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Focus on antimicrobials

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INTEREST in European Antibiotic Awareness Day has increased significantly since the event was started in 2008 and the number of activities associated with this year's event was unprecedented. To an extent, this reflects increased awareness of the event itself, which is held each year on November 18. More importantly, however, it reflects growing concern about the challenges presented by antimicrobial resistance and what should be done to tackle them.

Most notable among the developments associated with this year's event was the launch by the European Commission (EC) of an action plan against antimicrobial resistance setting out ‘12 concrete actions’ for the next five years. The BVA has broadly welcomed the plan, but expressed concern that it gives only qualified support for new antimicrobials for veterinary use (see pp 565–566 of this issue). This concern would appear to be justified. While, as far as human medicines are concerned, the plan includes actions to ‘promote unprecedented collaboration to bring new antimicrobials to patients’, the comparable recommendation for veterinary medicines is to ‘promote efforts to analyse the need for new antibiotics in veterinary medicine’. Although rightly emphasising the importance of research and innovation in making new products available for human use, this does seem rather to neglect the fact that research and innovation is also vital in the veterinary field, and that effective products must continue to be developed to treat infections in animals as well.

Of the remaining actions, four can be said to relate to antimicrobial use in people and animals, and include improving communication and raising awareness of appropriate use, reinforcing research and strengthening surveillance. Only one – ‘strengthen infection prevention and control in hospitals, clinics, etc’ – relates specifically to the use of antimicrobials in human medicine, compared with three dealing specifically with veterinary use. These are to: ‘strengthen EU law on veterinary medicines and on medicated feed’; ‘introduce recommendations for prudent use of antimicrobials in veterinary medicine, including follow-up reports’; and ‘introduce legal tools to tighten prevention and control of infections in the new EU Animal Health Law’.

All this tends to reinforce the impression, which has been hard to avoid in recent months, that political efforts to tackle resistance are focusing particularly on the use of antimicrobials in animals at present, when effort is needed across the board (see, for example, VR, November 5, 2011, vol 169, p 478). A truly coordinated approach is needed – not just in Europe, but worldwide, as the World Health Organization seemed to recognise when it made antimicrobial resistance the subject of this year's World Health Day (VR, April 30, 2011, vol 169, p 440), using the slogan ‘No action today, no cure tomorrow’.

The emphasis in the action plan on strengthening surveillance for antimicrobial resistance in relation to antimicrobial consumption is welcome, because this kind of data is often lacking and it is important that decisions are evidence-based (VR, August 20, 2011, vol 169, p 190). However, with the EC currently planning to update both veterinary medicines legislation and Animal Health Law, the concern must be that important legislative decisions could be made before the necessary data are available.

It is in everyone's interest that effective antimicrobials remain available to treat infections in people and animals and, in this respect, a joint approach to the problem of resistance is vital. This point was emphasised in a letter from the BVA and the British Medical Association published in Veterinary Record in July (VR, July 2, 2011, vol 169, p 25) and further underlined by a seminar organised by the Federation of Veterinarians of Europe last week, which considered the issues from the perspective of ‘one health’. A key message to emerge from that seminar was that antimicrobials must be used prudently in both the human and veterinary fields if their efficacy is to be preserved and that, as far as veterinary use is concerned, the veterinary prescription is fundamental to this process (see p 566 of this issue).

In the UK, both general and specific guidance on responsible use of antimicrobials is available to vets, such as guidance produced by the BVA, the BSAVA and RUMA (the Responsible Use of Medicines in Agriculture alliance). It has always been important to apply such guidance to help limit the spread of resistance in practical terms but, in the current political climate, it is becoming increasingly important to be seen to be doing so. Without such a demonstration, and with attention focusing so heavily on veterinary use, there is a danger that the WHO's slogan of ‘No action today, no cure tomorrow’ could have particular relevance for veterinarians in the future.

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