Tackling antibiotic resistance

Bush, Karen; Courvalin, Patrice; Dantas, Gautam; Davies, Julian; Eisenstein, Barry I.; Huovinen, Pentti; Jacoby, George A.; Kishony, Roy; Kreiswirth, Barry N; Kutter, Elizabeth; Lerner, Stephen A.; Levy, Stuart B.; Lewis, Kim; Lomovskaya, Olga; Miller, Jeffrey H; Mobashery, Shahriar; Piddock, Laura J. V.; Projan, Steven J.; Thomas, Christopher M.; Tomasz, Alexander; Tulkens, Paul M.; Walsh, Timothy R.; Watson, James D.; Witkowski, Jan; Witte, W; Wright, Gerry; Yeh, Pamela J.; Zgurskaya, Helen I.

doi:10.1038/nrmicro2693

Cited by 971 publications

(754 citation statements)

References 9 publications

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“…This estimate for the willingness-topay threshold is potentially problematic in that it is based on an estimate for incremental total annual U.S. costs of antibiotic resistance, which itself has limitations given the complexity of quantifying resistance costs. 25,26 Further, this estimate likely represents a lower bound estimate given the many potential sources of incremental costs attributable to antibiotic resistance, including treatment failure, use of costly second line antibiotics antibiotic stewardship programs and new antibiotic development. Fourth, this analysis relies on data from two European trials, and evidence suggests that physician compliance with procalcitonin protocols is higher among European physicians relative to U.S. physicians.…”

Section: Discussionmentioning

confidence: 99%

“…Given an annual total of 40 million antibiotic prescriptions for adult ARTIs, this result suggests that nation-wide adoption of procalcitonin testing could result in 30 million fewer antibiotic prescriptions annually. 25 In one-way sensitivity analyses, the parameters with the greatest impact on results were antibiotic cost, procalcitonin cost, and the probability of physician adherence with algorithm recommendations to withhold antibiotics given a normal procalcitonin level ( Table 3). The procalcitonin strategy dominated usual care (i.e., was both more effective and less costly) when the antibiotic cost >$61 or procalcitonin testing cost <$17.…”

Section: Willingness-to-pay Threshold: Costs Of Antibiotic Resistancementioning

confidence: 99%

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Cost-Effectiveness of Procalcitonin-Guided Antibiotic Therapy for Outpatient Management of Acute Respiratory Tract Infections in Adults

et al. 2013

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BACKGROUND:Two clinical trials suggest that procalcitonin-guided antibiotic therapy can safely reduce antibiotic prescribing in outpatient management of acute respiratory tract infections (ARTIs) in adults. Yet, it remains unclear whether procalcitonin testing is cost-effective in this setting. OBJECTIVE: To evaluate the cost-effectiveness of procalcitonin-guided antibiotic therapy in outpatient management of ARTIs in adults. DESIGN: Cost-effectiveness model based on results from two published European clinical trials, with all parameters varied widely in sensitivity analyses. PATIENTS: Two hypothetical cohorts were modeled in separate trial-based analyses: adults with ARTIs judged by their physicians to require antibiotics and all adults with ARTIs. INTERVENTIONS: Procalcitonin-guided antibiotic therapy protocols versus usual care. MAIN MEASURES: Costs and cost per antibiotic prescription safely avoided. KEY RESULTS: We estimated the health care system willingness-to-pay threshold as $43 (range $0-$333) per antibiotic safely avoided, reflecting the estimated cost of antibiotic resistance per outpatient antibiotic prescribed. In the cohort including all adult ARTIs judged to require antibiotics by their physicians, procalcitonin cost $31 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored compared to usual care was 58.4 % in a probabilistic sensitivity analysis. In the analysis that included all adult ARTIs, procalcitonin cost $149 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored was 2.8 %. CONCLUSIONS: Procalcitonin-guided antibiotic therapy for outpatient management of ARTIs in adults would be cost-effective when the costs of antibiotic resistance are considered and procalcitonin testing is limited to adults with ARTIs judged by their physicians to require antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Willingness-to-pay Threshold: Costs Of Antibiotic Resistancementioning

confidence: 99%

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Therapy for Outpatient Management of Acute Respiratory Tract Infections in Adults

et al. 2013

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“…Indeed, the cost of disease may be underestimated due to its multifactorial nature and the relative success, up to this point, in controlling its impact, at least in the developed world. The role of genetics in improving animal health will become increasingly important as focus increases on tackling antimicrobial drug resistance (Bush et al, 2011) including the resistance to anthelmintics (Gilleard, 2013). This challenge will also differ between species.…”

Section: Introductionmentioning

confidence: 99%

Genomics to benefit livestock production: improving animal health

Plastow

2016

R. Bras. Zootec.

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-The primary principle underlying the application of genomics is that it has the most value for difficult and expensive to measure traits. These traits will differ between species and probably also between markets. Maintenance of health will be one of the biggest challenges for efficient livestock production in the next few decades. This challenge will only increase in the face of demand for animal protein, resistance to existing drugs, and the pressure to reduce the use of antibiotics in agriculture. There is probably genetic variation in susceptibility for all diseases but little has been done to make use of this variation to date. In part this is because it is very difficult as well as expensive to measure this variation. This suggests that genomics should provide one of the ways of tackling the challenge of improving animal health. This paper will discuss the concepts of resistance, variation in susceptibility, and resilience; provide examples and present some recent results in cattle and pigs; and briefly discuss the application of gene editing in relation to disease resistance.

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“…In particular novel approaches that can replace or enhance current antimicrobials are highly desired. [3][4][5] Polymeric materials have often been postulated as alternatives in these areas, either as delivery vehicles for antimicrobials, 6,7 or as novel antimicrobial polymers, [8][9][10][11] and materials that can interfere with microbial adhesion. [12][13][14][15] Polymeric materials are especially attractive in these applications because of their multivalency, ease of manufacturing and the potential to precisely control polymer length and composition.…”

Section: Introductionmentioning

confidence: 99%

Engineering Microbial Physiology with Synthetic Polymers: Cationic Polymers Induce Biofilm Formation inVibrio choleraeand Downregulate the Expression of Virulence Genes

Pérez-Soto

Moule

Crisan

et al. 2016

Preprint

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Here we report the first application of non-bactericidal synthetic polymers to modulate the physiology of a bacterial pathogen. Poly(N-[3- is associated with the reduction to the number of free bacteria, but also the downregulation of toxin production. Finally we demonstrate that these polymers can reduce colonisation of zebrafish larvae upon ingestion of water contaminated with V. cholerae. Overall, our results suggest that the physiology of this pathogen can be modulated without the need to genetically manipulate the microorganism and that this modulation is an off-target effect that results from the intrinsic ability of the pathogen to sense and adapt to its environment. We believe these findings pave the way towards a better understanding of the interactions between pathogenic bacteria and polymeric materials and will underpin the development of novel antimicrobial polymers.

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Tackling antibiotic resistance

Cited by 971 publications

References 9 publications

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Therapy for Outpatient Management of Acute Respiratory Tract Infections in Adults

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Therapy for Outpatient Management of Acute Respiratory Tract Infections in Adults

Genomics to benefit livestock production: improving animal health

Engineering Microbial Physiology with Synthetic Polymers: Cationic Polymers Induce Biofilm Formation inVibrio choleraeand Downregulate the Expression of Virulence Genes

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