Use of Antibioticsin Animals

A European Perspectiveby a Dutch observer

Dr. Albert Meijering

IPPE, Atlanta, January 30, 2013

Use of antibiotics in animal production:

• Excessive

• Injudicious

• Where does it bring us?

• How to get away from there?

To use them is to lose them !

Antimicrobial Resistant Bacteria

Probably situation far more complicated:

Example 1: Livestock Associated MRSA

• A new variant of MRSA emerged in 2003

• Reservoir in pigs, veal calves and broilers

• Mainly people in direct contact with the living animals are affected

• 40% of new human MRSA cases in The Netherlands are LA-MRSA

Example 2: Extended Spectrum Beta Lactamase (ESBL)

• Rapid increase in positive hospitalized patients since 2005

• Mainly community-acquired infections

• Transmission in hospital is rare

• Main suspect outside the hospital: chicken!

• ESBL prevalence is increasing everywhere in Europeand all over the world…

• Are we heading for the post-penicillin era?

Europe

To update your geography:

Some facts about the EU

• Member states: 27 with 500 mln inhabitants and 23 different languages

• European Parliament: 754 members, proportionally elected by European citizens on national basis

• European Council: representation of national administrations

• Decision process: codecision of Parliament and Council as rule;by exception advisory right of Parliament

• European Commission: executive body of the EU responsible for proposing legislation, implementing decisions, upholding the Union treaties and day-to-day running of the EU. Commission operates as a cabinet government with 27 commissioners.Agencies: EMA, ECDC, EFSA

European strategy in brief

The EU strategy seeks to promote the continued availability of effective antimicrobials for the cure of diseased animals whilst at the same time acting to minimise risks to man or animals arising from their use.

Basic principles of the EU strategy

• AMR development is a natural and unavoidable consequence of its use

• process accelerated by injudicious and excessive use

• growing gap between rising AMR and development of new antimicrobials

� securing effectivity of existing antimicrobials is of paramount importance

� so is development of new classes of antibiotics

• antibiotics should be used responsibly, i.e. only when strictly necessary and over the specified time at the appropriate dosage;

• regular prophylactic use is strongly disapproved

• livestock farming should rely upon disease prevention, not on antibiotics.

• appropriate antimicrobial use depends on a change of attitude and practice

• drug resistance is a global problem; control requires a global effort

Development and milestones of EU policy (1)

• 2001/2002. Commission and Council, considering AMR had become a major public health problem, asked for Community action on prudent use of antimicrobials in human and vet medicine in 4 key areas:

� Strengthening monitoring of AMR, and consumption of antimicrobials in humans and animals

� Prevention of AMR development by a.o.:

o Full application of the prescription only rule

o Phasing out antimicrobials as growth promoters in feed

� Research and product development (new antimicrobials, prevention, alternative treatments + vaccines, rapid diagnostics and susceptibility tests)

� International (global) cooperation

Development and milestones of EU policy (2)

• 2006. Ban on antimicrobials as growth promotor in feed

• 2010. Start of European Surveillance of Veterinary Antimicrobial Consumption by EMA

• 2012. Decision to restrict use of 3rd/4th generation cephalosporins to clinical cases and after susceptibility testing

Development and milestones of EU policy (3)

• 2011. Commision presents new (One Health based) Action Plan, (motivated by ever increasing risk of AMR and insufficient efforts of MS to control it)

Main points for veterinary use:

� reinforcement of regulatory framework for veterinary drugs and medicated feed (labeling, restrictions on CIA's, revision of authorization

requirements)

� guidelines for prudent veterinary use to be drafted

� emphasis on disease prevention in animal health legislation

� examining desirability of specific antibiotics for vet. use

� reinforcement of monitoring AMR and use of antibiotics in livestock production

Development and milestones of EU policy (4)

• 2012. Council conclusions on the impact of AMR in human and veterinary sector – a One Health perspective, a.o. stress:

� the importance of diagnosis and susceptibility testing

� the need to be restrictive in both human and vet use of CIA's and new antibiotics

� the need to require that at least antibiotics for systemic use are available on prescription only

� the importance of hygienic measures to prevent infections

� ....and call upon MS to develop and implement national strategies to contain AMR

Development and milestones of EU policy (5)

• 2012. EP resolution:

endorses the Commission Action Plan and the content of the Council conclusions

calls for a firm commitment of all MS to implement corresponding AMR strategies on the national level

calls on the Commission to develop a roadmap for implemetation of the Action Plan

welcomes the Transatlantic Taskforce on Antimicrobial Resistance(TATFAR) and the set of recommendations adopted for future US-EU cooperation

calls on the Commission to join forces for the prevention and control of AMR with other global partners

Agreed during EU-US Summit, 3 November 2009

Focus:

• Appropriate therapeutic use of antimicrobials inthe medical and veterinary communities

•Prevention of healthcare- and community-associated drug-resistant infections

•Strategies for improving the pipeline of new antimicrobial drugs

Dutch policy on use of antibiotics in livestock production

Highly ambitious but with joint forces!

Animal Production in The Netherlands (Holland)

• 4 million cattle

• 12 million swine

• 400.000 horses

• 1,5 million sheep and goats

• 100 million poultry

• share 13,000 sq ml land(=Maryland)

• with 17 million people

www.hollandfoodpartner.comSource: CBS

• NL ranks among the EU countries with most restrictive and selective use of antibiotics in human health care (ESAC, 2008)

• NL ranks among the EU countries with highest use of antibiotics in livestock production (source: ESVAC, 2010 data)

Growing concern...

• Evidence for transfer of (multi)resistant strains from animals to humans -> medical, public and political concern about public health risk of AMR originating from livestock production

• Concern increased by animal disease outbreaks with (or without) impact on human health: CSF, AI, FMD, BSE, Blue Tongue, Q-fever

• Strong appeal for a more responsible and restrictive application of antibiotics in animal production

Licence to produce at stake!

Actions to reduce the use of antibiotics

• 2008/2010: Stakeholders1 presented master plans to reduce use of antibiotics in the major production sectors (pigs, broilers, veal calves, cattle).

Key elements:

• Central (private) databases for prescription and use on the herd level for transparency, benchmarking, improvement (and enforcement) purposes

• Foundation of an Animal Drug Authority for benchmarking, identification of exceptional use, supervision on databases and improvement programmes

• Reduction targets: -20% in 2011 and -50% in 2013 (reference: 2009)

• 1 producers, feed mills, trade and slaughter sector, dairy industry and the Royal Netherlands Veterinary Association

Sales of antibiotics (in kg active ingredient) in animal production in the Netherlands upto 2008

Development of sales and use for therapeutic purpose

• 2010: -13%

• 2011: -32%

• 2012: -51%

• (reference: 2009)

• new target:

• -70% in 2015

Approach for a further reduction of use in individual Dutch herds from 2012-2015 (outline: Animal Drug Authority)

• Example: frequency distribution of DDD/Y for farms with sows:

red zone: immediate operational action required orange zone: action required; adaptation of herd health plangreen zone: no specific action necessary

target: all herds in the green zone in 2015

Policy development on prudent use

• 2011: Advice by the Health Council of the Netherlands:

Development of ESBLs by veterinary use of antibiotics is major concern

Restrict off-label use to exceptional cases in short term

Restrict the use 3rd/4th gen. cephalosporines with priority (ban herd treatment and use in dry cow treatment)

Save new antibiotics and antibiotics not used for livestock for use in human health care

Ban systematic use of beta-lactam antibiotics, fluoroquinolones and aminoglycosides

(allow only individual therapeutic use in exceptional cases after a thorough

diagnosis and a mandatory susceptibility test)

Prevent marketing authorization of antibiotics not yet authorised for veterinary use (e.g. carbapenems!)

Developments in prudent use

• Medication guidelines revisited: critical antibiotics 3rd choice

• Porc production quality system refrained voluntarily from3rd/4th generation cephalosporines and fluoroquinolones

• Dairy sector refrained from 3rd/4th generation cephs. in dry cow treatment

• In 2012 use of 3rd/4th generation cephs. was almost zero

Challenges...

• Changing production systems that depend on the use of antimicrobials

• Alternatives should be found in:

• Different management and hygiene

• Preventive measures

• Disease control

• How to preserve sufficient treatment options for humans andanimals in future?

Final statements

• Abundant and injudicious use of antibiotics, our superdrugs, will inevitably create multiresistant superbugs

• Here, we are facing a global threat that requires a global strategy to control it: it's one world!

• It also requires understanding and cooperation between human and animal health care: a One Health approach

• Europe is slowly but steadily taking it's responsibility to safeguard Fleming's heritage while producing animal products in healthy and animal friendly production systems

Thank you very much for your attention