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IT IS 10 years now since, in an influential report, the House of Lords Science and Technology Committee highlighted concerns about antimicrobial resistance, emphasising the importance of antimicrobials in treating disease in people and animals and the need for such products to be used prudently to preserve their efficacy. The House of Lords committee's report was one of many produced around that time; others included a report from the Advisory Committee on the Microbiological Safety of Food, discussing veterinary antimicrobial use in relation to food safety and the development of resistance to products used in human medicine, and reports from the World Health Organization which, although largely concerned with the use of antimicrobials in humans, made specific recommendations aimed at reducing the risk to human health of antimicrobial use in food animals.
In Europe, the European Commission responded to such concerns by, among other things, introducing an eu-wide ban on the use of antibiotics as growth promoters in animal feed. The ban was phased in gradually and took full effect from January 1, 2006. In the uk, concern to slow the spread of resistance resulted in a number of initiatives, including publication by the bva of species-specific guidelines for veterinarians on the prudent use of antimicrobials in cattle, pigs, poultry and sheep, and of similar guidelines for producers by the Responsible Use of Medicines in Agriculture Alliance (ruma), a group involving organisations representing all stages of the food chain from ‘farm to fork’, on which the bva is represented. The bva's guidelines are available from its website, www.bva.co.uk; the ruma guidance, which also includes guidelines on the responsible use of antimicrobials in fish, is available at www.ruma.org.uk.
At government level, initiatives included the publication by the Department of Health in 2000 of a ‘uk antimicrobial strategy and action plan’. This identified surveillance, infection control and the prudent use of antimicrobials in humans and animals as ‘key elements’ in attempts to control antimicrobial resistance, and emphasised the need for a coordinated approach. defra, for its part, produced a strategy for developing and implementing a programme of surveillance for antimicrobial resistance in animals; this was published in 2004 and outlined plans for strengthening surveillance and monitoring future trends (see VR, May 22, 2004, vol 154, pp 642-643). The Government has just published a revised version of this strategy, along with a document summarising progress so far.1
The revised strategy is in most respects similar to the document published in 2004. The basic objectives are essentially the same, although a welcome change to one of the aims means that the surveillance programme now aims ‘to reduce the risk of adverse impacts occurring to animal health and/or public health as the result of transfer of antimicrobial resistance genes or resistant organisms between bacterial populations in animals and man’, rather than just ‘to reduce the risk of transfer of antimicrobial resistance genes from animals to man’ as previously. The strategy has been modified to take account of European initiatives regarding surveillance for antimicrobial resistance. It also makes a slightly firmer reference to surveillance in animals which are not used in food production. The main focus will still be on food-producing animals. However, whereas the original strategy indicated that samples from non-food-producing animals would only be included when the opportunity arose, the revised version states that work will be directed in this area where there are clear public health issues to address, giving mrsa in companion animals and horses as an example.
The progress report lists projects undertaken and initiatives developed since the launch of the strategy, matching these against the original objectives. Although a range of projects is described, it is clear that implementation of the strategy, inevitably a long-term process, is still a work in progress.
It is in the nature of surveillance that, unless something is startlingly obvious, you're only going to find it by actually looking for it. At the same time, it is never going to be possible to monitor everything and activities have to be prioritised. This is as true for surveillance for antimicrobial resistance as it is for disease surveillance, and is a point acknowledged in defra's antimicrobial resistance surveillance strategy, as well as in its veterinary surveillance strategy, to which the antimicrobial strategy is linked. The antimicrobial strategy makes clear how activities are being prioritised which, at a time when defra is struggling to live within its means, raises concerns about whether sufficient resources will be available. In this context, it is somewhat worrying that the revised strategy does not set a firm timetable for the work proposed. Like the original version, it simply states that this will be developed once it is clear what resources are likely to be available.
One thing that is certain is that the problem of antimicrobial resistance will not go away — a point which will be highlighted in the autumn when, on November 18, Europe will hold the first European Antibiotic Awareness Day.2 It remains important to monitor resistance, and to ensure that antimicrobials are used prudently and to best effect.