Download presented - EPP Group

Antimicrobial
resistance
“One health fits all”
Anja Schreijer, MD, PhD, MPH
Senior policy advisor AMR
Centre for Infectious Disease Control
RIVM
EU
25.000 deaths annualy
Costs: 1,5 billion euro/year
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)
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.
Transmission of resistant
microorganisms
One health approach:
8
intersectoral surveillance
Specific objectives of AMR surveillance & AB use
Monitor
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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..
1
Use of antibiotics in Europe
1
(humans)
Use of antibiotics in Europe
(animals)
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 + benchmarking + transparency
- Amendment to the law (2013): Antibiotics only with prescription from
veterinarian
- Guidelines
AMR control
Infection
control
Appropriate
use of
antibiotics
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
Control of AMR -> Appropriate use of antibiotics
●
Right indication, right dose, adequate period, at the lowest cost,
good quality
●
Treatment is correctly followed by the patient.
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Bacteria causing the infection need to be susceptible.
●
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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
Control of AMR:
raising awareness
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
AMR Dutch EU presidency
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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
Conclusions:
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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)
Questions?