On March 23, 2023, Dr. Ari Frenkel participated in the 23rd Public Meeting of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria. PACCARB provides advice, information, and recommendations to the U.S. Secretary of Health and Human Services regarding programs and policies intended to support and evaluate the implementation of U.S. government activities related to combating antibiotic-resistant bacteria.

Below is a transcript of Dr. Frenkel’s comments and presentation, as well as links to recordings of the meeting.

Ari Frenkel, M.D., of Arkstone Medical Solutions said that addressing the gap in antimicrobial stewardship is paramount. He reported seeing firsthand the overutilization of antimicrobials in rural America. Statistics are alarming; for example, most U.S. counties do not have access to infectious disease specialists, and only a fraction of health care providers are infectious disease specialists. Therefore, the use of technology to bring evidence-based medicine into practice is ever more important. During his time as a solo infectious disease physician in private practice, Dr. Frenkel was the only infectious disease doctor in two large counties, serving approximately 150,000 people spread across three hospitals. Throughout the United States, access to essential expertise is lacking, and community needs far outweigh the ability to deliver care. Just as society has embraced technology for communication, transportation, and information, technology can be used fight AMR. However, there is considerable pushback to technology by health care providers and systems. Dr. Frenkel said he is committed to improving the lives of others and reducing suffering. He encouraged everyone to think of technology as a tool to enhance the ability to treat infections and embrace it as a mechanism of extending care and expertise with boundless possibilities. 

Dr. Frenkel’s Public Comment begins at 16:33

Ari Frenkel, M.D., of Arkstone Medical Solutions pointed out that antimicrobial stewardship programs are limited to academic centers and well-resourced facilities, but according to CDC, 90 percent of antibiotic prescriptions occur in the outpatient setting, where antimicrobial stewardship is lacking. Skilled nursing facilities are required to have stewardship programs, but they account for less than half a percent of the total population, making little impact on antibiotic usage. Arkstone’s decision-making software employs technology (OneChoice) that uses electronically transmitted laboratory results, artificial intelligence, and an extensive database of AMR data to formulate a patient-specific plan for infection treatment that provides targeted recommendations, factoring in the patient’s age, allergies, pregnancy status, diagnosis, and the sample source, as well as resistance and the organism detected. In practice, limited knowledge or experience can lead clinicians to choose the wrong drug, the wrong dose, or the wrong duration or even to treat microbes that are colonizers or possible contaminants. With Arkstone, physicians order the laboratory results, as usual, and Arkstone generates the OneChoice report automatically, so the physician receives the recommendation with the laboratory result instantaneously, with a clear treatment regimen that includes the optimal drug, dosage, and duration to treat the infection with the least chance of adverse reaction.   Dr. Frenkel said that OneChoice recognizes commonly pathogenic microbes based on the sample source and often recommends no treatment at all when microbes are likely colonizers, contaminants, or self-limiting viruses. The proprietary ArkScore scoring system breaks down hard-to-understand concepts around resistance, allowing doctors to easily compare patients or understand the differences between antimicrobials. Physicians can add additional factors, such as a patient’s drug allergies, or check for drug interactions. The physician can even access the references and data that support the recommendation. All of this information allows physicians to make well-informed decisions that benefit their patients and reduce the overuse of antibiotics. Arkstone software is currently being used to reduce antibiotic use in the United States. At present, nearly a third of OneChoice reports recommend no treatment; thus, despite patient demand, doctors have receive clear, evidence-based guidance that they can share with their patients to help avoid prescribing unnecessary antibiotics. Arkstone software also acts as a powerful surveillance tool. By integrating with dozens of laboratories across the country, it can detect upticks in infection and resistance trends. This information is already being used to help individual laboratories track trends within their patient base. With further development and the right partners, these data can be used to benefit the entire population. Arkstone has proven that outpatient antimicrobial stewardship is possible. Dr. Frenkel called for more collaboration to change the face of outpatient prescribing together.

Dr. Frenkel’s presentation begin at 30:25