Hanne Bak Pedersen, Programme Manager

Health Technologies and Pharmaceuticals (HTP)

WHO Regional Office for Europe

Stockholm, 13 February 2015

Antimicrobial Medicines

Consumption (AMC)

Challenges of AMC data collection on national and

regional level in Europe

Key priorities of regional implementation• African region

– Building integrated AMR surveillance

capacity

• Region of the Americas

– Regional integrated AMR surveillance

networks, national programmes on AMR

• Eastern Mediterranean region

– Increased attention, promotion of rational use and infection control

• South-East Asian region

– One health approach emphasized

• Western Pacific region

– AMR surveillance in the health sector

• European Region

– Implemetation of 2011 European strategic action plan on antibiotic

resistance

Registers and drug utilisation studies in

Europe

• ATC/DDD - “International language for drug utilization research” -serve as a tool for presenting drug utilization research in order to improve quality of drug use

• Experiences and use vary and WHO/Europe am supporting countries with establishing medicines registers that build on the ATC/DDD methodology to facilitate retrieval, compare data and use evidence for policy action

• AMC is in target but with time the registers can expand and be used to support appropriate use of medicines broadly

• Support from WHO Collaborating Centre for Drug Statistics Methodology at the Norwegian Institute of Public Health

WHO/Europe AMC project

Initial findings: 2011 data in collaboration

with Antwerp University

Expanding AM consumption surveillance

throughout EuropeUse methodology

compatible with

ESAC-Net

Enable data

comparison in the

European Region

Lancet Infectious Diseases 2014

Published Online, March 20, 2014

http://dx.doi.org/10.1016/S1473-3099(14)70071-4

WHO/Europe AMC project

Preliminary 2013 results in collaboration with

Arno Muller

Consumption J01 2013

Total care – DDD per 1000 inh. per day

0

5

10

15

20

25

30

35

40

45

Turkey Montenegro WHO Serbia Ukraine* Belarus Republic ofMoldova

Georgia Bosnia andHerzegovina

Azerbaijan

DD

D p

er

10

00

inh

abit

ants

pe

r d

ay

Tetracyclines (J01A) Amphenicols (J01B) Penicillins (J01C)

Other beta-lactam antibacterials (J01D) Sulfanomides and trimethoprim (J01E) Macrolides, lincosamides and streptogramins (J01F)

Aminoglycoside antibacterials (J01G) Quinolone antibacterials (J01M) Combinations of antibacterials (J01R)

Other antibacterials (J01X)

* 2012 data

0

5

10

15

20

25

30

35

40

45

2011 2013 2011 2013 2011 2013 2011 2013 2011 2013 2011 2013 2011 2013 2011 2013 2011 2013

Azerbaijan Bosnia andHerzegovina

Belarus Georgia Republic ofMoldova

Montenegro Serbia Turkey Ukraine*

DD

D p

er

10

00

inh

abit

ants

pe

r d

ay

Tetracyclines (J01A) Amphenicols (J01B) Penicillins (J01C)

Other beta-lactam antibacterials (J01D) Sulfanomides and trimethoprim (J01E) Macrolides, lincosamides and streptogramins (J01F)

Aminoglycoside antibacterials (J01G) Quinolone antibacterials (J01M) Combinations of antibacterials (J01R)

Other antibacterials (J01X) * 2012 data for 2013

Consumption J01 in Europe, 2013

Total care – DDD per 1000 inh. per day

0

5

10

15

20

25

30

35

40

45

Turk

ey

Gre

ece

Fran

ce

Mo

nte

neg

ro

WH

O

Bel

giu

m

Ital

y

Ro

man

ia

Cyp

rus*

*

Luxe

mb

ou

rg

Serb

ia

Slo

vaki

a*

Irel

and

Mal

ta

EUR

OP

E

Spai

n*

Po

rtu

gal*

*

Ukr

ain

e**

Bel

aru

s

Cro

atia EU

Rep

ub

lic o

f M

old

ova

Icel

and

Un

ite

d K

ingd

om

*

Bu

lgar

ia

Fin

lan

d

Cze

ch R

epu

blic

Lith

un

ia

Po

lan

d*

Geo

rgia

Den

mar

k

Bo

snia

an

d H

erz

ego

vin

a

No

rway

Au

stri

a*

Slo

ven

ia

Latv

ia

Ger

man

y*

Swed

en

Hu

nga

ry*

Esto

nia

Aze

rbai

jan

The

Net

he

rlan

ds

DD

D p

er

10

00

inh

abit

ants

pe

r d

ay

Tetracyclines (J01A) Amphenicols (J01B) Penicillins (J01C)

Other beta-lactam antibacterials (J01D) Sulfanomides and trimethoprim (J01E) Macrolides, lincosamides and streptogramins (J01F)

Aminoglycoside antibacterials (J01G) Quinolone antibacterials (J01M) Combinations of antibacterials (J01R)

Other antibacterials (J01X) * provided only community data

** 2012 data

Consumption of ATC J01 in Europe, 2013

Total care – DDD per 1000 inh. per day

Similarities/Differences between EU and

WHO methodologies• Both methodologies are very similar

• Management of combined products is slightly different.

– WHO follows strictly the ATC/DDD methodology

– ECDC does not follow strictly the ATC/DDD methodology

– However both methods should give the same figuresex: J01EE01

• WHO: 1 DDD = 4 unit doses (1 unit dose = sulfa: 0.4g, trim: 80mg)

• ESAC-Net: 1 DDD = 1.92g

• Main difference is the data sources and types used by both projects.

– WHO uses mostly wholesales (one country reported reimbursement data), no clear differentiation between hospital and community sectors

– ESAC-Net uses either sales or/and reimbursement data, for most of the countries, it is possible to differentiate between both sectors

Member State actions taken examples:

Armenia: Development of national drug register ; MoH activities to increase

awareness on resistance to antibiotics; Development of

Strategy for Containment of Antimicrobial Resistance

Azerbaijan: Development of national drug register

Georgia: Lobbying for new law to stop OTC dispense of antibiotics; Activities to

increase awareness on resistance to antibiotics; Development of national AMR

action plan

Former Yugoslav Republic of Macedonia: MoH activities to increase awareness

on resistance to antibiotics; enforcement of prescription only dispensing

Kyrgyzstan: Development and adoption of national drug policy

Kosovo (in accordance with UN Security Council resolution 1244 (1999)) :Activities to increase awareness on

resistance to antibiotics incl. mass media

Serbia: Development of national drug policy; enforcement of prescription only

dispensing

Turkey: National plan on rational drug use (2013-2017); MoH activities to increase

awareness on resistance to antibiotics incl. mass media; enforcement of

prescription only dispensing

Next steps

• Multi-country AMR consultation 24-27 February

including ATC/DDD workshop, consultation on AMC

data from 2012-13 as well as on qualitative follow up

study initially carried out in Albania and Turkey

• Finalise and publish 2011/12/13 AMC data and

continue with 2014 surveillance

• The qualitative research protocol is developed with

the Institute of social pharmacy, Copenhagen

University and we plan to support that studies are

undertaken in all the AMC project group countries

Next steps: Responsible use of antimicrobial

medicines

• Regulatory mechanisms for new antibiotics

• Effective low-cost tools for diagnosis and susceptibility

testing – support appropriate use of these in the country

specific context

• Access to medicines accompanied by measures to

protect continued efficacy incl. in line with Good

Distribution Practices, prescription restrictions etc

• Codes of practice; standards for presence of

antimicrobials and antimicrobial residues in the

environment, water supply and food

Key messages for shaping and implementing

the Global Action Plan

Support country action:

• Strengthen national intersectoral and interdisciplinary

coordination

• Promote prudent use policies and enforcement

• Building surveillance capacity

• Awareness-raising among all stakeholders

Thank you for your attention !The role of pharmacist in encouraging prudent use of antibiotic medicines

and averting antimicrobial resistance – a review of current policies and

experiences in Europe

http://www.euro.who.int/en/health-topics/Health-

systems/medicines/publications2/2014/the-role-of-pharmacist-in-

encouraging-prudent-use-of-antibiotic-medicines-and-averting-

antimicrobial-resistance-a-review-of-current-policies-and-experiences-in-

europe

Health Technologies and Pharmaceutical web site:

http://www.euro.who.int/en/health-topics/Health-systems/medicines

Programme manager hba@euro.who.int