Pandemic flu preparedness – role of antibiotics

Abstract number: 1733_546

McIntosh E., Wu D., Paradiso P., Tucker H., Burlington B., Brenner R., Clarke J., Cooke J., Puz P., Temple M., Papiernik D., Mallick R., Kuznik A., Barrett L., Woodrow A.

Objectives: This work analyses the potential role of antibiotics in pandemic flu preparedness using examples drawn from past pandemics, interpandemic flu and SARS, and makes recommendations to improve antibiotic availability in the event of a pandemic.

Methods: Commercial data for antibiotic sales during interpandemic flu and SARS was obtained. The following assumptions were made: 50% of the population would be affected by pandemic flu, 10% would be diagnosed with post-flu bacterial CAP, 20% of those will be hospitalised and 85% would require IV antibiotics. It was also assumed that 20% would be infected by MRSA and that 30% of the patients would ideally received ICU management.

Results: Sales of some IV antibiotics were found to follow the flu season by up to 3 weeks. The sales of 7 IV antibiotics were significantly related to the number of individuals testing positive for flu, an overall 4.1% incremental effect. About 40 to 60% of hospitalisations in the USA (350,000 to 1.2 million) for secondary CAP are projected to optimally warrant IV antibiotic therapy with coverage for MRSA. In a ``moderate'' pandemic there would be 209 thousand and in a ``severe'' pandemic 1.9 million flu-related deaths in the USA alone. In Hong Kong there was a very sharp rise in antibiotic use associated with SARS.

The expected successes of the following antibiotics in flu-related CAP are: ceftriaxone 39.3%, piperacillin/tazobactam 39.9%, azithromycin + ceftriaxone 63.8%, vancomycin + azithromycin + ceftriaxone 79.5%, levofloxacin 79.6%, ceftriaxone + levofloxacin 80.8%, azithromycin + ceftriaxone + levofloxacin 80.8%, piperacillin/tazobactam + levofloxacin 83.1%, tigecycline 85.1%, vancomycin + levofloxacin 93.2%.

Conclusions: In a flu pandemic, there will be a requirement for broad-spectrum hospital intravenous antibiotics to cover common pathogens, especially those resistant to conventional antibiotics. Further efforts should be made to incorporate antibiotic preparedness into pandemic flu preparedness plans.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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