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Momentum on resistance

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THE level of interest in antimicrobial resistance generated by European Antibiotic Awareness Day, which is held each year on November 18, continues to grow. Last year's event saw a number of developments, the most significant of which was the launch by the European Commission of an action plan against antimicrobial resistance setting out 12 ‘concrete actions’ over the next five years (VR, November 26, 2011, vol 169, p 564). This year's event has again been accompanied by a flurry of activity, including a well-publicised warning from England's Chief Medical Officer that ‘antibiotics are losing their effectiveness at a rate that is both alarming and irreversible – similar to global warming’. The Department of Health, working with Defra and other government departments, is currently in the process of developing a new cross-governmental Antimicrobial Resistance Strategy and Action Plan, which it intends to publish sometime next year. Meanwhile, attention continues to focus on veterinary use of antimicrobials, as various developments have illustrated.

Most recently, earlier this month the European Parliament's Environment, Public Health and Food Safety Committee adopted a resolution which emphasises that ‘more efforts are needed to control the use of antimicrobials in the veterinary sector’ and which ‘strongly disapproves of the uncontrolled prophylactic use of antimicrobials in animal husbandry’. It also calls on the European Commission to come up with a legislative proposal for the veterinary sector to limit the use of third- and fourth-generation antimicrobials that are critically important in human medicine (VR, November 17, 2012, vol 171, p 490).

The resolution, which was adopted unanimously by the committee, will be considered by a plenary session of the European Parliament in December. Although not binding on the Commission, it is nevertheless worrying because the Commission is currently in the process of updating legislation on veterinary medicines and has previously indicated that is considering whether the legal framework should be changed to restrict the use of antimicrobials considered critical in human medicine. More generally, it comes on the back of a series of developments in Europe and further afield which suggest that political efforts to tackle antimicrobial resistance are focusing particularly on the use of antimicrobials in animals at present when effort is needed across the board.

This is illustrated in the European Commission's action plan itself. Although this aims to tackle the problem in both people and animals, it appears to give only qualified support to developing new antimicrobials for veterinary use and contains more actions relating to veterinary use than to use in human medicine. There is clearly a need to develop new products and preserve the efficacy of existing products for use in people, but it is also important to ensure that effective products remain available for use in animals when they are needed. Unfortunately, there seems to be a political momentum gathering around veterinary use that could be difficult to stop.

In tackling antimicrobial resistance, legislative and other measures must be evidence based. However, there is a danger, in the current political climate, that the precautionary principle might be applied inappropriately and that animal health and welfare will suffer as a result. An example might be if, as the European Parliament has already suggested, there should be a ban on prophylactic use (VR, November 5, 2011, vol 169, pp 479-480). While blanket prophylaxis is clearly inappropriate, there are many situations where preventive treatment is necessary to safeguard animal health and welfare and, indeed, where withholding treatment could result in more antimicrobials having to be used. Vets need to be able to apply their clinical and professional judgement in such cases, while being fully mindful of the risks of resistance development, and it would be wrong to force them to wait for an animal to become sick before starting treatment.

Antibiotics are needed for people and animals. In practical terms, it is important that both vets and doctors use them appropriately, for example, by following guidelines on responsible use, while in political terms it currently seems particularly important that vets are seen to be doing so. Political and practical issues concerning veterinary use were considered in a contentious issues debate and some of the clinical sessions at this year's BVA Congress (VR, October 27, 2012, vol 171, pp 418-419), while a recent symposium in London brought together medical and veterinary professionals to explore ways in which the two professions can work together more effectively in tackling a problem that is common to both (VR, October 20, 2012, vol 171, pp 391-392). Resistance is undoubtedly a problem, but it is one that needs to be addressed at a practical level rather than by kneejerk legislation that could all too easily end up doing more harm than good.

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