Letter in Response to the Infectious Diseases Society of America's 10 × ′20 Initiative

To the Editor—The Society of Infectious Diseases Pharmacists (SIDP) has read the 10 × ′20 Initiative recently published by the Infectious Diseases Society of America (IDSA)'s Antimicrobial Availability Task Force in the 15 April issue of Clinical Infectious Diseases[1]. As clinicians working alongside our infectious diseases physician colleagues, we too are troubled and dismayed at the heightened morbidity and mortality associated with infections due to drug-resistant organisms [2]. The fact that there are too few drugs in the pharmaceutical pipeline that will be available to treat infections due to the so-called “ESKAPE” organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) is cause for a reevaluation of priorities by all stakeholders, including academia, pharmaceutical companies, professional societies, and government agencies around the world. A recent review by Spellberg et al [3] published in 2004 documented only 6 new antibiotics in the research and development pipeline among more than 506 drugs in development. In 2002, several companies halted or substantially reduced their anti-infective discovery efforts as a result of financial or technical issues in the discovery process [4]. In addition, the lack of diagnostic tests to identify resistant organisms necessitates new approaches, and the SIDP supports the idea of providing additional resources that would be needed to develop these diagnostic tests. The SIDP supports the development of initiatives that would repopulate the antibiotic pipeline and policies that would increase the long-term viability of these valuable resources.

To safeguard new antibiotics against misuse and overuse as they become available, antimicrobial stewardship programs are needed more than ever at every institution. The SIDP appreciates the recognition of the need for an infectious diseases-trained pharmacist as a key member of the antimicrobial stewardship team as described in the IDSA/Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Although the SIDP embraces the key role that infectious diseases pharmacists play in protecting the effectiveness of existing antibiotics as a nonrenewable resource and in preserving the viability of the new antibiotics as this biological resource becomes replenished through the 10 × ′20 initiatives, we face a critical shortage of postgraduate antibiotic stewardship training programs to train the next generation of clinical pharmacists who will be qualified to take on this responsibility. The SIDP urges the IDSA to support provisions in regulations that would encourage institutional leaders to develop and maintain institutional programs for antibiotic stewardship and to support training programs before these new antibiotics come to the market.

The SIDP supports the 10 × ′20 initiative and would be delighted to join the other societies that have also endorsed this initiative. We are committed to continuing to provide education, service, and research collaboration to our medical and surgical colleagues around the country to combat the dangers of resistant organisms and promote the 10 × ′20 initiative. We stand beside you and are willing to assist with this initiative, including by selecting an SIDP member to serve on the Antimicrobial Availability Task Force. The SIDP also needs your help to ensure that institutional priorities are put in place to develop antibiotic stewardship training programs that will ensure that sufficient numbers of clinical pharmacists with training in infectious diseases are available to help protect the viability of these new precious resources.

Acknowledgments

Potential conflicts of interest. D.S.B. reports that he has received research funding from Astra-Zeneca and Wyeth-Ayerst, has served as a consultant for Wyeth-Ayerst, and has served on the speakers' bureau of Televance. All other authors: no conflict.