Antimicrobial resistance day, week, year is almost over – where are we?

The European Commission's DG Sanco has come out with their five-year Action Plan to fight antimicrobial resistance based on 12 key actions – so where are we and where do we envisage we are going?

Action 1.
Strengthen the promotion of the appropriate use of antimicrobials in all Member States (MS). This is a hard one to nail down but groups such as the RUMA Alliance in the UK and now EPRUMA in the EU are calling for the same action. Vets and farmers need to listen and act. Bravo!

Action 2.
Strengthen the regulatory framework on veterinary medicines and on medicated feed. I am not sure quite what is meant by the first part but there has been some encouraging views on the second, in-feed use, recently released "Oral administration of VMPs via MF is a safe and efficient way and should be feasible in a harmonised way throughout the EU" – (Wolfgang Trunk, DG Sanco, EC). Although in-feed administration of antibiotics is frequently criticised, if properly regulated and controlled it is a high quality route of delivering medicines. Some countries have taken it to extremes but it is better than the hap-hazard administration of top-dressing that goes on in Denmark and Germany. Ideal route for metaphylactic use. Bravo!

Action 3.
Introduce recommendations for prudent use in veterinary medicine, including follow up reports. This is linked to Action 1. But there may be more monitoring and control of how vets use or prescribe medicines. More bureaucracy?

Action 4.
Strengthen infection prevention and control in healthcare settings. This is really down to the farmer to improve biosecurity to stop diseases coming in, eradicate diseases such as swine dysentery, enzootic pneumonia, mange to name but a few – but possible. Use high health herds. Bravo!

Action 5.
Introduce a legal tool to enhance prevention and control of infections in animals in the new Animal Health Law. This needs some clarification.

Action 6.
Promote, in a staged approach, unprecedented collaborative research and development efforts to bring new antimicrobials to patients. This is for human medicine but Bravo!

Action 7.
Promote efforts to analyse the need for new antibiotics into veterinary medicine. This will be interesting, to see how this is done. It may suggest that we may not need new antibiotics, especially as the old ones are still working quite well, as long as they do not withdraw current products from the market. Getting new antibiotic molecules is going to be difficult because the costs of registration are so high and the potential returns are not there in comparison with human medicines.

Action 8.
Develop and/or strengthen multilateral and bilateral commitments for the prevention and control of AMR in all sectors. If it means better research and understanding of the development and spread of antimicrobial resistance between animals and man then that is positive. Most human resistance issues are manmade. Bravo!

Action 9.
Strengthen surveillance systems on AMR and antimicrobial consumption in human medicine. This is for human medicine but Bravo!

Action 10.
Strengthen surveillance systems on AMR and antimicrobial consumption in animal medicine. Good news. I think it will confirm that the transmission from animals to man is comparatively small but it will also clarify some of the issues around MRSA and ESBLs and why they have increased in recent years. Bravo!

Action 11.
Reinforce and co-ordinate research efforts. About time – Bravo!

Action 12.
Survey and comparative effectiveness research. I guess they mean survey and compare efficacy research. Vets and farmers are doing this all the time, when they are treating their animals, so should be positive. Bravo!

Out of the 12 actions it has brought forth nine Bravos. There is a lot of work to do over the next five years and the devil is in the detail but hopefully a lot of it will be positive. What do you think?

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