WASHINGTON — Experts on antibiotic-resistant bacterial infections on Tuesday urged Congress to pass legislation that would address the issues that lead to so-called superbugs.
Kansas Sen. Roger Marshall, the top Republican on the panel and an OB-GYN, said the issue is critically important for Congress because more than 3 million Americans will be diagnosed this year with an antimicrobial resistant superbug.
Those infections translated to about 100 Americans dying every day from some form of bacterial infection that gets around the antibiotics available, he said.
“We need to look in the mirror — we, meaning physicians, nurse practitioners and (physician assistants),” Marshall said. “Half of the antibiotics we prescribe are probably not indicated. I wish I could tell you which half it is. But certainly my profession needs to look in the mirror, do more cultures and pay more attention to this as well.”
One of the drivers of antibiotic-resistant infections is overuse of the medications in both humans and animals. Antibiotics are often used in livestock, and health care providers can prescribe them for illnesses where they aren’t indicated.
For example, antibiotics aren’t able to treat viral infections such as the common cold, the flu or COVID-19.
Medical progress under threat
The hearing was held by the U.S. Senate Health, Education and Labor Committee’s subcommittee on Primary Health and Retirement Security.
Massachusetts Democratic Sen. Ed Markey, chair of the panel, said that everyone must use antibiotics responsibly.
“Antibiotics alone have extended our average lifespan by 23 years,” Markey said. “But the rise in antimicrobial resistance threatens to undo 100 years of medical progress.”
Dr. Helen Boucher, dean and professor of medicine at Tufts University School of Medicine in Massachusetts, urged the committee to pass a bipartisan bill already introduced this Congress and called on the Biden administration to appoint someone to oversee issues related to antibiotic resistance.
The legislation — known as the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act — would change how the United States approaches antibiotics, she said.
“The PASTEUR Act uniquely values antibiotics for their value, not for their use. So it delinks any incentive to overuse antibiotics and it focuses on the most needed antibiotics for the most resistant infections,” she said.
That bill, Boucher said, would be “a much-needed first step to getting us back to a healthy economic framework for antibiotics.”
The legislation would establish clear criteria for those that develop antibiotics to receive a subscription or guaranteed reimbursement that wouldn’t be linked to when and how the antibiotics are used, she said.
“It’s linked to stewardship, which is very, very important to ensure that we clinicians use the antibiotics in the best way possible so that they’re preserved for as long as possible,” Boucher said.
The subscription model typically pays one rate per month or per year, regardless of how many patients are prescribed the antibiotics, according to an article in The Lancet, a medical journal.
“The aim is two-fold: to avoid antibiotic overuse, and to guarantee a viable market for pharmaceutical companies even if their drugs are reserved as antibiotics of last resort,” the article said.
Christine Ann Miller, president and chief executive officer at Melinta Therapeutics in New York City, said the legislation would help to address some of the “brain drain” the industry has seen and could help to draw researchers back towards developing new antibiotics.
The ongoing underinvestment in antimicrobials, Miller said, has led many people to leave for other areas of the industry, like oncology or chronic diseases because those commercial markets are more stable.
The PASTEUR Act, Miller said, would help to create some stability within the commercial marketplace for new antibiotics.
Miller told the subcommittee that without effective antibiotics, routine medical procedures like hip replacements or cesarean sections, chemotherapy and organ transplants would be even more complicated.
“In the United States, (antimicrobial resistance) is the third leading cause of death behind heart disease and cancer,” Miller said.
Antibiotics and veterinarians
Dr. Michael Apley, a professor at the College of Veterinary Medicine at Kansas State University, told senators the way the agriculture sector uses antibiotics has changed in recent years, though more work is being done.
“I want to be very clear that new antibiotics are very, very important. But as a clinical pharmacologist, I also see a need for advancing our understanding of the regimens we use for existing antimicrobials,” Apley said.
He noted that veterinarians and doctors who deny use of antibiotics in medical care can take on some risk in doing that.
“When a physician or a veterinarian takes a stand on antimicrobial stewardship in saying, ‘I know you want one, but we’re not going to,’ there’s a risk that’s undertaken,” Apley said. “And supporting physicians and veterinarians undertaking that risk with information and collaboration is incredibly important.”
