[Federal Register Volume 63, Number 139 (Tuesday, July 21, 1998)]
[Notices]
[Pages 39096-39097]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-19319]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration
[Docket No. 98N-0517]


Development of Antimicrobial Drug Products; Development and Use 
of FDA Guidance Documents; Request for Comments

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice; request for comments.

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SUMMARY: The Food and Drug Administration (FDA), Center for Drug 
Evaluation and Research (CDER), Office of Drug Evaluation IV (ODE IV), 
is providing notice to drug manufacturers regarding its current plans 
for revising existing guidance documents and preparing new guidance 
documents on the development of antimicrobial drug products for the 
treatment of infections. ODE IV is reviewing, updating, consolidating, 
and revising its existing guidance documents and identifying topics for 
future guidance. The agency is requesting public comment on topics for 
future guidance development.

DATES: Written comments may be submitted by October 19, 1998. General 
comments on agency guidance documents are welcome at any time.

ADDRESSES: Copies of agency guidance documents can be obtained on the 
Internet at ``http://www.fda.gov/cder/guidance/index.htm''. Submit 
written comments to the Dockets Management Branch (HFA-305), Food and 
Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville MD 20852. 
Comments are to be identified with the docket number found in brackets 
in the heading of this document.

FOR FURTHER INFORMATION CONTACT: Renata Albrecht, Center for Drug 
Evaluation and Research (HFD-590), Food and Drug Administration, 9201 
Corporate Blvd., Rockville, MD 20850, 301-827-2336.

SUPPLEMENTARY INFORMATION: 

I. Background

    In the Federal Register of February 27, 1997 (62 FR 8961), FDA 
published a notice explaining its policy for guidance document 
development, issuance, and use. The notice included an agency document 
entitled ``Good Guidance Practices'' (GGP's), which sets forth agency 
policies and procedures for developing, issuing, and using guidance 
documents. The GGP's emphasize the importance of gaining public input 
early in the guidance development process.
    Since the 1970's the agency has issued guidance in a variety of 
forms to the pharmaceutical industry to facilitate the development of 
antimicrobial drug products. In addition to advice and guidance 
provided verbally during various industry and FDA meetings and other 
interactions between the regulated industry and FDA, or in individual 
letters written to sponsors, general written guidance has also been 
provided. In 1977, the agency issued guidance on the development of 
antimicrobial drug products entitled ``Clinical Evaluation of Anti-
Infective Drugs (Systemic).'' In fulfillment of a contract from FDA, in 
November 1992, the Infectious Disease Society of America (IDSA) 
published its ``Guidelines for the Evaluation of Anti-Infective Drug 
Products'' in the supplement of ``Clinical Infectious Disease'' 
(formerly, ``Reviews of Infectious Diseases''). That same month, FDA's 
Division of Anti-Infective Drug Products issued ``Points to Consider: 
Clinical Development and Labeling of Anti-Infective Drug Products'' 
(1992) on issues related to evaluating new drug applications for anti-
infective drug products. All of these documents contain information 
helpful for designing clinical trial protocols for evaluating the 
safety and effectiveness of new therapies to treat infections and 
gaining approval for supplemental indications.
    In 1996, in an attempt to outline in more detail the elements the 
agency considers important when evaluating clinical studies, the agency 
initiated efforts to develop guidance that would provide investigators, 
academia, and industry with insight on those elements (often referred 
to as ``evaluability criteria'') considered important during the 
evaluation of clinical studies for antimicrobial drug products. In 
March 1997, an early draft guidance, entitled ``Evaluating Clinical 
Studies of Antimicrobials in the Division of Anti-Infective Drug 
Products,'' was discussed at an Anti-Infective Drug Products Advisory 
Committee meeting. That early draft contained an introduction and 
individual sections addressing 12 specific indications. Space was 
reserved to provide guidance at some later date on approximately 15 
additional indications.
    Since the 1997 advisory committee meeting, several events have 
occurred that affect how clinical trials are designed, conducted, 
evaluated, and reported and that are relevant to the revision and 
development of guidance on antimicrobial drug products. ODE IV, which 
includes the Division of Anti-Infective Drug Products, the Division of 
Special Pathogens and Immunologic Drug Products, and the Division of 
Anti-Viral Drug Products, reviewed all of its guidance documents and 
determined that certain revisions were necessary. In November 1997, the 
Food and Drug Administration Modernization Act of 1997 (Modernization 
Act) was enacted (Pub. L. 105-115); it contains several provisions 
related to drug development and will lead to additional agency guidance 
documents on a variety of subjects relating to clinical trial design 
and evaluation. For example, section 119 of the Modernization Act 
addresses meetings and agreements concerning the design and size of 
clinical trials. In addition, in May 1998, the agency published a 
guidance for industry entitled ``Providing Clinical Evidence of 
Effectiveness for Human Drugs and Biological Products'' (63 FR 27093, 
May 15, 1998) that fulfills certain requirements in section 403(b) of 
the Modernization Act and that also has implications for antimicrobial 
drug products.
    ODE IV is continuing its efforts to develop comprehensive guidance 
on evaluability criteria by reviewing, updating, consolidating, and 
revising its existing guidance documents, taking into account these 
broader agency initiatives. Specifically, the office is deciding which 
elements of current guidance documents remain applicable, which 
elements need to be removed, which elements need to be updated, and 
which elements need to be added. In the process, all guidances are 
being developed consistent with the agency's GGP's.
    Throughout the 1990's, ODE IV has approached the development of 
guidance in an open forum as part of its advisory committee process. It 
wishes to continue this public and transparent process for guidance 
document development. ODE IV generally expects to include advisory 
committee review as part of the process of reviewing and developing 
guidance for industry on antimicrobial drug development.

II. Guidance Development Plan

    ODE IV has reviewed all existing, relevant documents. Within the 
next few months, ODE IV expects to issue a general draft guidance that 
addresses issues common to all indications and a series of companion 
draft guidances that address the following individual indications:
    1. Uncomplicated urinary tract infections,
    2. Uncomplicated skin and superficial skin structure infections,
    3. Complicated skin and soft tissue infections,
    4. Community-acquired pneumonia,
    5. Nosocomial pneumonia,

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    6. Acute bacterial exacerbation of chronic bronchitis,
    7. Secondary bacterial infection of acute bronchitis,
    8. Acute otitis media,
    9. Acute uncomplicated gonorrhea,
    10. Acute sinusitus,
    11. Complicated urinary tract infections and pyelonephritis,
    12. Bacterial prostatitis,
    13. Early Lyme disease,
    14. Empiric therapy of febrile neutropenia,
    15. Vulvovaginal candidiasis,
    16. Streptococcal pharyngitis and tonsillitis,
    17. Bacterial meningitis, and
    18. Bacterial vaginosis.
Key aspects of these draft guidances will be discussed in a July 1998 
advisory committee meeting. After the meeting, ODE IV will work toward 
finalizing these guidances.
    The next step will involve developing draft guidance documents for 
the following proposed indications:
    1. Nongonoccocal urethritis/cervicitis,
    2. Endocarditis,
    3. Uncomplicated intra-abdominal infections,
    4. Complicated intra-abdominal infections,
    5. Gynecologic infections (except sexually transmitted disease and 
pelvic inflammatory disease),
    6. Pelvic inflammatory disease,
    7. Osteomyelitis (acute and chronic),
    8. Acute bacterial arthritis, and
    9. Helicobacter pylori infections.
Once developed, the agency expects that it will release the guidances 
in draft for review and comment, with key elements discussed before the 
advisory committee.
    ODE IV also is considering developing guidance during the next few 
years for the following agents:
    1. Agents to treat opportunistic infections related to AIDS;
    2. Antimycobacterial agents;
    3. Antifungal agents;
    4. Antiparasitic agents;
    5. Immunologic/transplant agents;
    6. Antiviral agents;
    7. Dermatologic surgical scrubs, etc.;
    8. Agents to treat sepsis/septic shock; and
    9. Agents used in surgical prophylaxis.
As with the other guidances, it is expected that these guidances will 
first be issued in draft for review and comment and discussed before 
the advisory committee.

III. Comments

    ODE IV is seeking suggestions and recommendations for future 
guidance development. Interested persons may submit comments to the 
Dockets Management Branch (address above). Two copies of any comments 
are to be submitted, except that individuals may submit one copy. 
Comments are to be identified with the docket number found in brackets 
in the heading of this document. Received comments may be seen in the 
office above between 9 a.m. and 4 p.m., Monday through Friday.

    Dated: July 13, 1998.
William K. Hubbard,
Associate Commissioner for Policy Coordination.
[FR Doc. 98-19319 Filed 7-20-98; 8:45 am]
BILLING CODE 4160-01-F