Antimicrobial resistance

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Antimicrobial resistance One health fits all
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EU

• 25.000 deaths annualy
• Costs 1,5 billion euro/year

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WHO draft global action plan Five strategic
objectives 1. to improve awareness and
understanding of antimicrobial resistance 2. to
strengthen knowledge through surveillance and
research 3. to reduce the incidence of
infection 4. to optimize the use of
antimicrobial agents 5. to develop the economic
case for sustainable investment that takes
account of the needs of all countries, and
increase investment in new medicines, diagnostic
tools, vaccines and other interventions. (to be
presented at WHA May 2015)
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Identifies 7 areas in which actions are most
necessary - making sure antimicrobials are
used appropriately in both humans and animals -
preventing microbial infections and their
spread - developing new effective antimicrobials
or alternatives for treatment - cooperating with
international partners to contain the risks of
AMR - improving monitoring and surveillance in
human and animal medicine - promoting research
and innovation - improving communication,
education and training.
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Transmission of resistant microorganisms
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One health approach intersectoral surveillance
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Specific objectives of AMR surveillance AB use

• Monitor
• Antibiotic-susceptibility patterns common
  pathogens
• Magnitude and trends of AMR
• Emergence of new AMR
• Use/overuse/misuse of antibiotics
• In order to
• Improve quality, safety and costs of health care
• Guidance adequate antibiotic therapy
  appropriate use
• Support infection prevention control
• Awareness advocacy
• Benchmarking
• Improve laboratory capacity, expertise quality

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No surveillance no control..
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Use of antibiotics in Europe (humans)
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Use of antibiotics in Europe (animals)
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Intersectoral Coordination

• Ministry of Health, Welfare and Sports Ministry
  of Economic Affairs (Agriculture and Livestock)
• Health Council of the Netherlands report (2011)
  Antibiotics in food animal production and
  resistant bacteria in humans.
• Preventive use was prohibited
• Restricted use of all critically important
  antibiotics (3rd choice)
• Last resort antibiotics excluded from veterinary
  use
• Mandatory sensibility testing 3rd choice
  antibiotics
• Independent Veterinary Drug Authority (2011)
  Monitor trends bench-marking transparency
• Amendment to the law (2013) Antibiotics only
  with prescription from veterinarian
• Guidelines

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AMR control
Appropriate use of antibiotics
Infection control
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Control of AMR infection control

• Infection prevention hygiene
• Professional guidelines for each setting
• Search and destroy or control/contain
• Awareness and sense of urgency
• Outbreakmanagement
• Enforcement by the national health inspectorate
• Problem ownership/responsibilities

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Control of AMR -gt Appropriate use of antibiotics

• Right indication, right dose, adequate period, at
  the lowest cost, good quality
• Treatment is correctly followed by the patient.
• Bacteria causing the infection need to be
  susceptible.
• Inappropriate use includes over-prescription,
  under prescription, and prescription and
  dispensing of unnecessary antibiotic combination
• (From The evolving threat of antimicrobial
  resistance - Options for action, WHO 2012)
• Control surveillance, awareness, problem
  ownership, responsibilities, professional
  guidelines, antibiotic stewardship, enforcement

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Control of AMR raising awareness
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TAP when knowledge is not enough

• Guide to Tailoring AMR Programmes
• Design tailored interventions instead of spray
  campaigns
• Describes an step by step approach and provides
  tools to assist national AMR programmes to
  increase prudent antibiotic use
• Based on TIP (Guide to Tailoring Immunization
  programmes)
• TAP is a conceptual model that combines several
  behavioural change theories, social marketing
  concepts with previous experience.
• TAP brings together several stakeholders from the
  start to gain ownership and to recognize the work
  that has to be done together in order to work
  towards the intervention together
• Current state in development/pilot fase ?
  Sweden, England, Netherlands

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AMR Dutch EU presidency

• NL involvement in WHO GAP and GHSA (one of the
  leading countries)
• Minister of Health announced at the 3rd
  International One Health Congress in Amsterdam
  (March 2015) AMR will be one of my priorities
  during the Dutch EU presidency first half 2016
• Focus on One Health approach to AMR measures
  needed in human health sector, animals, food and
  environment
• Further recommendations for the next EU AMR
  Action plan

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• Conclusions
• No action today no cure tomorrow
• No surveillance no control of AMR and use of
  antibiotics
• AMR control consists of infection prevention and
  appropriate us of antibiotics
• Knowledge is not enough for behavior change
• One health fits all (better safe then sorry)

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Questions?