antibiotic consumption and resistance in ......2018/10/29 · antibiotic consumption and resistance...

ANTIBIOTIC CONSUMPTION AND RESISTANCE

IN VETERINARY MEDICINE IN BELGIUM

Fabiana Dal Pozzo, DVM, PhD

[email protected]

AntiMicrobial Consumption and Resistance in Animals - AMCRA

Spanish Agency of Medicines and Medical Devices, Madrid, Spain

29 October 2018

mailto:[email protected]

Center of expertise

Antimicrobial Consumption and Resistance in Animals

TIMELINE

1999: BAPCOC and the working group in veterinary medicine

2007 and 2009: First Flemish and Walloon reports about AMR in veterinary pathogens

2010: First BelVet-SAC report on veterinary AMU in Belgium

2011: Start of national surveillance programs on AMR in major livestock species using indicator bacteria

2012: Creation of AMCRA

Center of expertise


AMU – SALES DATA BELGIUM

Center of expertise


Mission

• Tackle antibiotic resistance • Preserve human and animal

health and welfare • Promote rational reduction of

antibiotic use and sustainable antibiotic policy in veterinary medicine

AntiMicrobial Consumption and Resistance in Animals

Activities

• Analyse • Communicate • Awareness raising

Recommendations

Center of expertise


Staff: advices and communications

STEERING COMMITTEE

Advisory board

Technical committees

Staff: scientific analyses

BOARD OF DIRECTORS

Center of expertise


TIMELINE

2012-2014: first AMCRA recommandations

Center of expertise


AMCRA VADE MECUM

• Guidelines for veterinarians in antibiotic therapy

• For the most important food-producing and companion animal species – organized per indication

• Paper format in 2013

• Second edition, electronic format in 2016

Center of expertise


AMCRA VADE MECUM

Prophylactic 2 months

stock at the farm level

Pathogen identification

Antibiotic sensitivity test

No Yes By preference By preference

No Yes Condition By preference

No No Condition Condition

1st – 2nd – 3rd option Based on susceptibility/resistance, pharmacokinetic, pharmacodynamic

• Per species and indication: most frequent bacterial agents, general information on the disease, preventive measures, prophylaxis

• Antibiotic therapy:

Color codes used to classify the molecules in function of the importance/priority in human and veterinary medicine (WHO and OIE classifications)

9 9

9

Center of expertise


TIMELINE

2012-2014: AMCRA guidelines for prudent use,

numerous published advices ……

2014: AMCRA Vision 2020

Center of expertise


AMCRA 2020: ACTION PLAN

1. 50% total antibiotic use by 2020

2. 75% critical antibiotics by 2020

3. 50% with antibiotics feed medicated by 2017

4. A global data collection system by 2016

5. A plan for each farm

6. Benchmarking of farmers and veterinarians

7. No antibiotics for prophylaxis, promotion of alternatives

8. Awareness-raising, repeatedly

9. Transparency and monitoring of suppliers and users

10. Surveillance of antibiotic resistance

Reduction targets

Operational targets

11

Center of expertise


TIMELINE

2012-2014: AMCRA guidelines for prudent use,

numerous published advices ……

2014: AMCRA Vision 2020

2014:

Center of expertise


AMCRA DATA ANALYSIS

Center of expertise


Monthly use

Benchmarking

Evolution

Center of expertise


www.e-vademecum.be

http://www.e-formularium.be/



Center of expertise


Use of colistin

Use of zinc oxide

Center of expertise


EVOLUTION AMU AT FARM LEVEL PIGS

2014 2015 2016 2017 2017-2014

BDAB-R_KG-varken 31,1 30,4 27,5 24,7 - 20,6%

P50: -65,6% P50: -27,9%

P50: -18,9% P50: -36,8%

Fattening pigs Sows/bears

Weaning pigs Suckling piglets

www.amcra.be

Center of expertise


www.aacting.org

Center of expertise


AMU AT FARM LEVEL IN BELGIUM

• 1 apr 2017 – 31 march 2018

PIG: 75,1% – 81,5% mean: 79,0%

VEAL: 9,0% – 14,5% mean: 11,3%

POULTRY: 8,6% – 11,1% mean: 9,7%

www.amcra.be

Center of expertise


Totaal: 62,731 39,473 37,567 26,449 11,170 7,211 3,289 1,991 1,438 1,431 0,828 0,382 0,249 0,099 0,006 0,001

AMU AT FARM LEVEL IN BELGIUM

BROIR VECLF PIGB PIGLW PIGF PIGLU

Cefalosporines 3G/4G 0,003 0,115 0,143 0,048 0,098

Fluoroquinolones 17,635 2,908 1,050 0,869 0,218 0,034

0

5

10

15

20

Miljoen dagdosissen rode producten per diercategorie

Market authorization for Coryza Colibacillosis Mycoplasmosis Pasteurellosis

Million of daily doses of critical molecules per animal type

Center of expertise


2016: ANTIBIOTIC COVENANT

•Action Plan defined by AMCRA, authorities and

stakeholders in a Covenant “Covenant between the Federal Government and all relevant sector partners regarding the reduction in the use of antibiotics in the animal sector”

www.amcra.be

Center of expertise


ROYAL DECREE OF JULY 21 2016: CONDITIONS OF USE OF CRITICAL MOLECULES IN FOOD-PRODUCING ANIMALS

ROYAL DECREE OF JANUARY 31 2017: COMPULSORY REGISTRATION OF ANTIMICROBIALS AT FARM LEVEL

14/11/2018 23 Center of expertise


EXAMPLES OF ACTIONS UNDERTAKEN WITHIN THE ANTIBIOTIC COVENANT

• Pharmaceutical industry Training and seminaries for

employees Awareness raising

communications for farmers and veterinarians

• Private quality schemes Compulsory registration of AMU

at farm level Implementation of the herd

health plan Follow-up of farmers in function

of the AMU

• Animal health associations Laboratory diagnosis and report

of AMR in animal pathogens

• Medicated feed industry Electronic prescription only Medicated feed only from one

veterinarian Benchmarking of members

• Agricultural organizations Participation to private data

collection systems Trainings Awareness raising

communications

• Veterinarians organizations Trainings Awareness raising

communications

Center of expertise


AMCRA: AWARENESS RAISING

24 24 24 24

Center of expertise


AMCRA YOUTUBE CHANNEL TV-SPOTS

Center of expertise


WWW.AMCRA.BE

• Informative about AMR for a broad public

•Gathering information about AMU and AMR

•Awareness raising with specific tools for different animal sectors

• Link to the e-vademecum

•Methodology about quantification of AMU at farm level

• Links to national and international organisations and reports

Center of expertise


EVOLUTION OF PREMIX CONSUMPTION IN REFERENCE TO 2011

0,0

5,0

10,0

15,0

20,0

25,0

30,0

2011 2012 2013 2014 2015 2016 2017

realisation goal

2011 -> 2017: -66,6%

mg

acti

ve s

ub

stan

ce/k

g b

iom

ass

www.amcra.be

Center of expertise


EVOLUTION TOTAL CONSUMPTION OF CRITICAL IMPORTANT ANTIBIOTICS

IN REFERENCE TO 2011

0,0000

0,0005

0,0010

0,0015

0,0020

0,0025

0,0030

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

realisation goal

2011 -> 2017: -84,4%

Fluoroquinolones, cephalosporins of 3rd and 4th generation

mg

acti

ve s

ub

stan

ce/k

g b

iom

ass

www.amcra.be

Center of expertise


EVOLUTION TOTAL CONSUMPTION IN REFERENCE TO 2011

0,0

20,0

40,0

60,0

80,0

100,0

120,0

140,0

160,0

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

realisation goal

2011 -> 2017: -25,9%

mg

acti

ve s

ub

stan

ce/k

g b

iom

ass

www.amcra.be

Center of expertise


EVOLUTION AMR IN INDICATOR ESCHERICHIA COLI IN FOOD-PRODUCING ANIMALS

Pre

vale

nce

of

resi

stan

ce (

%)

Pre

vale

nce

of

resi

stan

ce (

%)

Resistance to fluoroquinolones (%)

Veal calves Beef cattle Broilers Fattening pigs

Veal calves Beef cattle Broilers Fattening pigs

Resistance to cephalosporins of 3rd generation (%)

www.amcra.be

Center of expertise


EVOLUTION MDR IN INDICATOR ESCHERICHIA COLI IN FOOD-PRODUCING ANIMALS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 2012 2013 2014 2015 2016 2017

Broilers

0 1 2 3 ≥ 3

0%

20%

40%

60%

80%

100%

2011 2012 2013 2014 2015 2016 2017

Beef cattle

0 1 2 3 ≥ 3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 2012 2013 2014 2015 2016 2017

Veal calves

0 1 2 3 ≥ 3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 2012 2013 2014 2015 2016 2017

Fattening pigs

0 1 2 3 ≥ 3

Center of expertise


•Current BAPCOC & AMCRA action plans end in 2019

and 2020

•Opportunity to implement a national One Health AMR

Action Plan with interactions between human health,

animal health and the environment

PERSPECTIVES ONE HEALTH APPROACH

Center of expertise


www.amcra.be [email protected]

http://www.amcra.be/

antibiotic consumption and resistance in ......2018/10/29 · antibiotic consumption and resistance...

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