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Raising awareness of resistance

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THE European Centre for Disease Prevention and Control has designated November 18, 2008 as the first European Antibiotic Awareness Day. The aim of the day is to educate the public about the need to keep antibiotics working and how everyone can and should be involved in the responsible use of antibiotics. It is anticipated that this will be an annual event, with a focus each year on a different theme.

The key messages of European Antibiotic Awareness Day relate to the concern that antibiotics are losing their effectiveness at a pace that was unforeseen even five years ago. The prospect of new classes of antibiotics being developed in the near future is remote, so it is important to ensure that the efficacy of the antibiotics currently available is maintained by using products responsibly.

To support the day, the Department of Health is currently rerunning a campaign to encourage more prudent use of antibiotics, while its Advisory Committee for Antibiotic Resistance and Healthcare Associated Infection will be holding a one-day conference in London. Details are available at www.dh.gov.uk/en/Publichealth/Patientsafety/Antibioticresistance/DH_089439.

Although the main focus of the day will be on the use of antibiotics in humans, it is also relevant to the veterinary profession because of the use of antibiotics in animals. There is a need to keep antibiotics available and working in animals as well as people, otherwise there would be a heavy price to pay in terms of animal health and welfare, as well as economic implications. In addition, there is a need to consider the impact of veterinary use of antibiotics on the use of these drugs in humans. The use of antibiotics in animals may not be the main driver for the development of resistance to antibiotics used in human medicine, but it has been shown that it can contribute, so it is important for the veterinary profession not only to use antibiotics responsibly, but to get the message across to the public and other professions that it is doing so.

Species-specific guidelines for veterinarians on the prudent use of antimicrobials in cattle, pigs, poultry and sheep were produced a few years ago by the bva, and the Association plans to review these in 2009. Similar guidelines for producers have been developed by the Responsible Use of Medicines in Agriculture (ruma) Alliance, and include guidelines on the responsible use of antimicrobials in fish. These are available at www.ruma.org.uk.

For a number of years now, the Veterinary Medicines Directorate has produced an annual report providing information on sales of veterinary antimicrobial products in the uk. The data for 2007 (see VR, August 30, 2008, vol 163, pp 256-257) show that there has been an overall decrease in the sales of veterinary antimicrobials, which is largely accounted for by a decrease in the sales of tetracyclines and macrolides. However, there is no room for complacency here, as the report also describes an increase in the use of products which may be of importance in human therapy, such as fluoroquinolones and cephalosporins.

mrsa in humans continues to make the headlines, and mrsa in animals is also of concern, but evidence in the uk suggests that many cases in animals are likely to have a human source. However, in the Netherlands, where the prevalence of mrsa in human healthcare is very low, a strain of mrsa has been identified that is present on a high percentage of the pig farms sampled and also in many pig farmers and vets. Thus, although food is very unlikely to be a source of mrsa for the general public, contact with animals, in particular certain species such as pigs, may be a risk for human infection. To date, this specific strain has not been found in pig farms in the uk; however, studies have identified that veterinary workers appear to have a higher prevalence of nasal carriage of other mrsa strains compared with the general population.

An increasing resistance problem in human medicine involves extended spectrum β-lactamases (esbls). esbls have been found in bacteria from cattle and other animal species in the uk and elsewhere. Identification of the particular gene conferring this resistance allows comparison of isolates of human and animal origin. For the most part in the uk the genes appear to be different between animal and human sources; however, in other countries the picture is different, with isolates from animals containing the human resistance genes most commonly present in that geographical area.

There is a need to maintain a watching brief on antibiotic resistance in animals, not only for public health reasons, but also to ensure that effective antibiotics will continue to be available for veterinary use in the future. The revised strategy for developing and implementing a programme for antimicrobial resistance published by defra recently is relevant in this context (see VR, August 23, 2008, vol 163, p 227). Nobody wants to end up in a situation where bacterial infections in humans and animals can no longer be treated because of resistance to all the products that are currently available, or where the use of available products is restricted to humans.

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