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(2011; 23 pages)
Antibiotic resistance policies: evidence for effective policy measures and interventions
Antibiotic policies should aim at prudent use of antibiotics and at the prevention of spread or transmission of resistant bacteria. Therefore antibiotic policies need a mix of several preventive interventions which should be implemented on different levels. National campaigns may help to create awareness of the problem of antibiotic resistance and the need for prudent use among European citizens. The repetition of these awareness campaigns increases effectiveness. Furthermore, educational interventions and restrictive prescribing policies may reduce resistance through a decrease of antibiotic use. Computer-based programs improve prescribing practices among healthcare professionals. In addition, hygienic measures are effective in combating transmission of antibiotic resistance. Therefore the Dutch "search and destroy" policy can be seen as an effective approach within hospitals. However, little is known about the effectiveness of infection control strategies in nursing homes. Finally, surveillance of antibiotic use and resistance can help shape effective antibiotic policies. Antibiotic resistance policies in international perspective: EU policies and strategies
In 2001 the European Commission adopted the European Community Strategy against antimicrobial resistance. The Council Recommendation 2002/77/EC on the prudent use of antimicrobial agents in human medicine states that multidisciplinary coordination on the Community-level is needed to lower the burden of antibiotic resistance. This Council Recommendation asks Member States to take action on a national level through:
- The development of national surveillance systems on antibiotic use and resistance;
- The implementation of prevention methods and infection control (support of prudent use and elimination of the transmission of infectious diseases);
- The improvement of education and training of health professionals (such as on the appropriate use of antimicrobials and hygiene standards);
- Informative approaches to raise awareness of prudent use of antibiotics among the general public.
In addition several projects on antibiotic resistance are funded through the EU Public Health Action Programmes or the Seventh Framework Programme. The main European Institution in the field of antibiotic resistance is the European Centre for Disease Prevention and Control (ECDC), which coordinates and funds a European network of national surveillance systems. Another important European institution is the European Food Safety Authority (EFSA), which provides scientific advice on the risks of spread and transfer to humans of antimicrobial resistant micro-organisms via food products.
Antibiotic resistance policies in international perspective: impact of WHO At European level, the WHO is developing a regional strategy, recognizing the need for an interdisciplinary approach to combat antibiotic resistance. This policy is expected to be finished in September 2011 and will contain seven strategic objectives to promote this integrated approach:
- Promote national intersectoral coordination;
- Strengthen surveillance of antimicrobial resistance;
- Strengthen surveillance and promote stewardship of antimicrobial drug use;
- Strengthen surveillance of resistance to and use of antimicrobial agents in the animal food industry;
- Improve infection control and stewardship of antimicrobial resistance in health care settings;
- Promote research and innovation on new drugs and technology; and
- ensure patient safety and improve awareness of antimicrobial use and resistance.
National antibiotic resistance policies and strategies
In spite of large differences in the incidence rates of antibiotic resistance, most European countries base their policies to combat antibiotic resistance on the same European approach, which is described in Recommendation 2002/77/EC on the prudent use of antimicrobial agents in human medicine. Therefore, their national policies contain similar elements although there are some striking differences as well. The Commission summarized the main actions taken at Member States and European Union level in the first (2005) and the second report (2009) from the Commission to the Council on the implementation of the Recommendation. The general conclusion from both reports is that even though progress has been made since the implementation of Recommendation 2002/77/EC, still work has to be done in order to combat antimicrobial resistance. Overall, the participation in European projects and partnerships is well established, but the field of raising awareness via campaigns targeting health professionals and the general public needs to be further developed. Also more focus is needed on collaboration between the human and animal health sectors, especially in the countries where no collaboration between the two sectors has been initiated yet. More information on the main conclusions of these reports can be found in chapter 5.