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Stewardship / Resistance Scan for Jun 18, 2021

Outpatient antibiotic durations frequently longer than needed, study finds

Nearly 40% of outpatient antibiotic prescriptions in an integrated healthcare system in Denver were longer than necessary, researchers reported yesterday in Open Forum Infectious Diseases.

The analysis of antibiotic prescribing across the ambulatory care network of Denver Health from July 2018 to June 2019 looked at prescribing linked to visits for uncomplicated infections, including acute sinusitis, acute otitis media (AOM), community-acquired pneumonia, urinary tract infections (UTIs), and skin and soft-tissue infections (SSTIs). Antibiotics prescribed for more than 5 days were considered longer than necessary.

Of the 5,331 antibiotic prescriptions included in the analysis, the duration of therapy was longer than recommended for 39%. Prescribed durations varied significantly by ambulatory care site, sex of patient, provider type, and type of infection. Urgent care centers accounted for 52.8% of longer than recommended prescriptions, followed family medicine clinics (29%) and internal medicine clinics (11.4%). Acute sinusitis and AOM together accounted for 43.7% of longer than recommended prescriptions, while SSTIs accounted for 33.5% and UTIs 20%.

Further analysis found that advanced care practitioners (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.09 to 1.41), urgent care centers (aOR, 1.51; 95% CI, 1.20 to 1.89), and family medicine clinics (aOR, 2.24; 95% CI, 1.76 to 2.86) were independently associated with longer than recommended durations of therapy, as were SSTIs (aOR, 3.82; 95% CI, 2.84 to 5.14), acute sinusitis (aOR, 4.66; 95% CI, 3.41 to 6.36), and AOM (aOR, 12.41; 95% CI, 8.68 to 17.73).

The study authors say universal adherence to the recommended 5-day duration of therapy for these uncomplicated infections would have averted 6,657 antibiotic-days over the 1-year period, or 20% of the total antibiotic-days prescribed.

“These data add to recent evidence that reducing excessive durations of therapy is an essential component of outpatient antimicrobial stewardship and highlight areas of focus that may be high yield,” they wrote.
Jun 17 Open Forum Infect Dis abstract

Phase 1 trial to begin for novel antibiotic

Qpex Biopharmaceuticals of San Diego announced yesterday that it has initiated a phase 1 clinical trial for a novel antibiotic for infections caused by drug-resistant gram-negative pathogens.

The trial will evaluate the safety, tolerability, and pharmacokinetics of QPX9003, an intravenously-administered synthetic polymyxin that has shown potent activity against target pathogens, including multidrug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa. The drug was developed in collaboration with scientists at Monash University in Australia. 

Polymyxins are considered a last-resort class of antibiotics for difficult-to-treat, resistant infections, but are known to be nephrotoxic. No new polymyxins have been approved since polymyxin B and colistin became available in the late 1950s.

“QPX9003 has shown reduced toxicity compared to the currently used polymyxin B and colistin in preclinical studies,” Jian Li, PhD, a research professor at Monash University, said in a Qpex press release. “This property, coupled with greater antimicrobial potency, is expected to translate to improved effectiveness for patients with MDR gram-negative infections.”

The research that led to the development of QPX9003 was funded by a 5-year grant from the National Institutes of Health. Qpex has also received support from the Biomedical Advanced Research and Development Authority.
Jun 17 Qpex press release

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