Non-antibiotic treatment for pediatric outpatients with common cold inhibits the emergence of drug resistant pneumococci

Toward economic evaluation of the value of vaccines and other health technologies in addressing AMR

We discuss the need to make economic evaluations of vaccines antimicrobial resistance (AMR)-sensitive and ways to do so. Such AMR-sensitive evaluations can play a role in value-for-money comparisons of different vaccines within a national immunization program, or in comparisons of vaccine-centric and non-vaccine-centric technologies within an anti-AMR program. In general terms, incremental cost-effectiveness ratios and rates of return and their associated decision rules are unaltered by consideration of AMR-related value. The decision metrics need to have their various health, cost, and socioeconomic terms disaggregated into resistance-related subcategories, which in turn have to be measured carefully before they are reaggregated. The fundamental scientific challenges lie primarily in quantifying the causal impact of health technologies on resistance-related health outcomes, and secondarily in ascertaining the economic value of those outcomes. We emphasize the importance of evaluating vaccines in the context of other potentially complementary and substitutable nonvaccine technologies. Complementarity implies that optimal spending on each set of interventions is positive, and substitutability implies that the ratio of spending will depend on relative value for money. We exemplify this general point through a qualitative discussion of the complementarities and (especially the) substitutability between pneumococcal conjugate vaccines and antimicrobial stewardship and between research and development (R&D) of a gonorrhea vaccine versus R&D of a gonorrhea antibiotic. We propose a roadmap for future work, which includes quantifying the causal effects of vaccination and other health technologies on short-term and long-term resistance-related outcomes, measuring the health-sector costs and broader socioeconomic consequences of resistance-related mortality and morbidity, and evaluating vaccines in the context of nonvaccine complements and substitutes.

Emergence of Antibiotic-Producing Microorganisms in Residential Versus Recreational Microenvironments

Aims

To identify novel antibiotic-producing microbial strains with unprecedented pertinence. We hypothesize that site-specific soil samples will contain a variety of antibiotic-producing species (APS) with diverse specificity of molecular elements.

Place and Duration of Study

Laboratory of Microbiology, Division of Biological and Health Sciences, University of Pittsburgh, Bradford, PA-16701, USA, between August 2010 and May 2011.

Methodology

The environmental soil samples were collected from residential and recreational sites in Southern, PA, USA at longitude: −76 42 21.7116, latitude: 39 56 35.7252; approximately 201 meters above sea level. Over 70 natural antibiotic-producing soil bacteria were screened against 19 pathogenic microorganisms. Agar-plug assay was established to identify the antibiotics’ potency and pathogenic inhibitory index calculations were employed to measure the inhibitory potential of each isolate; 16S rRNA sequencing was used for microbial classification.

Results

A total of 71 microorganisms from residential soil demonstrated zones of inhibition (ZOI), followed by 9 organisms from recreational soil sample. A total of 15 bioactive strains demonstrated convincing growth inhibitory properties against 16 clinically relevant pathogens; 40% revealed pDNA presence, of which 67% exhibited stringent potencies against S. aureus. We observed a highly bioactive residential soil microbiota compared to recreational soil.

Conclusion

16S rRNA sequence analysis corroborated several of the species belonging to Enterobacteriaceae, Xanthomonadaceae, and Bacillaceae. These findings may indicate a co-evolutionary biosynthesis of novel antibiotics driven by the increase of bioactive microbiota in residential environments.

A challenge to appropriate antibiotic use in children with respiratory infections: a 5-year single-institution experience

BACKGROUND

We have studied the rate of emergence of antibiotic-resistant Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae (H. influenzae) and the subsequent antibiotic use in host patients of those isolates at the Department of Pediatrics, Soma General Hospital, Fukushima. Moreover, we carried out several studies investigating the risks and benefits of antibiotic-free treatment for children with respiratory infections. In this report, we summarize our research and suggest better treatment options for pediatric patients with respiratory infections.

METHODS

We investigated the necessity of antibiotic use in the treatment of pediatric inpatients with respiratory syncytial virus (RSV) infection, and tested our hypothesis that antibiotic-free treatment for common cold will reduce the number of resistant S. pneumoniae strains in the pediatric nasopharynx. Therefore, we restricted prescribing antibiotics for pediatric patients with respiratory infections. The rates of resistant S. pneumoniae and H. influenzae and the medication history of the host patients before and after the intervention were compared.

RESULTS

We found that most of the RSV-infected patients recovered without antibiotic treatment, and that the antibiotic-free treatment inhibited the emergence of antibiotic-resistant strains. The rate of penicillin-resistant S. pneumoniae decreased but the rate of ampicillin-resistant H. influenzae did not change significantly during the study.

CONCLUSION

We concluded that patients with respiratory infections can be treated without antibiotics, under careful examination and observation. Continued monitoring of such new interventions as well as recommending their use to other caregivers and physicians will help inhibit the spread of resistant strains.