My first thought in trying to combat antibiotic resistance was to develop an electronic database were the government would monitor the type and quantity of antibiotics prescribed by each provider. There will be no patient data affiliated with the database. This will be more of tracking of data to help combat antibiotic resistance. The only personnel to be privy to this information will be government officials who were properly trained with this information. This tracking system would be similar to DEA’s prescription drug monitoring program. Researchers would be able to potentially develop stricter guidelines for antibiotic prescribing to help combat resistance. Also more provider education on prescribing antibiotics could be developed.
As it relates to drug resistance I found the development of a tool called Comprehensive Antibiotic Research Database (CARD) which is a bioinformatics tool to sequence the genomics of a pathogen. According to McArthur et al. (2013):
“the CARD integrates disparate molecular and sequence data, provides a unique organizing principle in the form of the Antibiotic Resistance Ontology (ARO), and can quickly identify putative antibiotic resistance genes in new unannotated genome sequences. This unique platform provides an informatics’ tool that bridges antibiotic resistance concerns in health care, agriculture, and the environment.”
Dr. Fauci and Collins from the National Institute of Health (2014) stated, “Enhanced surveillance of antimicrobial resistance will draw on cutting-edge genetic sequencing technologies, developed and deployed by the NIH and our colleagues at the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).” Older technology is currently used to detect resistant microbes, however with newer technology and genetic sequencing, researchers will be able to detect outbreaks sooner and determine outbreak linkage and spread. Additionally the US government will like to put the microbe’s sequence in a database called National Database of Resistant Pathogens.
All these databases whether it is how many antibiotics a certain provider prescribes or a database of the genetic sequencing of microbes will have to have ethical implications associated with them. Patient information should not be associated with the databases. Additionally employees and researchers privy to this information should undergo proper training such as Collaborative IRB Training initiative (CITI) if indicated.
Fauci, A. S. & Collins, F. S. (2014). New strategies in battle against antibiotic resistance. National Institutes of Health. Retrieved from http://directorsblog.nih.gov/2014/09/18/new-strategies-in-battle-against-antibiotic-resistance/
McArthur, A. G. …& Wright, G. D. (2013). The comprehensive antibiotic resistance database. Antimicrobial Agents Chemotherapy 57(7). 3348-57
McArthur, A. G. …& Wright, G. D. (2013). The comprehensive antibiotic resistance database. Antimicrobial Agents Chemotherapy 57(7). 3348-57.
Over Prescribing of Antibiotics 
Candice, I think that you are correct that a database tracking provider prescribing would require ethical considerations, even if direct patient data are not included. Can you outline what these ethics would look like? -HMR
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Dr. Ross – When looking into the ethics of an antibiotic prescriber database, I tried to find research on the ethics of a prescription drug monitoring programs (PDMPs). The Obama administration supports a PDMP system as part of the National Drug Control Strategy, however I couldn’t find much information about the ethics behind the program. It seems that many states have their own PDMP program and programs vary from state to state. For instance some states even allow regulatory and law enforcement agencies access PDMP database inorder to investigate an incident. Even though this is not what the database is set up for. So I think an ethical concern will be who has access to the database, and will programs vary state to state? Also I feel provider and patient name will need to be protected. I feel this will be more of monitoring system in order to research the trend of antibiotics and the immergence of resistance.
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