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Advancing Microbial Stewardship Guidance with Neil Clancy, MD

The IDSA representative discusses advances made in recent years, and how foundational guidance could be set by the FDA with input from specialists.

This month, Neil Clancy, MD, a member of the Infectious Diseases Society of America’s Antimicrobial Resistance Committee, presented on behalf of the organization feedback to the US Food and Drug Administration (FDA) for its recent concept paper on a potential ranking of new animal antimicrobial drugs, based on their importance in human medicine.

The FDA concept paper, which follows a similar proposed ranking from 2003, describes a suggested revised process for ranking antimicrobial drugs based on their relative importance in medicine.

It also provides potential revised criteria to determine the medical importance rankings, and the list of antimicrobial drug medical importance rankings that would result if those criteria were to be used.

Among the recommendations from Clancy, chief of Infectious Diseases at the VA Pittsburgh Health System and associate professor of Infectious Disease at the University of Pittsburgh, were to prioritize cephalosporins for their treatment of non-serious bacterial human infection, as well as sulfonamides particularly pediatric use, and to review data more frequently in such a ranking.

As Clancy noted, such lists should be updated every 5 years, with provided mechanisms for qualified experts to request a formal review in a timely fashion.

After all, antimicrobial stewardship remains a highly critical and progressively improved strategy in infectious disease medicine. Even during a pandemic, there’s too much momentum for stewardship strategies to fall to the wayside.

But there is a pandemic, so some focus has fallen off. This week, Contagion spoke with Clancy on his advisories to the FDA, the current state of antimicrobial stewardship, how COVID-19 has affected progress, and what he sees to be the next tangible steps in bolstered informed and precise antimicrobial prescribing.