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41 ANTIBIOTIC RESISTANCE & STEWARDSHIP 4 ways scientists are fighting superbugs By Mackenzie Bean M ultidrug resistant infections are on the rise and could kill up to 10 million people a year by 2050, the UN warned in an April 2019 report. In response, researchers are working to de- velop new treatments for superbugs and improve on existing treatments. Four new approaches scientists are exploring to defeat superbugs, according to AAMCNews: 1. Bacteriophages. These viruses prey on bacte- ria and can be used as an alternative to antibiotics in curing bacterial infections. The approach was originally used in the 1920s and 1930s but was abandoned after the discovery of penicillin. The use of bacteriophages to fight infection came back into fashion, however, after Steffanie Strathdee, PhD, an infectious disease epidemiologist at the University of California, San Diego, successfully used phage thera- py to cure her husband of a deadly infection. 2. Small Streptomyces molecules. Two out of every three antibiotics comes from the bacteria Streptomy- ces and its cousins. Researchers previously thought the bacteria could only produce three or four drug compounds, but advances in genetic sequencing recently revealed Streptomyces has genetic in- structions for up to 40 distinct molecules that could potentially produce medicines. Scientists hope to find a way to modify the bacteria so it will make more of these molecules. 3. Traditional medicine. Some scientists are consult- ing ancient sources, such as 16th-century Chinese herbal texts, to identify plants with medicinal prop- erties that may help address the superbug crisis. Ethnobotanist Cassandra Quave, PhD, an assistant professor at Emory University, also interviews local healers in remote areas to find plant-based rem- edies. She and her colleagues study the chemical components and potential bioactivity of these rem- edies, and they have identified a few that may help stem the damage of multidrug resistant infections. 4. Combining existing drugs. Scientists are also developing more strategic ways to use drugs that already exist. A team from Emory University School of Medicine has shown many "resistant" infections are only partly resistant: some cells resist antibiotic treatment while others remain susceptible. The key to treating these infections may be combining two or more antibiotics, which increases the odds of killing all the bacteria. n Extra focus on antibiotic stewardship helps residents stick to prescribing guidelines By Anuja Vaidya A dding dedicated antibiotic stewardship-fo- cused training rounds into the medical educa- tion curriculum helped increase adherence to guidelines governing the duration of antibiotic therapy, according to a study published in Infection Control & Hospital Epidemiology. Researchers examined antibiotic prescribing for three common infections — pneumonia, cellulitis and urinary tract infections — at a medical center. ey studied the prescribing patterns of three medical teams: one com- posed of family medicine residents, another composed of internal medicine residents and a hospitalist group. All three medical teams received identical baseline anti- biotic stewardship education and daily prescribing audit with feedback via clinical pharmacists. e family medicine resident group received additional targeted antibiotic stewardship training, which included biweekly stewardship-focused rounds with an antibiotic stewardship physician and a clinical pharmacist leader. Of 1,572 patients admitted to the hospital between July 1, 2016, and June 30, 2017, 295 were eligible for inclusion in the study. e percentage of patients receiving antibiotics selected in adherence with the medical center's guidelines was similar across all three groups for all three infections. However, the family medicine group prescribed antibiot- ics in adherence with facility guidelines on duration for 74 percent of patients, as compared to the internal med- icine group that did the same for 56.6 percent of patients and the hospitalist group for 44.6 percent. n