Developing and Implementing Policies To Promote Access and Limit

Antibiotic Resistance

Prof Otto Cars, Uppsala University, Sweden , ReAct Dr Nithima Sumpradit, Food and Drug Administration, Thailand Prof Arturo Quizphe-Peralta, University of Quenca, Ecuador Dr Chand Wattal, Sir Ganga Ram Hospital, New Dehli, India

An international network to improve the management of antibiotic

resistance

”Our vision is that current and future

generations will have access to effective

prevention and treatment of bacteral

infections as part of their right to health.” www.reactgroup.org

Efffective antibiotics are a prerequisite for fundamental health care…

Hip replacement

Organ transplants

Cancer chemotherapy

Intensive care

Care of preterm babies

Modern medicine is not possible without effective antibiotics

The Current Paradox:

Antibiotic Resistance

Drug Development

Morbidity Mortality

Costs

Pneumonia Typhoid

fever

Gonnorrhea

Septichemia

Surgical infections

Antibiotic

Resistance

2001

2005

URGES Member States: (1) to ensure the development of a coherent, comprehensive and integrated national approach to implementing the strategy for containment of antimicrobial resistance taking account, where appropriate, of financial and other incentives that might have a harmful impact on policies for prescribing and dispensing;

Antibiotic Resistance

Scientific Technical

Social Political

The interface between science, politics and people

Implementation of National Intersectoral Coordination

Mechanisms on AMR

Adapted from: European Commission, Directorate - General Health and Consumers, 2010. http://ec.europa.eu/health/antimicrobial_resistance/key_documents/index_en.htm

0

1

2

3

4

5

6

No.

cou

ntrie

s im

plem

entin

g th

eir

inte

rsec

tora

l coo

rdin

atio

n m

echa

nism

As of 2008, 18 EU Member States had implemented an Intersectoral Coordination Mechanism

Data  from  the  European  An0microbial  Surveillance  System,  EARSS  0 10 20 30 40 50 60

Norway  (NO)The  Netherlands  (NL)

Sweden  (SE)Iceland  (IS)

Denmark  (DK)Finland  (FI)Estonia  (EE)Slovenia  (SI)Austria  (AT)

Luxembourg  (LU)Switzerland  (CH)

Lithuania  (LT)Latvia  (LV)Poland  (PL)

Czech  Republic  (CZ)Germany  (DE)Belgium  (BE)

Bosnia  Herzegovina  (BA)Hungary  (HU)France  (FR)

Bulgaria  (BG)Spain  (ES)

United  Kingdom  (UK)Ireland  (IE)

Romania  (RO)Italy  (IT)Israel  (IL)

Croatia  (HR)Turkey  (TR)Greece  (GR)Cyprus  (CY)

Portugal  (PT)Malta  (MT)

Percent  MRSA  of  all  isolates  of  S.  aureus  from  blood  in  the  EU  2008  

Total Outpatient Antibiotic Use in 27 European Countries and the US in 2004

Goossens H, et al. Clin Infect Dis. 2007;44:1091-1095.

DD

D p

er 1

000

inha

bita

nts

and

per d

ay

GR USA LU HR SK IE PL HU SI CZ UK DK AT EE RU FR IT PT BE IS IL ES FI BG NO SE DE LV NL CH

0

5

10

15

20

25

30

Other (J01 classes) Sulfonamides and trimethoprim (J01E) Quinolones (J01M) Macrolides, lincosamides, and streptogramins (J01F) Tetracyclines (J01A) Cephalosporins and other beta-lactams (J01D) Penicillins (J01C)

35

For more information: Earnshaw S, et al. Euro Surveill 2009;14(30) & http://antibiotic.ecdc.europa.eu

2008

•  Materials for general public •  32 countries participated

2009

•  Materials for primary care prescribers •  Website translated in all EU

languages •  TV spots developed

0

10

20

30

40

50

60

1990

2005

% R

esis

tan

t

0

20

40

60

1990

2005

% R

esi

sta

nt

S. pneumoniae, penicillin-non susceptible

S. pneumoniae, erythomycin-resistant

S. pyogenes, erythromycin-resistant

France Belgium

Source: French Nat. Ref. Ctr. for S. pneumoniae (Courtesy: E. Varon, L. Gutmann & B. Schlemmer) & Belgian Nat. Ref. Ctrs. for S. pneumoniae and for S. pyogenes (Courtesy: BAPCOC, H. Goossens)

Decreases in antimicrobial resistance following national media campaigns

Adapted from Källander, 2005

Access Excess

The balance between access and excess