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News from the National Academies
Date: May 14, 1998
Contacts: Dan Quinn, Media Relations Officer
Sean McLaughlin, Media Relations Assistant
(202) 334-2138; e-mail <>

Publication Announcement

Better Surveillance and More Awareness Needed
To Deal With Rise in Antibiotic Resistance

As early as 1945, scientists discovered a pathogen that had developed resistance to penicillin. Since that time, antibiotic resistance has risen dramatically, posing a threat to public health, increasing medical costs, and fueling a resurgence in pathogens that were considered under control.

Fighting the problem of antibiotic resistance will require a better, more coordinated system of surveillance, as well as an increased effort to prolong the effectiveness of existing antibiotics and to develop new drugs, says a new report from the Institute of Medicine's (IOM) Forum on Emerging Infections. The report summarizes the findings and opinions of participants at a recent workshop, and outlines options that policy-makers, pharmaceutical industry leaders, health officials, clinicians, researchers, and others may consider to combat this problem.

Though health officials have long argued the need for better surveillance, no country has developed a reliable, comprehensive system for tracking drug resistance, the report says. Efforts to understand its full impact are stifled by uncoordinated efforts to track across local, national, and international jurisdictions, as well as a lack of common standards among laboratories and health organizations for collecting data. An effective national surveillance program should allow broad access to information and data gathered from all parties, integrate information from participating laboratories into a national database, and distinguish cases of drug resistance occurring in hospitals from those found in the local community. On an international scale, policy-makers need to evaluate whether it is desirable to give more authority to the United Nations' World Health Organization or to the U.S. Centers for Disease Control and Prevention to lead a global surveillance effort.

Widespread, inappropriate use of antibiotics has led to premature emergence of resistance. Increasing the life of antibiotics will require changes in attitude and behavior among health care providers, patients, parents, managed-care organizations, the pharmaceutical industry, and others. Since no adequate enforcement mechanisms exist to ensure proper antibiotic use, current efforts consist primarily of trying to educate people about the hazards of antimicrobial overuse or misuse. Professional societies should collaborate to develop uniform guidelines that encourage better practices, the report says.

More research is needed to examine the impact of antibiotic overuse and misuse on humans; on finding new ways to define a drug's effectiveness; and on the benefits and risks of reducing antimicrobial dose and duration of therapy. Research also is needed on the human health effects of widespread agricultural use of antibiotics. A separate study on the use of antibiotics in chicken, cattle, and other food animals and products, and their potential impact on human health, will be completed by the National Research Council later this year.

In addition to preserving the effectiveness of the current groups of antibiotics, incentives are needed to develop new drugs. Pharmaceutical industry representatives at the workshop felt that efforts need to be directed towards promoting and fostering joint ventures that meet the scientific, legal, and regulatory concerns of industry and academic institutions alike.

The IOM's Forum on Emerging Infections was created in response to a request from the Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases. It brings together representatives from academia, industry, government, and professional and interest groups to examine and discuss scientific and policy issues related to emerging infections. The Institute of Medicine is a private, non-profit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences.

This project is funded by Abbott Laboratories; the American Society for Microbiology; Applied Microbiology Inc.; Bristol Myers Squibb; the Burroughs Wellcome Fund; the Centers for Disease Control and Prevention; Eli Lilly & Co.; F. Hoffmann-La Roche; the Food and Drug Administration; Glaxo Wellcome; Merck and Co. Inc.; the National Institute of Allergy and Infectious Diseases; Pfizer Inc.; SmithKline Beecham Corp.; the U.S. Department of State; the U.S. Department of Veterans Affairs; and Wyeth-Ayerst.

Copies of are available from the National Academy Press for $25.00 (prepaid) plus shipping charges of $4.00 for the first copy and $.50 for each additional copy; tel. (202) 334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

Read the full text of Antimicrobial Resistance: Issues and Optionsfor free on the Web, as well as more than 1,800 other publications from the National Academies. Printed copies are available for purchase from the National Academy Press Web siteor at the mailing address in the letterhead; tel. (202) 334-3313 or 1-800-624-6242. Reporters may obtain a pre-publication copy from the Office of News and Public Information at the letterhead address (contacts listed above).

      Division of Health Sciences Policy

      Forum on Emerging Infections

      Joshua Lederberg, Ph.D.1,2 (chair)
      Sackler Foundation Scholar
      Molecular Genetics and Informatics
      Rockefeller University
      New York City

      Vincent I. Ahonkhai, M.D.
      Vice President and Director, Anti-Infectives and Biologicals
      SmithKline Beecham Corp.
      Collegeville, Pa.

      Steven J. Brickner, Ph.D.
      Manager of Medicinal Chemistry, Central Research Division
      Pfizer Inc.
      Groton, Conn.

      Gail H. Cassell, Ph.D.2
      Vice President for Infectious Diseases Research
      Drug Discovery Research and Clinical Investigation
      Eli Lilly & Co.

      Gordon H. DeFriese, Ph.D.2
      Director and Professor of Social Medicine,
      Epidemiology, Health Policy, and Administration
      Sheps Center for Health Services Research
      University of North Carolina
      Chapel Hill

      Nancy Carter Foster
      Director, Program for Emerging Infections and HIV/AIDS
      U.S. Department of State
      Washington, D.C.

      Renu Gupta, M.D.
      Senior Medical Director, Infectious Diseases
      Bristol-Myers Squibb Co.
      Princeton, N.J.

      Margaret A. Hamburg, M.D.2
      Assistant Secretary for Planning and Evaluation
      U.S. Department of Health and Human Services
      Washington, D.C.

      Dieter Hinzen, M.D.
      Professor and Director, Preclinical Research and Development
      F. Hoffmann-La Roche Ltd.
      Basel, Switzerland

      James M. Hughes, M.D.
      Assistant Surgeon General, and
      Director, National Center for Infectious Diseases
      Centers for Disease Control and Prevention

      J. Stanley Hull
      Vice President, Global Commercial Development
      Glaxo Wellcome
      Research Triangle Park, N.C.

      Samuel L. Katz, M.D.2
      Chairman of the Board
      Burroughs Wellcome Fund, and
      Wilbert C. Davison Professor
      Department of Pediatrics
      Duke University Medical Center
      Durham, N.C.

      Kenneth W. Kizer, M.D., M.P.H.
      Undersecretary for Health
      U.S. Department of Veterans Affairs
      Veterans Health Administration
      Washington, D.C.

      William Kohlbrenner, Ph.D.
      Director, Antiviral Research
      Abbott Laboratories
      Abbott Park, Ill.

      John R. LaMontagne, Ph.D.
      Deputy Director
      National Institute of Allergy and
      Infectious Diseases
      National Institutes of Health
      Bethesda, Md.

      Carlos Lopez, Ph.D.
      Executive Director, Infectious Disease Research
      Eli Lilly Research Laboratories

      Stephen S. Morse, Ph.D.
      Assistant Professor of Epidemiology
      Columbia University School of Public Health
      New York City, and
      Program Manager, Biological Defense Warfare Program
      Defense Advanced Research Projects Agency
      Arlington, Va.

      Solomon Mowshowitz, Ph.D.
      Vice President, Research and Development
      Applied Microbiology Inc.
      Tarrytown, N.Y.

      Stuart L. Nightingale, M.D.
      Associate Commissioner for Health Affairs
      Food and Drug Administration
      U.S. Department of Health and Human Services
      Rockville, Md.

      Michael T. Osterholm, Ph.D., M.P.H.
      State Epidemiologist, and Chief, Acute Disease Epidemiology Section
      Minnesota Department of Health

      David M. Shlaes, M.D., Ph.D.
      Vice President, Infectious Disease Research
      Wyeth-Ayerst Research
      Pearl River, N.Y.

      John D. Siegfried, M.D.
      Associate Vice President, Medical, Regulatory,
      and Scientific Affairs
      Pharmaceutical Research and Manufacturers of America
      Washington, D.C.

      P. Frederick Sparling, M.D.
      Chair of Medicine
      University of North Carolina, and
      Infectious Diseases Society of America
      Chapel Hill


      Jonathan R. Davis, Ph.D.
      Senior Study Director (beginning February 1998)

      Polly Harrison, Ph.D.
      Senior Study Director (ending January 1998)

      1 Member, National Academy of Sciences
      2 Member, Institute of Medicine