President Obama’s administration today laid out a five-year, five-point plan for combating and preventing antibiotic-resistant bacteria—more than a month after proposing a near-doubling of federal spending for the task as part of his budget for the federal fiscal year that starts October 1.

The administration cited statistical estimates from the U.S. Centers for Disease Control and Prevention (CDC) that drug-resistant bacteria cause 2 million illnesses and about 23,000 deaths each year nationwide.

The National Action Plan for Combating Antibiotic Resistant Bacteria (NAP) identifies five priorities it says will underpin federal policy across agencies to lower those numbers—as well as govern the spending of the $1.2 billion sought by the president against resistance in FY2016.

The first priority is slowing the emergence of resistant bacteria and preventing the spread of resistant infections through “judicious” use of antibiotics in healthcare and agriculture settings. According to CDC, up to half of all human antibiotic use is unnecessary or inappropriate, such as treatment for infections caused by viruses—such as colds, flu, most sore throats, bronchitis, and many sinus or ear infections.

The NAP calls for reducing inappropriate antibiotic use by 50% in outpatient settings and by 20% in inpatient settings by 2020—in part by creating “antimicrobial stewardship” programs in all acute care hospitals and improved antimicrobial stewardship across all healthcare settings.

The plan also calls for eliminating antibiotics for growth promotion in food-producing animals, and establishing antibiotic resistance (AR) prevention (Protect) programs in all 50 states to monitor multidrug resistant organisms and assist healthcare facilities.

However, at least one environmental group says the NAP didn't go far enough to end overuse of antibiotics in animal agriculture. The Natural Resources Defense Council (NRDC) argues that the plan should have also eliminated use of antibiotics for “disease prevention” uses such as helping animals survive unsanitary confinement conditions. “Leaving this loophole in place means that antibiotic use on animals will not decline significantly,” Mae Wu, NRDC program attorney, wrote on the group's staff blog Switchboard.

The second priority, strengthening national disease surveillance efforts, is based on a “one-health” approach that according to CDC “recognizes that the health of humans is connected to the health of animals and the environment.”

NAP recommends creation of a regional public health network—“the Detect Network of AR Regional Laboratories”—to oversee resistance testing, as well as a specimen repository for resistant bacterial strains, and a National Sequence Database of Resistant Pathogens.

The plan also urges routine reporting of both antibiotic use and resistance data to the National Health Safety Network (NHSN) by 95% of Medicare-eligible hospitals, as well as by Department of Defense and Veterans Affairs healthcare facilities. Also routine by 2020, the plan states, should be testing for zoonotic and animal pathogens for antibiotic susceptibility at 10 to 20 National Animal Health Laboratory Network (NAHLN) and Veterinary Laboratory Investigation and Response Network (Vet-LIRN) member laboratories.

The third priority, advancing the development and use of rapid diagnostic tests, could “significantly” reduce unnecessary antibiotic use, the administration contends. The NAP proposed only generalized outcomes by 2020, while detailing the tests it envisions as includingpoint-of-need diagnostic tests that rapidly distinguish between bacterial and viral infections,” as well as “diagnostic tests that rapidly determine the antibiotic resistance profiles of bacteria of public health concern.”

The NAP was more specific in articulating how to achieve the fourth priority of accelerating basic and applied research and development, with the goal of increasing the number of candidate drugs at all stages of the development pipeline.

The NAP envisions achieving that goal by advancingat least two” preclinical drugs and/or vaccines to clinical trials for treatment or prevention of human disease, developing “at least three” new treatments as alternatives to antibiotics, and launching an antibiotic-focused incubator through a consortium of academic and biopharma industry partners. To promote animal growth without using antibiotics, the resistance plan calls for characterization of the gut microbiome of at least one animal species raised for food.

For the fifth priority, improving international collaboration and capacities, the resistance plan recommended among outcomes the establishment of a common U.S.-European Union system for sharing and analyzing bacterial resistance patterns for priority pathogens, and elevation of antibiotic resistance as an international priority for global health and security.

Also recommended were development of a global database focused on use of antibacterial agents in animals, and development of national plans in low- and middle-income countries to combat antibiotic resistance and improve antibiotic stewardship. In those countries, the NAP also calls for strengthened regulatory and supply chain systems.

“The emergence of drug resistance in bacteria is undermining the effectiveness of current antibiotics and our ability to treat and prevent disease,” three members of President Obama’s Cabinet declared today in a post on the White House blog announcing the NAP. The three are Secretary of Health and Human Services Sylvia Mathews Burwell, Secretary of Agriculture Tom Vilsack, and Secretary of Defense Ashton B. (Ash) Carter.

“Antibiotic resistance also limits our ability to perform a range of modern medical procedures, such as chemotherapy, surgery, and organ transplants. That’s why fighting antibiotic resistance is a national priority,” Burwell, Vilsack, and Carter added.

NAP follows up on earlier Obama administration efforts aimed at combating antibiotic resistance: Last September, the president issued Executive Order (EO) 13676: Combating Antibiotic-Resistant Bacteria. The order created the task force that developed the NAP in order to implement the National Strategy on Combating Antibiotic-Resistant Bacteria, following policy recommendations of a President’s Council of Advisors on Science and Technology report, Combating Antibiotic Resistanceboth of which were also released in September 2014.

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