White House Forum on Antibiotic Stewardship Convenes Government and Private Sector Leaders Committed to Improving Antibiotic Prescribing

Few of us remember the time before antibiotics, when a simple infection could kill. With these miracle drugs, we opened the doors to the world of modern medicine, making surgery and even transplants not just safe, but possible.

And yet, 70 years after discovering penicillin, we face a new reality: The more we use antibiotics, the faster they lose their effectiveness.  Some infectious bacteria are becoming increasingly resistant to the drugs designed to kill them, making them less and less effective in their ability to fight infection and illness.  Overuse and misuse of these drugs in humans and animals, could push us closer to a world where we are challenged to be able to treat and prevent some of even the simplest infections. 

That’s why working to improve antibiotic use and combating the threat of antibiotic resistance is so important.  The Administration is committed to leading efforts to change how antibiotics are prescribed and used to address this growing health risk.

A world without effective antibiotics is a frightening prospect.  But our greatest threat isn’t evolution of bacteria—it’s inaction from people.  Through smart policies and cross-sector partnerships, we can make sure effective medicine is there when we need it. Together we will win this fight, because we must.

Combating and preventing antibiotic resistance is a long-term effort but public and private leaders can steward optimal use of antibiotics nationwide right now.

As part of these ongoing efforts and in response to the National Action Plan for Combating Antibiotic-Resistant Bacteria, which outlines key actions to be taken by the Federal government, the following commitments will help us win this fight:

The Department of Health and Human Services (HHS):

• The Centers for Medicare and Medicaid Services (CMS) will work with the Centers for Disease Control and Prevention (CDC) to gather evidence to propose regulatory changes or other actions, as appropriate, that adhere to best practices, such as those identified by the CDC, to provide flexible and tailored implementation guidance for hospitals implementing antibiotic stewardship programs and further promote antimicrobial stewardship programs in hospitals and long-term care facilities.
• CDC will continue to expand its National Healthcare Safety Network (NHSN) to help hospitals and other health care facilities track antibiotic use and resistance.  CDC will also expand its national education campaign so patients get the right medicine, at the right dose, at the right time.
• On May 20, 2015, the Food and Drug Administration (FDA) published a proposed regulation that includes reporting requirements for sponsors of antibiotics approved for use in food-producing animals in order to obtain estimates of sales of major food-producing species (cattle, swine, chickens, and turkeys).
• FDA, CDC, and the USDA are jointly planning a public meeting for late summer of 2015 to seek public input on a plan to collect additional data regarding antibiotic use and resistance in food-producing animals. 
• FDA announced today the Veterinary Feed Directive (VFD) regulation which outlines the requirements under which the use of VFD drugs are authorized and provides veterinarians with a consistent framework for providing oversight of VFD drugs. 
• This summer, CDC and the Agency for Healthcare Research and Quality (AHRQ) will roll out new stewardship guidance and tools for nursing homes and other long-term care settings.
• CDC and AHRQ are also intensifying activities that contribute to the national effort to address resistance and stewardship.
• HHS, through the National Institutes of Health (NIH) and Biomedical Advanced Research and Development Authority (BARDA), is releasing a Request for Information to obtain stakeholder input from the medical and scientific communities, industry, and the public on the parameters of the diagnostic test(s) that should be eligible for the $20 million prize competition HHS previously announced for the development of an in vitro diagnostic test for health care providers to use at the point of care to rapidly and effectively identify bacterial infections.

The United States Department of Agriculture (USDA):

• USDA, CDC, and FDA continue to work with partners in the agriculture industry to advance appropriate use of antibiotics in food animals and promote collaborations among partners in medicine, veterinary medicine, and public health.
• USDA’s National Institute of Food and Agriculture (NIFA) awarded food safety grants that include research on alternatives to antimicrobials, such as improved vaccines, which could lead to a decrease in antimicrobial use.

The Department of Defense (DOD):

• By the end of calendar year 2016, the DoD and Veterans Affairs (VA) will review their existing regulations and, as appropriate, propose new regulations and other actions requiring their hospitals and long-term care facilities to implement robust antibiotic stewardship programs.
• DoD and VA will also take steps to encourage other health care facilities, such as ambulatory surgery centers and outpatient clinics, to adopt antibiotic stewardship programs.  To this end, VA will enhance and conduct follow-up evaluation of its Antimicrobial Stewardship Program already in place across the country.

The Department of Veterans Affairs (VA):

• VA is collaborating with the CDC to improve monitoring of antibiotic use across all VA hospitals.  In April 2015, more than 40 VA hospitals began reporting antibiotic use data to CDC’s NHSN, and additional VA hospitals will begin reporting throughout the year. 
• Today, President Obama signed a memorandum that encourages the responsible use of medically important antibiotics in livestock and poultry production by creating a purchasing and acquisition preference for meat and poultry produced under responsible use policies.

Along with these commitments, representatives from more than 100 human and animal health organizations joined together this week at the White House Forum on Antibiotic Stewardship to discuss  implementing antibiotic stewardship programs, and their critical role in addressing the threat of antimicrobial resistance. We are committed to combating resistance by expanding and improving antibiotic stewardship, slowing the emergence of resistant bacteria, and preventing the spread of resistant infections.

Through smart policies and cross-sector partnerships, we can make sure effective medicine is there when we need it. Together we will win this fight, because we must. Our lives depend on it.

Sylvia Matthews Burwell is Secretary Health and Human Services.

Tom Vilsack is Secretary of Agriculture.