Dr. A. Lenore Ackerman on antibiotic stewardship in managing UTIs

In this video, A. Lenore Ackerman, MD, PhD, discusses the problem of antimicrobial resistance in the context of the recent FDA Antimicrobial Drugs Advisory Committee meeting that discussed the submitted new drug application for sulopenem etzadroxil/probenecid (oral sulopenem) for the proposed indication of adult patients with uncomplicated urinary tract infection caused by designated susceptible bacteria. Ackerman is an assistant professor in the department of surgery, division of urology at the University of California, Los Angeles. She is an advisor for GlaxoSmithKline.

Transcription:

I'm incredibly concerned about [antimicrobial resistance]. I think we have a need just to stress the idea that this has nothing to do with the antibiotic itself. I think the development of oral alternatives for our carbapenems is fantastic and a really, really needed thing, but I think there is a lot of concern, and I echo that in terms of overuse. Our guidelines already say things like, especially for uncomplicated UTI, we should be careful about our use of the fluoroquinolone antibiotics and really reserve them for times when people have either a need for them based on extensive antimicrobial resistance, or for times when people are allergic to every other alternative, and yet we still see that, say, for example, out of my own hospital system, 40% of first prescriptions are still ciprofloxacin and levofloxacin, and so we are not conforming to the guidelines that we as communities and as experts, we've set out for providers. And given that, I think there's a lot of concern that somebody comes in with the same symptoms and they're just not getting better with the first antibiotic. There's this tendency, even though it's not usually appropriate, to just keep escalating in terms of the spectrum of the antibiotic and the duration of the antibiotic. And we have tons of evidence to show that's not actually an effective way of taking care of this, but also tons of evidence to show that that's what people are doing anyway. And so I think, again, the issue's not with the antibiotic itself. I think it's great, but the concern, I think, is substantial, that when we have already demonstrated we're not really doing a great job of sticking to what we need to stick to, to take care, to be good stewards of our antibiotics, that there is a substantial concern for off-label use, as well as for inappropriate use, inappropriate durations. And so, I think there really is a big concern. And again, I think it's hard, because we want to see these drugs out in the community for use. And so it's really upon us, as the medical community, to be better about not just antibiotic stewardship, but also diagnostic stewardship. I think that's another area in which we could really, really improve, is doing a better job of just only sending testing for urinary tract infections when there's a suspicion for it, not just culturing everybody that walks in the office, and then also being careful about only giving antibiotics when they're the right ones and when they're needed and the right antibiotic for the right infection—shortest duration, least broad spectrum that's possible for The infection that you're that you're trying to treat.

This transcript was edited for clarity.