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Trends in Antimicrobial Consumption and Resistance in Europe and the First Annual Antibiotic Day

Trends in Antimicrobial Consumption and Resistance in Europe and the First Annual Antibiotic Day. Herman Goossens University of Antwerp, Belgium Vice-Chair Belgian Antibiotic Policy Coordination Committee (BAPCOC) Co-ordinator of ESAC Chair Technical Advisory Group ECDC EU Antibiotic Day.

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Trends in Antimicrobial Consumption and Resistance in Europe and the First Annual Antibiotic Day

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  1. Trends in Antimicrobial Consumption and Resistance in Europe and the First Annual Antibiotic Day Herman Goossens University of Antwerp, Belgium Vice-Chair Belgian Antibiotic Policy Coordination Committee (BAPCOC) Co-ordinator of ESAC Chair Technical Advisory Group ECDC EU Antibiotic Day

  2. We made great progress in Europe since ... October 18, 2001.

  3. Outline of Presentation • Antibiotic resistance in Europe (EARSS) • Antibiotic consumption in Europe (ESAC) • Link between use and resistance • At population level • At individual level • Strategies to curb resistance in Belgium • EU Antibiotic Day • Conclusions

  4. “If you cannot measure it, you cannot improve it” Lord Kelvin, 1824-1907

  5. EARSS Participating countries: 31 27 EU Member States 1 Applicant countries Turkey 3 Other countries Iceland, Israel, Norway

  6. Methicillin-Resistant Staph. aureus in Europe, 2006

  7. Fluoroquinlone-Resistant E.coli in Europe, 2001-2006

  8. Outline of Presentation • Antibiotic resistance in Europe (EARSS) • Antibiotic consumption in Europe (ESAC) • Link between use and resistance • At population level • At individual level • Strategies to curb resistance in Belgium • EU Antibiotic Day • Conclusions

  9. ESAC Participating countries: 34 27 EU Member States 2 Applicant countries Croatia, Turkey 5 Other countries Former Republic of Macedonia, Iceland, Israel, Norway, Russia, Switzerland

  10. Total Outpatient Antibiotic Use in 25 European Countries in 2006(on-going validation for some countries) * Greece, Cyprus, Lithuania, Bulgaria: total care, i.e. hospital and primary care combined. ** Spain: reimbursement data, which do not include over-the-counter sales without a prescription.

  11. Regional Variation of Outpatient Antibiotic Use in Italy

  12. Regional Variation of Outpatient Antibiotic Use in Germany

  13. ESAC Longitudinal Survey in 18 Hospitals in Europe: Total, Parenteral and Oral Use of Antibacterials in 2005

  14. ESAC Point Prevalence Survey in 20 Hospitals in Europe: Length of Pre-operative Prophylaxis in Surgery

  15. Outline of Presentation • Antibiotic resistance in Europe (EARSS) • Antibiotic consumption in Europe (ESAC) • Link between use and resistance • At population level • At individual level • Strategies to curb resistance in Belgium • EU Antibiotic Day • Conclusions

  16. Correlation Between Macrolide Use and Macrolide-Resistant Strept. pneumoniae Goossens et al, Lancet 2005

  17. Effect of Macrolide versus Placebo Use on Temporal Changes of Proportion of Macrolide-Resistant Oral Streptococci • Mean preantibiotic carriage of Mac-R streptococci was 28% • Use of both Clar and Azi resulted in a huge increase in resistant streptococci which persisted for at least 6 months (P 0.01) • Macrolide use is the single most important driver for the emergence of macrolide resistance Malhotra et al, Lancet 2007

  18. Outline of Presentation • Antibiotic resistance in Europe (EARSS) • Antibiotic consumption in Europe (ESAC) • Link between use and resistance • At population level • At individual level • Strategies to curb resistance in Belgium • EU Antibiotic Day • Conclusions

  19. Belgium: a Federal Country...

  20. Strategies to Curb Resistance in Belgium • Seven multimedia campaigns to promote the prudent use of antibiotics in outpatients • Two national campaigns to promote hand hygiene in hospitals • Antibiotic management teams in ALL Belgian hospitals • Several practice guidelines • Antibiotic guide for ambulatory care • Improve infection control practices (better financing and clear organisation) • Finance surveillance programmes on antibiotic use and resistance in humans and animals

  21. Actors: Ad hoc Working Group and “Question Santé/Omtrent Gezondheid” Approach: Inform the public in general on the use and misuse of antibiotics and on the risk of bacterial resistance Slogan: ”Use antibiotics less frequently but better” Actors: Ad hoc Working Group and Social Marketing agency (Duval Guillaume, Antwerp) Approach: Tackle directly the hot spots of unjustified antibiotic treatment: viral respiratory tract infections Slogan: “Antibiotics don’t work against acute bronchitis, flu and common colds” Belgium Media Campaigns: Switch from Threat to Negative Message Latter campaigns (2004 - 2008) First 3 campaigns (2000–2003)

  22. Belgiumwww.antibiotics-info.be > 2004 1999 - 2003

  23. Outpatient Antibiotic Use in BelgiumPackages per 1,000 inhabitants per day 1997 – 2006, July to June Verpakkingen per 1,000 inwoners per dag

  24. Antibiotic Resistance of S. pneumoniae in Belgium. 1985 - 2007 National Reference Centre S. pneumoniae (University of Leuven)

  25. Antibiotic Resistance of Throat Isolates of S. pyogenes in Belgium. 2002 – 2007 National Reference Centre S. pyogenes (University of Antwerp)

  26. Outpatient Antibiotic Use in EUR, 1997-2006 53 52 52 50 46 45 44 178 170 174 169 39 42 153 38 146 EUR, miljoenen 139 122 123 108

  27. Outline of Presentation • Antibiotic resistance in Europe (EARSS) • Antibiotic consumption in Europe (ESAC) • Link between use and resistance • At population level • At individual level • Strategies to curb resistance in Belgium • EU Antibiotic Day • Conclusions

  28. Why do we need another awareness day? • Awareness days have shown to mobilise people, politicians, resources, ... (Drinking and Driving; AIDS Day) • Consolidate “healthy” situation of low antibiotic use and resistance (e.g. North) or reverse situation of emerging resistance (e.g. South) • Success of national campaigns in Belgium and France: reduction of antibiotic use and resistance in primary care and hospitals • Empty pipeline of new antibiotics; new rapid diagnostic tests not yet available • The EC supports many public health and research programmes which allow to measure the impact of campaigns and provide materials: • ECDC: EARSS (antibiotic resistance), ESAC (antibiotic use), … • DG SANCO: e-BUG (educational packs for children), … • DG RESEARCH: GRACE (qualitative research), CHAMP (database on campaigns, questionnaires, economic impact), … EUROPE IS READY TO KICK OFF AN EU ANTIBIOTIC DAY

  29. How did we get here? • September 07: AMR focal group unanimously agreed on need for EU Antibiotic Day • October 07: Member States and MEPs support the idea of an EU Antibiotic Day • October 07: ECDC’s Director launches first EU Antibiotic Day for…18 November 2008 • January 08: Installation of Technical Advisory Group at ECDC • March 08: Selection of logo, slogans, etc

  30. What will be done? • By ECDC: • Development of slogan, logo & key messages • Launch of public website • Delivery of media toolkit • Press conference in European Parliament on 18 November • By Member States: • Press conference with Health experts & AMR experts • National conference on AMR involving doctors, pharmacists, vets & dentists • Editorials in national medical journals • Letter from Health Minister to all doctors • Leaflets & posters for general public • Development of in-school activities for children & parents • TV spots

  31. Suggested logo/slogan

  32. Outline of Presentation • Antibiotic resistance in Europe (EARSS) • Antibiotic consumption in Europe (ESAC) • Link between use and resistance • At population level • At individual level • Strategies to curb resistance in Belgium • EU Antibiotic Day • Conclusions

  33. Conclusions: what can be done?First EU Antibiotic Day on November 18, 2008 • Reduce unnecessary antibiotic use (e.g. in patients with common colds and flu) • Raise awareness that overuse of antibiotics will increase antibiotic resistance, through increasing awareness of the public (e.g. public campaigns), professsionals (e.g. undergraduate and postgradute education), and children (e.g. educational packs in schools). • Ensure that public campaigns employ techniques of social marketing and use appropriate quality indicators and outcome measures, such as antibiotic use and resistance • Monitor adverse effects associated with a reduction in antibiotic prescribing • Support the use of rapid point-of-care diagnostic tests which result in reduced antibiotic prescribing • Provide incentives for benchmarking of antibiotic prescribing in hospitals and nursing homes through quality indicators, such as Longitudinal and Point Prevalence Surveys

  34. The European Union is making the Difference! “The European Dream emphasizes community relationships over individual autonomy, cultural diversity over assimilation, quality of life over the accumulation of wealth, sustainable development over unilateral material growth, deep play over unrelenting toil, universal human rights and the rights of nature over property rights, over global cooperation over the unilateral exercise of power” From: The European Dream, by Jeremy Rifkin

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