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Obama Signs Executive Order to Fight Antibiotic-Resistant Bacteria


President Barack Obama last week issued an executive order outlining measures to reduce the emergence and spread of antibiotic-resistant bacteria and to help ensure continued availability of effective treatments for drug-resistant infections. The order was released along with a report on Combatting Antibiotic Resistance by the President’s Council of Advisors on Science and Technology and a new National Strategy on Combating Antibiotic Resistant Bacteria.

Resistance to antibiotic drugs is a growing threat both in the U.S. and worldwide, as described in a report issued last year by the Centers for Disease Control and Prevention (CDC). Overuse of antibiotics when they are not necessary, and inappropriate use such as not completing a full course of treatment, can encourage development of resistance.

The rise of antibiotic-resistant bacteria "represents a serious threat to public health and the economy," the order states as background. The CDC estimates that at least 2 million illnesses and 23,000 deaths annually are caused by antibiotic-resistant bacteria in the U.S., with $20 billion in related direct health care costs.

"Detecting, preventing, and controlling antibiotic resistance requires a strategic, coordinated, and sustained effort," the order states. "It also depends on the engagement of governments, academia, industry, healthcare providers, the general public, and the agricultural community, as well as international partners."

According to the order, success will require significant efforts to minimize the emergence of antibiotic-resistant bacteria; preserve the efficacy of new and existing antibacterial drugs; advance research to develop improved methods for combating antibiotic resistance and conducting antibiotic stewardship; strengthen surveillance efforts in public health and agriculture; develop and promote the use of new, rapid diagnostic technologies; accelerate scientific research and facilitate the development of new antibacterial drugs, vaccines, diagnostics, and other novel therapeutics; maximize the dissemination of the most up-to-date information on the appropriate and proper use of antibiotics to the general public and healthcare providers; work with the pharmaceutical industry to include information on the proper use of over-the-counter and prescription antibiotic medications for humans and animals; and improve international collaboration and capabilities for prevention, surveillance, stewardship, basic research, and drug and diagnostics development."

Declaring that "combating antibiotic-resistant bacteria is a national security priority," the order outlines the federal agencies that will coordinate its implementation: the National Security Council staff, the Office of Science and Technology Policy, the Domestic Policy Council, and the Office of Management and Budget.

The order establishes a Task Force for Combating Antibiotic-Resistant Bacteria, which will include representatives from the Department of State, Department of Justice, Department of Veterans Affairs, Department of Homeland Security, Environmental Protection Agency, U.S. Agency for International Development, Office of Management and Budget, Domestic Policy Council, National Security Council staff, Office of Science and Technology Policy, and the National Science Foundation.

By February 15, 2015, the Task Force is expected to submit a 5-year National Action Plan that outlines specific actions to implement the National Strategy. Within 180 days of the release of the Action Plan, and each year thereafter, the Task Force will update the president on actions taken to combat antibiotic resistance and progress made in implementing the National Strategy and Action Plan.

The order also calls on the Secretary of Health and Human Services, in consultation with the Secretaries of Defense and Agriculture, to establish a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, which will provide information and recommendations on preservation of antibiotic effectiveness by optimizing their use, improved methods for combating antibiotic resistance, antibiotic stewardship, strengthening surveillance of antibiotic-resistant infections, preventing transmission of antibiotic-resistant bacteria, development of rapid diagnostics, research on new treatments for bacterial infections, development of alternatives to antibiotics for agricultural use, and dissemination of up-to-date information on the appropriate use of antibiotics to the general public and human and animal healthcare providers.

By the end of 2016, DHHS and the Department of Veterans Affairs are instructed to review existing regulations and propose new regulations requiring hospitals and other inpatient healthcare facilities to implement robust antibiotic stewardship programs. The Task Force agencies will also help implement stewardship programs for other facilities such as ambulatory surgery centers and dialysis facilities, office-based practices, outpatient settings, emergency departments, pharmacies, and institutional and long-term care facilities such as nursing homes and prisons.

Additionally, the Food and Drug Administration is directed to take steps to eliminate agricultural use of medically important antibiotics to promote growth of livestock.

Finally, the order calls for U.S. agencies to engage in international action to combat antibiotic-resistant bacteria, including participating in the development of the World Health Organization Global Action Plan for Antimicrobial Resistance and expanding multinational scientific and research cooperation.

The White House also announced the launch of a $20 million prize, sponsored by the National Institutes of Health and the Biomedical Advanced Research and Development Authority, to facilitate the development of a rapid diagnostic test that healthcare providers can use to identify highly resistant bacterial infections at the point of patient care.



White House. National Strategy for Combatting Antibiotic-Resistant Bacteria. September 2014.

President's Council of Advisors on Science and Technology. Report to the President on Combatting Antibiotic Resistance. September 2014.

White House Office of the Press Secretary. Executive Order -- Combating Antibiotic-Resistant Bacteria. September 18, 2014.

White House Office of the Press Secretary. FACT SHEET: Obama Administration Takes Actions to Combat Antibiotic-Resistant Bacteria. September 18, 2014.

L Monaco and JP Hudson. New Executive Actions to Combat Antibiotic Resistance and Protect Public Health. White House Blog. September 18, 2014.

E Lander and C Chyba. PCAST Releases New Report on Combating Antibiotic Resistance. White House Blog. September 18, 2014.