In a clinical cohort study, only 31.9% of high-risk adult COVID-19 outpatients were prescribed an antiviral drug, which the researchers said underscores the need to identify and reduce treatment barriers.

A team led by scientists from the California genomics firm Helix analyzed electronic health records from two healthcare systems in Minnesota and Nevada to determine prescribing patterns of nirmatrelvir-ritonavir (Paxlovid), molnupiravir, and remdesivir among 3,247 high-risk COVID-19 patients from April 2022 to June 2023.

The findings were published yesterday in Clinical Infectious Diseases.

Prescribing rose slightly in 2023

In total, 31.9% of patients were prescribed a COVID-19 antiviral, the most common of which was Paxlovid (87.6%), followed by molnupiravir (11.9%) and remdesivir (0.5%). The vast majority of patients were given their prescription on either the day they tested positive (30.3%) or the day after (56.3%).

The prescribing rate rose slightly over time, from 28.0% in 2022 to 34.6% in 2023. The proportion of patients with underlying conditions prescribed an antiviral was 32.2% to 42.6%. The percentage of patients with Charlson Comorbidity Index (CCI) scores of 1, 2, 3-4, and greater than 5 was 26.2% to 45.5%.

There is a need to identify and address treatment barriers and raise awareness and understanding among providers and patients around oral antiviral eligibility, prescribing considerations, and proven benefits.

Antiviral prescribing rates were similar for adults aged 65 and older (39.6%), including those with chronic lung disease (39.8%) or a weakened immune system (43.0%). Of the 1,732 patients (53.3%) with symptoms, prescribing was not meaningfully different overall (35.4% vs 27.9%) among asymptomatic patients or those 65 and older (42.6%).

Ages 50 to 64 years and 65 and older (vs 18 to 49); asthma, diabetes, obesity; and CCI values of 1, 2, or 3-4 (vs 0) were significantly tied to a higher likelihood of prescription. Conversely, unvaccinated status (vs vaccinated 0 to 5 months earlier) and having an emergency department or laboratory-only (vs outpatient) visit or chronic kidney disease were significantly linked to lower chances of prescription.

"There is a need to identify and address treatment barriers and raise awareness and understanding among providers and patients around oral antiviral eligibility, prescribing considerations, and proven benefits," the authors wrote.

The city of Dourados in Brazil's Mato Grosso del Sul state yesterday became the country's first to launch a mass dengue vaccination campaign.

In a prefecture statement today, officials said 537 doses were given on the first day of the campaign, which was developed by the municipal health department in a partnership with Takeda, which produces the Qdenga vaccine.

Targeting 150,000 people between ages 4 and 59 years old, the dengue vaccine will be administered in two doses, 3 months apart.

Prefecture health secretary Waldno Lucena, MD, said, "Dourados has been an example for the entire country, vaccination strengthens individual defenses and also contributes to building a collective barrier against the spread of dengue."

Newly approved vaccine

Brazilian drug regulators approved the Takeda vaccine in March 2023. The live attenuated vaccine, given subcutaneously, is built on a serotype 2 backbone and targets all four dengue serotypes.

The Americas region experienced record dengue activity in 2023, with Brazil the hardest-hit country, with more than 2.9 million cases. The World Health Organization last month noted a marked rise in dengue activity over the past two decades and warned that multiple factors could fuel further rises, including vector distribution changes, climate change, El Nino weather pattern consequences, and fragile healthcare systems.

Most US hospitals now meet the antibiotic stewardship standards set by the Centers for Disease Control and Prevention (CDC), according to a paper published today in Open Forum Infectious Diseases.

Using data from the National Healthcare Safety Network Annual Hospital Survey, CDC researchers found that 95% of US acute care hospitals reported using all seven of the CDC's Core Elements of Hospital Antibiotic Stewardship Programs (ASPs), up from just 41% in 2014. Across all survey years, uptake has been highest in large and teaching hospitals and lowest in small, critical access, and non-teaching hospitals.

The CDC has been monitoring uptake of the core elements—hospital leadership commitment, accountability, pharmacy/stewardship expertise, action, tracking, reporting, and education—since they were published in 2014. The CDC's objective was to help hospitals develop ASPs by outlining the structural and procedural components associated with successful programs.

While only 10% of hospitals reported uptake of all six Priority Elements, which highlight a subset of ASP implementation approaches considered highly effective by experts, 46% of hospitals reported uptake of four or five of those elements. In addition, 91% of hospitals reported monitoring antibiotic resistance patterns at least annually, and 74% said they tracked antibiotic use at least quarterly.

The CDC noted that hospitals have also made progress on uptake of recommended best practices, with 76% reporting implementation of prospective audit and feedback and 64% reporting that their ASP was co-led by a physician and pharmacist in 2021 (up from 23% in 2015). From 2014 to 2020, the percentage of ASPs that had a formal statement of support from hospital leadership rose from 53% to 97%.

Unclear impact on antibiotic use

Despite the signs of progress, the authors of the paper note that there has not yet been convincing evidence at the national level that increased implementation of the core elements has improved antibiotic use (AU) in US hospitals.

"The data in this report demonstrate that US hospitals have built a strong foundation for antibiotic stewardship," they wrote. "Our goal must now be to translate that infrastructure into even more effective interventions to improve AU."

A new report by British members of parliament (MPs) is calling on the UK government to address issues hampering research and development of bacteriophage therapy.

Interest in phages, which are viruses that target and kill bacteria, has grown in recent years amid the global rise in antimicrobial resistance (AMR) and the weak pipeline for new antibiotics. But the report from the House of Commons Science, Innovation and Technology Committee says their potential as a treatment for drug-resistant infections in the United Kingdom can't be fully realized, because most UK and imported phages have not been manufactured to meet the required Good Manufacturing Process (GMP) standards and therefore can't be used in clinical trials or compassionate use cases.

The committee says this issue has hindered attempts to conduct research of phage safety and efficacy, develop phage infrastructure, and integrate phage therapy into the UK health system.

To address the problem, the report says the UK Department for Health and Social Care (DHSC) should bring together funders and innovation centers to build a GMP facility that can be used by phage researchers and developers.

"Such research could harness the UK's genomic research prowess and artificial intelligence to match phages to bacteria and allow manipulation to increase effectiveness," the committee wrote.

Until then, the committee argues that the government should allow compassionate use of non-GMP phages produced in the UK for last-resort medical cases.

Defining the role of phage therapy

The report, which is based on interviews and written evidence submitted by phage researchers and AMR experts, also calls for a dialogue between phage researchers, DHSC, and other UK health agencies on what specific evidence is needed to fully assess the safety and efficacy of phages; identification of bottlenecks for phage transitional research; an annual report on the progress made in all phage-related technologies; inclusion of information about the clinical use of phages within medical training; and guidance on how phages will be regulated.

"More broadly, the Government should produce a clear statement on the role that phages could play in fighting AMR and how they will be supported," the report states.