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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


The Growing Threat Of Resistance In Anti-Infective Medicine


GOAL
To provide primary care physicians with an interest in anti-infective medicine and the treatment of respiratory tract infections with up-to-date information on the growing threat of the resistance problem.

TARGET AUDIENCE
This activity is designed for primary care physicians with an interest in anti-infective medicine and the treatment of respiratory tract infections. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, the participant should be able to:

  • Assess the global burden of antibiotic resistance.
  • Identify the mechanisms by which antibiotic treatment can promote antibiotic
    resistance.
  • Recognize the widespread problem of patient noncompliance with antibiotic therapy and judge its impact on clinical outcomes, treatment costs, and antibiotic resistance.
  • Explain the importance of appropriate antibiotic use strategies to address the antibiotic resistance issue.
  • Demonstrate awareness of the impact of the pneumococcal conjugate vaccine in reducing the prevalence of infections caused by resistant pneumococci and the concern about replacement disease caused by nonvaccine serotypes.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The estimated time to complete this educational activity: 2 hours.
Release date: July 15, 2006. Expiration date: July 15, 2008.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Pfizer Inc.

Full Disclosure Policy Affecting CME Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

John G. Bartlett, MD
Professor, Department of Medicine
Chief, Division of Infectious Diseases
Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Bartlett reports having no financial relationships with corporate organizations related to this activity.

PARTICIPATING FACULTY

William R. Bishai, MD, PhD
Professor of Medicine
Department of Medicine
Division of Infectious Diseases
Johns Hopkins School of Medicine
Baltimore, Maryland
Dr Bishai reports receiving grants/research support from Abbott Laboratories, Bayer, Merck and Company, Pfizer Inc, and Sanofi-Aventis; receiving honoraria from Abbott Laboratories, Bayer, Merck and Company, Ortho-McNeil, Oscient, Pfizer Inc, Roche, and Sanofi-Aventis.

H. Goossens, MD, PhD
Director, Department of Medical Microbiology
University Antwerp
Edegem, Belgium
Laboratory of Medical Microbiology
University of Leiden
Leiden, The Netherlands
Dr Goossens reports having no financial or advisory relationships with corporate organizations related to this activity.

Przemyslaw Kardas, MD, PhD
The First Department of Family Medicine
Medical University of Lodz
Lodz, Poland
Dr Kardas reports having no financial or advisory relationships with corporate organizations related to this activity

Marc Lipsitch, MD
Assistant Professor
Department of Epidemiology
Department of Immunology and Infectious Diseases
Harvard School of Public Health
Boston, Massachusetts
Dr Lipsitch reports having no financial or advisory relationships with corporate organizations related to this activity.

Cynthia G. Whitney, MD
Acting Chief, Respiratory Diseases Branch
Division of Bacterial and Mycotic Diseases
National Center for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia
Dr Whitney reports having no financial or advisory relationships with corporate organizations related to this activity.


Notice: Faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Johns Hopkins Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Johns Hopkins Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

The Growing Threat Of Resistance In Anti-Infective Medicine
John G. Bartlett, MD

The introduction of antibiotics in the mid-20th century provided effective medical treatment for what were previously life-threatening bacterial infections. However, over time, bacteria can develop resistance to antibiotics. The usual approach to combating antibiotic resistance has been to develop novel antimicrobial drugs that target the resistant strains. The present situation is more worrying; research and development into new antimicrobial drugs is declining and very few new antibiotics are being developed. The response to this should be 2-fold: the implementation of policies to encourage the development of new antibiotics that are effective against high-priority resistant pathogens, and efforts to make the most effective use of those antibiotics that are currently available to preserve their usefulness.

This issue of Johns Hopkins Advanced Studies in Medicine will review the growing threat of resistance in anti-infective medicine, with a particular focus on respiratory tract infections. The article by H. Goossens, MD, PhD, and Marc Lipsitch, MD, looks at the global burden of antibiotic resistance and reviews the impact of antibiotic overuse, in addition to the differences between major antibiotic classes in terms of resistance induction.

The article by Przemyslaw Kardas, MD, PhD, and William R. Bishai, MD, PhD, looks at the problem of antibiotic overuse in terms of patients failing to complete their course of antibiotics and the impact this may have on clinical outcomes and antibiotic resistance.

The article by John G. Bartlett, MD, and Cynthia G. Whitney, MD, examines the effectiveness of current interventions to reduce antibiotic resistance, including methods to promote research and development of new antimicrobials, the role of improved diagnostics to reduce the need for empirical prescribing, the potential value of appropriate antibiotic use programs, the risks of clinical guidelines, and the unanticipated impact of pneumococcal vaccine in children on the rate of pneumococcal infections in adults.

I hope that this issue of Johns Hopkins Advanced Studies in Medicine will provide an overview of the resistance problem facing infectious disease specialists, and provide useful insight into appropriate interventions to preserve our antibiotic resources.

*Professor, Department of Medicine, Chief, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Address correspondence to: John G. Bartlett, MD, Professor, Department of Medicine, Chief, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 437, Baltimore, MD 21287. E-mail: jb@jhmi.edu.

The content in this monograph was developed with the assistance of a medical writer. Each author had final approval of his/her article and all its contents.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.