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Balance and resistance

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THERE is no shortage of interest in antimicrobial resistance at present. Globally, the World Health Organization (WHO) chose antimicrobial resistance as the subject for World Health Day in April this year, and it will also be one of the main topics for discussion at the conference of the World Veterinary Association in October. At an EU level, John Dalli, the commissioner for health and consumer policy, set out the European Commission's (EC's) views on the subject in a speech to the French national parliament in June1, and the Federation of Veterinarians of Europe (FVE) has recently produced a position paper on the subject2. In the UK, the President of the BVA and the chairman of the British Medical Association's Council highlighted the problem in a recent letter to Veterinary Record, urging their members to use antimicrobials responsibly (VR, July 2, 2011, vol 169, p 25). Earlier this month, the European Food Safety Authority (EFSA) gave an opinion on the public health risks of bacterial strains producing extended-spectrum beta-lactamases (ESBL) and AmpC beta-lactamases (AmpC) in food and food-producing animals3, enzymes which inactivate the effects of critically important antimicrobials such as penicillins and cephalosporins.

Biologically, there is a need to use antimicrobials responsibly, to help preserve their efficacy and ensure that they continue to be available for use when really needed. Politically, the pressure for action continues to grow. The WHO launched a campaign on World Health Day, under the slogan ‘Antimicrobial resistance: no action today, no cure tomorrow.’ Concerned primarily with safeguarding antimicrobials for human use, the campaign also focused on the use of antimicrobials in animals, with a press release noting that ‘Collaboration between human and animal health and agriculture professionals is also vital, as the use of antibiotics in food animal production contributes to increased drug resistance.’ A booklet published by the WHO's Regional Office for Europe during World Health Day aimed to ‘raise awareness of the importance of antibiotic resistance as a food safety issue and the responsibilities of all players in food production to prevent and control the spread of antibiotic resistance through the food chain’.

Commissioner Dalli's speech is significant because EU legislation on veterinary medicines is currently being reviewed, and one aspect being considered is whether the legal framework should be changed to include a specific provision to restrict the veterinary use of antimicrobials that are critical for human medicine. In his speech, he argued that ‘appropriate use of antimicrobials by all parties is the only way forward if we want to continue to treat patients with effective medicines in the future’. He suggested that, in view of advances in disease prevention and control, biosecurity and farm management, the need to use antimicrobials to treat animals had ‘thankfully decreased somewhat’, but noted that they remained essential in the treatment of sick animals affected by bacterial infections. The key, he said, was to ‘find the right balance’, with their use ‘duly justified and targeted at the infection in question’.

Commissioner Dalli also highlighted the need for more data on antimicrobial use and surveillance for resistance. The need for more data is underlined by the EFSA opinion: in the absence of information on the comparative efficacy of different options for controlling ESBL- and AmpC-producing bacteria, it suggests that ‘a highly effective control option would be to stop all uses of cephalosporins/systemically active 3rd/4th generation cephalosporins, or to restrict their use’.

All these developments add to the relevance of the FVE's position paper, which draws attention to the contribution that the veterinary profession can make to preventing resistance, both through responsible prescribing and by helping to optimise health surveillance and management on farms. Advocating stricter conditions in best practice for the use of antimicrobials such as fluoroquinolones and third- and fourth-generation cephalosporins, the FVE believes that ‘improvements will best be achieved by striking the correct balance between best practice and regulation, and allowing veterinarians to apply their knowledge whilst keeping him/her responsible and accountable for doing so.’ Everyone seems keen to achieve the right balance. The key concern for the future is where that balance will lie.

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