Dr otto cars 1

Developing and Implementing Policies To Promote Access and Limit Antibiotic Resistance Prof Otto Cars, Uppsala University, Sweden , ReAct Dr Nithima Sumpradit, Food and Drug Administration, Thailand Prof Arturo Quizphe-Peralta, University of Quenca, Ecuador Dr Chand Wattal, Sir Ganga Ram Hospital, New Dehli, India

An international network to improve the management of antibiotic resistance �Our vision is that current and future generations will have access to effective prevention and treatment of bacteral infections as part of their right to health.� www.reactgroup.org

Efffective antibiotics are a prerequisite for fundamental health care‌

Modern medicine is not possible without effective antibiotics Hip replacement Organ transplants Cancer chemotherapy Intensive care Care of preterm babies

The Current Paradox:

Antibiotic Resistance

Drug Development Morbidity Mortality Costs

Septichemia

Surgical infections

Antibiotic Resistance

Pneumonia

Gonnorrhea

Typhoid fever

2001

2005

URGES Member States: (1) to ensure the development of a coherent, comprehensive and integrated national approach to implementing the strategy for containment of antimicrobial resistance taking account, where appropriate, of financial and other incentives that might have a harmful impact on policies for prescribing and dispensing;

Antibiotic Resistance The interface between science, politics and people

Scientific Technical

Social Political

No. countries implementing their intersectoral coordination mechanism

6 5 4 3

Implementation of National Intersectoral Coordination Mechanisms on AMR As of 2008, 18 EU Member States had implemented an Intersectoral Coordination Mechanism

2 1 0

Adapted from: European Commission, Directorate - General Health and Consumers, 2010. http://ec.europa.eu/health/antimicrobial_resistance/key_documents/index_en.htm

Malta (MT) Portugal (PT) Cyprus (CY) Greece (GR) Turkey (TR) Croatia (HR) Israel (IL) Italy (IT) Romania (RO) Ireland (IE) United Kingdom (UK) Spain (ES) Bulgaria (BG) France (FR) Hungary (HU) Bosnia Herzegovina (BA) Belgium (BE) Germany (DE) Czech Republic (CZ) Poland (PL) Latvia (LV) Lithuania (LT) Switzerland (CH) Luxembourg (LU) Austria (AT) Slovenia (SI) Estonia (EE) Finland (FI) Denmark (DK) Iceland (IS) Sweden (SE) The Netherlands (NL) Norway (NO)

Percent MRSA of all isolates of S. aureus from blood in the EU 2008

0

10

20

30

40

Data from the European An0microbial Surveillance System, EARSS

50

60

Total Outpatient Antibiotic Use in 27 European Countries and the US in 2004

DDD per 1000 inhabitants and per day

35 30 25

Other (J01 classes) Sulfonamides and trimethoprim (J01E) Quinolones (J01M) Macrolides, lincosamides, and streptogramins (J01F) Tetracyclines (J01A) Cephalosporins and other beta-lactams (J01D) Penicillins (J01C)

20 15 10 5 0

GR USA LU HR SK IE PL HU SI CZ UK DK AT EE RU FR IT PT BE IS IL ES FI BG NO SE DE LV NL CH

Goossens H, et al. Clin Infect Dis. 2007;44:1091-1095.

2008 • Materials for general public • 32 countries participated

2009 • Materials for primary care prescribers • Website translated in all EU languages • TV spots developed

For more information: Earnshaw S, et al. Euro Surveill 2009;14(30) & http://antibiotic.ecdc.europa.eu

Decreases in antimicrobial resistance following national media campaigns 60

France

Belgium

40

% Resistant

% Resistant

50

60

30 20

40

20

10 0

05 20

90 19

20 05

19 90

0

S. pneumoniae, penicillin-non susceptible S. pneumoniae, erythomycin-resistant S. pyogenes, erythromycin-resistant

Source: French Nat. Ref. Ctr. for S. pneumoniae (Courtesy: E. Varon, L. Gutmann & B. Schlemmer) & Belgian Nat. Ref. Ctrs. for S. pneumoniae and for S. pyogenes (Courtesy: BAPCOC, H. Goossens)

The balance between access and excess

Access

Adapted from K채llander, 2005

Excess