US issues national plan to combat drug-resistant bugs

The White House has released its National Action Plan for Combating Antibiotic-Resistant Bacteria - a five-year, $1.2 billion plan to fight antibiotic resistance, which includes human and animal health factors.

In September 2014, President Obama issued an executive order, Combating Antibiotic-Resistant Bacteria, which created an interagency taskforce led by the secretaries of agriculture, defense and health and human services.

The taskforce's latest effort was to develop the plan that has five goals: slow the emergence of resistant bacteria and prevent the spread of resistant infections, strengthen national One Health surveillance efforts, develop rapid diagnostic tests, accelerate the research and development of new antibiotics and other therapies, and improve international collaboration on prevention, surveillance, control and research.

''Although its primary purpose is to guide activities by the US government, the National Action Plan is also designed to guide action by public health, healthcare, and veterinary partners in a common effort to address urgent and serious drug-resistant threats that affect people in the US and around the world,'' according to the agencies.

''By 2020, implementation of the National Action Plan will lead to major reductions in the incidence of urgent and serious threats, including carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile.''

Animal proposals
First, the National Action Plan highlights FDA's Guidance for Industry 209 and 213 that will eliminate the use of medically important antibiotics for growth promotion in food-producing animals and bring under veterinary oversight the use of medically important antibiotics in feed and water for treatment, control, or prevention.
The National Action Plan calls on the US Food & Drug administration (FDA) to evaluate the adoption of the proposed changes under guidance 213, phasing in veterinary oversight of antibiotics in feed and water, and ''take further action as appropriate.''

As the veterinary community and farmers and ranchers prepare for the final rule relating to guidance 213 and changes to veterinary feed directive rules, one big concern is the amount of training and education that will be necessary to ensure the rules are implemented. To address this, the National Action Plan says FDA, within three years, will collaborate with affected stakeholders to develop and implement educational outreach.

''Stewardship of antibiotics in animals'' is another area addressed in the plan, with a call to action to FDA and USDA to work with livestock and veterinary organizations to develop educational and outreach materials on the judicious use of antibiotics and antibiotic stewardship, which may include incorporating additional material into curricula at veterinary colleges in the United States. It also says FDA and USDA will work with livestock and veterinary organizations to incorporate assessments of antibiotic stewardship activities into quality assurance programs.

The National Action Plan calls for ''enhanced data collection on antibiotic sales and use'' within animal agriculture. Within five years, FDA, USDA and the industry will evaluate and report on the impact of guidance 213 by analyzing ''total sales of antibiotics in animal agriculture and types and prevalence of antibiotic-resistance among selected foodborne pathogens and commensals isolated from retail meat and farm animals.''

According to the plan, the FDA summary report on antibiotic sales from 2009 through 2013 will provide the baseline information for measuring implementation results of guidance 213.
An ''enhanced annually summary'' will be released within one year.

This enhanced monitoring will also look at usage and management practices at multiple points in the production chain. Specifically, according to the plan, the agencies will ''investigate whether certain antibiotic use practices in food production facilitate the development of resistance.'' While the National Animal Health Monitoring System (NAHMS) collects voluntary on-farm use information, the plan says there is need for increased on-farm antibiotic-use data and calls on USDA to develop a plan for expanded monitoring and notes that on-farm sampling will be voluntary.

President Obama's latest budget proposal requested the $1.2 billion necessary to implement the National Action Plan. It will be up to Congress to approve a budget that will guide federal funding issues.