Weekly Digest: Updated ranking of health interventions by cost-effectiveness; New info-sharing platform for antibiotic innovation

11 Aug 2017

A weekly roundup of news on drug resistance and other topics in global health.

Updated ranking of health interventions by cost-effectiveness. In a study in PLOS ONE, CDDEP researcher Hellen Gelband and colleagues update cost-effectiveness rankings for health interventions in low- and middle-income countries, based on 1400 studies published from 2000 to 2013. Important changes since previous rankings in 2005 and 2006 result from the introduction of new technologies, new methods for changing behavior, and price changes for certain vaccines and drugs. Cost-effectiveness rankings are useful in prioritizing health expenditures in national healthcare planning and budgeting. This analysis comes as strategies and priorities are being considered for the U.N. Sustainable Development Goals. [PLOS ONE]

Rapid diagnostic tests for malaria reduce antimalarial prescribing, but increase antibiotic use. Researchers reviewed 10 studies carried out between 2007 and 2013, comparing patient management where malaria rapid diagnostic tests (mRDTs) were and were not available, in five African countries and Afghanistan. The analysis, reported in The American Journal of Tropical Medicine and Hygiene, included more than a half million patients in total. In each of the 10 studies, antimalarial prescribing was lower and antibiotic prescribing higher where mRDTs were available, but the variation among studies was considerable. Patients who tested negative for malaria were also more likely to get an antibiotic than the malaria positive patients. In most settings, about 75 percent of patients got either an antimalarial or an antibiotic, suggesting that “in the absence of other diagnostic options, presumptive antimalarial treatment may be exchanged for presumptive antibiotic treatment” when mRDTs are used. The results raise obvious concern about pushing up antibiotic resistance rates. [New York Times, CIDRAP, ASTMH]

New info-sharing platform for antibiotic innovation: A digital platform launched by the Pew Charitable Trusts will allow researchers from across the globe to share data to stimulate the discovery of new antibiotics. The Shared Platform for Antibiotic Research and Knowledge (SPARK) will integrate research data and analyses for open, real-time collaboration. The database will initially be curated from publicly available sources, but will have the capability to “host and harmonize” findings from previously unpublished and prospective research. SPARK will begin in a pilot phase, focusing on data relevant to antibiotics for Gram-negative bacteria, among the most difficult to treat. [Pew Charitable Trusts]

After pneumococcal vaccine, ear infections declined and pathogen profile shifted. Ear infections in young children declined following the U.S. introduction of pneumococcal conjugate vaccines in the 1980s, and infecting bacteria shifted from predominantly Streptococcus pneumoniae to a mix including more Haemophilus influenzae and Moraxella catarrhalis. The study, reported in Pediatrics, tracked 615 children in their first 3 years of life in Rochester, NY, from 2006 to 2016. By age one, 23 percent of children had one or more occurrence of acute otitis media (AOM), rising to 60 percent by age three—down from 80 percent in a similar 1989 study. According to CIDRAP News, the American Academy of Pediatrics estimates more than 5 million AOM infections occur each year in U.S. children, with 30 million associated doctor visits and 10 million antibiotic prescriptions. [Pediatrics, CIDRAP]

Just in time: new class of antibiotics to treat gonorrhea. The World Health Organization (WHO) recently sounded the alarm about the rising incidence of untreatable gonorrhea, which has been reported from almost every country. A new candidate antibiotic, closthioamide, representing a new drug class, has been found effective in vitro against about 150 strains of gonorrhea from U.K. hospital patients. No cross-resistance with existing antibiotics was found, indicating that the drug could be effective against drug-resistant gonorrhea. Testing in animals and humans has not yet taken place, so possible clinical use is still years away. The results appear in Antimicrobial Agents and Chemotherapy. [Guardian, AAC]

Changing behaviors for antibiotic prescription practices. A study in JAMA Internal Medicine reports on a successful behavioral approach to influencing antibiotic prescription practices in two Dutch hospital centers. After one year of the behavioral interventions, appropriate prescribing increased from 64 to 77 percent, based on analysis of 7,000 patient experiences. The results are consistent with other studies of behavioral approaches to antibiotic stewardship. [JAMA Internal Medicine]

Cholera continues to spread in Yemen. The Lancet journals flag the continued cholera crisis in Yemen as a humanitarian failure, on the eve of World Humanitarian Day, August 19. Cholera outbreaks are containable with low-level and affordable interventions: prevention through clean water and sanitation, and treatment through rehydration. Will humanity step up to its commitments to protect the world’s most vulnerable, in 2017 in Yemen? [The Lancet]