health Wadsworth Center David Axelrod Institute PO Box 22002 NY Albany, 12201-2002 V p roject Staff Clyde J. Behney PRIMARY STAFF David Frankel OTA Assistant Director, The Lancet Michael Gough Project Director Sean Tunis Sandra Handwerger Health Program Director Rockefeller University Elise Berliner ADMINISTRATIVE STAFF Congressional Fellow Kathie E. Hanna Churchton, Maryland Charlotte Brown Dwayne L. Smith Word Processing Specialist Research Assistant Judith Hellerstein Northwestern University Monica Finch Word Processing Specialist Jacqueline T. Keller Research Analyst James H. Jorgensen University ofTexas Louise Staley CONTRIBUTING STAFF Office Administrator Karen Kaunitz Beth Hadley Jacksonville Baptist Medical Carolyn Swann Senior Analyst Center PC Specialist CONTRACTORS Calvin Kunin Ohio State University Michael J. Bennett Washington, DC David H. Persing Mayo Clinic Rochester Mitchell Burken Philadelphia V.A. Hospital David Reiman Stanford University Julian Davies The University ofBritish Barbara Rosenkrantz Columbia Harvard University Susan Feinman Lee Sabath Potomac, Maryland University ofMinnesota VI ontents 1 Summary, Conclusions, Issues and Options 1 Summary 1 Origins ofthe Antibiotic Era 2 Survey ofAntibiotic Resistance 3 Costs ofAntibiotic-Resistant Bacterial Diseases 6 Reducing the Impacts ofAntibiotic-Resistant Bacteria 8 Conclusions 18 Issues and Options for Prolonging Effectiveness of Antibiotics 19 Issues and Options for Encouraging Development ofNew Antibiotics 28 2 Introduction 33 The Discovery ofAntibiotics 36 Confronting Antibiotic Resistance 45 References 46 3 Antibiotic Use and Resistance in the Community 49 Introduction 49 Populations Susceptible to Antibiotic-Resistant Bacteria 53 Factors in the Emergence ofBacterial Diseases 57 Changes in Disease Patterns 59 Surveillance ofAntibiotic-Resistant Bacteria 61 Conclusions 63 References 65 4 Antibiotic Use in Hospitals 69 Infections Acquired in the Hospital 69 The Rise ofAntibiotic-Resistant Infections in Hospitals 71 The Uses ofAntibiotics in Hospitals 73 Legal Aspects ofAntibiotic Use 75 Controlling the Emergence and Spread ofAntibiotic Resistance in Hospitals 76 vii Hospital Accreditation and Infection Control Regulations UnderMedicare 80 Costs ofControlling the Emergence and Spread of Antibiotic-Resistant Bacteria 93 Conclusions 96 References 96 5 Antibiotic Development 101 Designing New Antibiotics 101 Antibiotics in Current Clinical Use 104 DNA Antibiotics That Inhibit or Block Replication or Protein Synthesis 109 Development ofNew Antibiotics From Old 110 New Research Tools 113 Antibiotics From New Sources 113 Getting New Antibiotics to Market 118 Patents 120 Pricing ofDrugs Developed in Part by Federal Research 121 Conclusions 121 References 122 6 New Technologies for infection Diagnosis and Control 127 Diagnostic Methods 127 Vaccines 142 Stimulating the Immune System 146 Targeted Delivery ofAntibiotics 146 Reducing Infections by Modifying Devices 147 Old Therapies 150 Summary 151 References 151 viii
The list of books you might like
