REPORT FROM THE 2006 NAPCRG ANNUAL MEETING: ANTIMICROBIAL USE IN PRIMARY CARE

Vanessa Diaz

doi:10.1370/afm.673

The 2006 NAPCRG Annual Meeting held October 15–18 in Tucson, Ariz, featured plenary speakers who highlighted the role of primary care research in developing strategies to address the important public health issue of antimicrobial resistance. J. Todd Weber, MD, FACP, who is the director of the Office of Antimicrobial Resistance in the Coordinating Center for Infectious Diseases at the Centers for Disease Control (CDC), emphasized the dangers of antimicrobial resistance by describing the lack of new antibiotics to replace older antibiotics with high-resistance profiles. For example, studies show an increasing prevalence of Methicillin-resisistant Staphylococcus aureaus (MRSA) with devastating consequences of necrotizing pneumonia, sepsis, septic emboli, necrotizing fasciitis, and mortality. Dr. Weber reported that most of the new drugs approved in recent decades have been chemical modifications of existing drugs, not novel drug classes, with only 2 new antibiotic drug classes having been approved by the US Food and Drug Administration since 1968.

Although inappropriate antibiotic prescribing is declining in the primary care setting, further reductions are needed. To that end, Dr. Weber described the “Get Smart” campaign, which represents an effective collaboration between the CDC and external partners to develop a successful public health program to decrease unnecessary antimicrobial use and reduce the spread of resistance. He discussed the continuing importance of primary care research for improving preventive strategies that decrease the incidence of resistant infections, describing the epidemiology of antibiotic use and infections, and developing interventions that decrease inappropriate use of antimicrobials. Dr. Weber stated interventions should be developed both for health care providers and the general public, since the use of antibiotics without a prescription is also a growing concern, especially within Latino communities outside the United States.

This theme was highlighted in the plenary of Paul Little, MD, MBBS, a general practitioner from the United Kingdom who is a professor of primary care research at the University of Southampton. While discussing his journey as a clinical researcher, Dr. Little presented his work on improving antibiotic prescribing within the primary care visit, which includes studies on using delayed antibiotic prescriptions. He believes that the immediate prescription of antibiotics can ‘medicalize’ a self-limited illness. Dr. Little also described strategies to improve patient education within visits, which could lead to less antibiotic prescribing while maintaining patient satisfaction. His work is an example of practical research that directly informs the practice of primary care and which derives its questions from common problems in that arena.

Dr. Little listed the need for ideas and passion as key ingredients for a clinician to develop a successful research career. Research training, adequate funds, multidisciplinary teamwork, and the support of senior leadership were also important to his success. He ended his plenary by reminding us that the final ingredient was persistence, which is achieved by being confident in who we are, in our questions, and in our perspective as primary care providers. NAPCRG members can draw inspiration and direction from these lessons as they work to improve the quality of primary health care in the United States, Canada, and around the world.