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Acting on resistance

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ANTIMICROBIAL resistance (AMR) has been in the news so often over the past 12 months that it would be difficult not to be aware of it. When the Prime Minister weighs into the debate, as he did in July (VR, July 12, 2014, vol 175, p 30), things really must be getting serious. Nevertheless, European Antibiotic Awareness Day, which takes place each year on November 18, continues to serve a useful purpose – not just in drawing attention to the problem, but also in encouraging everyone to take appropriate action. The day has done much to raise awareness of the threat posed by resistance since it was launched six years ago (VR, November 8, 2008, vol 163, p 551). However, experience in many fields has shown that there is a difference between making people aware of a problem and getting them to do something about it – and that can certainly be said to apply in the case of AMR.

Concern about AMR is nothing new. In the UK, for example, the problem was highlighted in a report from a House of Lords select committee, chaired by veterinary peer Lord Soulsby, in 1998, having also been highlighted in the Swan report some 30 years before. At a European level, a flurry of activity in the late 1990s resulted in an EU-wide ban on the use of antibiotics in animal feed as growth promoters. This was phased in gradually but took full effect from January 2006. Interest continued to grow and there have been numerous conferences, reports and initiatives since, but it is, perhaps, only in the past three years or so that things have really started to come to a head. Thus, for example, in 2011, the World Health Organization chose antibiotic resistance as the subject for World Health Day, using the slogan ‘No action today, no cure tomorrow’ (VR, April 30, 2011, vol 168, p 440), and the European Commission launched an AMR action plan setting out 12 ‘concrete actions’ to tackle resistance over the next five years (VR, November 26, 2011, vol 169, p 564). In 2013, England's Chief Medical Officer (CMO), Dame Sally Davies, made AMR the subject of her annual report, warning that ‘Global action is needed to tackle the catastrophic effects of resistance, which in 20 years could see any of us dying following minor surgery’ (VR, March 16, 2013, vol 172, p 276). The need for a concerted, multidisciplinary approach to tackling resistance was further emphasised by the CMO and the UK's Chief Veterinary Officer, Nigel Gibbens, when the Department of Health and Defra published the UK Five Year Antimicrobial Resistance Strategy later the same year (VR, September 21, 2013, vol 173, p 254).

Concern about resistance has largely centred on ensuring that products remain effective for use in human medicine. However, it remains important to emphasise that antimicrobials are needed, and will continue to be needed, to treat and help to prevent infections in animals, too. That maintaining the ability to treat human infections will continue to be the priority is reflected in a proposed new EU Regulation on veterinary medicines. Although this generally aims to make more medicines available to treat and prevent disease in animals, it will also make it possible to restrict the use in animals of certain antimicrobials that are reserved for human infections (VR, September 20, 2014, vol 175, p 262).

Much of the debate about AMR over the past 15 years and more has focused on the extent to which the use of antimicrobials in animals might be contributing to the problems being encountered in human medicine. In view of this, it may be to some extent reassuring that the UK's five-year strategy should have noted that ‘increasing scientific evidence suggests that the clinical issues with antimicrobial resistance that we face in human medicine are primarily the result of antibiotic use in people rather than use of antibiotics in animals’. However, this does not in any sense absolve veterinarians from doing everything they can to ensure that antimicrobials are used responsibly. There is evidence that resistant organisms can be transferred between animals and people (and vice versa) and, as the strategy also points out, ‘use of antibiotics in animals (which include fish, bees, birds and reptiles) is an important factor contributing to the wider pool of resistance, which may have long-term consequences’.

Looking at the issue from a solely animal health perspective (which isn't, in fact, appropriate) there is even less prospect of new antibiotics being developed for veterinary use in the coming years than there is for antibiotics for human medical use, so it makes sense to do everything possible to ensure that the products available remain effective. Information on the use of antibiotics in animals, including guidance on responsible use and other supporting material, is available on the BVA website at www.bva.co.uk/eaad

Dame Sally Davies will be discussing AMR during the BVA Congress at the London Vet Show next week, in a debate called ‘Antimicrobial resistance – one health, one problem’. With a One Health approach forming an important part of the UK strategy, it will be interesting to hear her perspective on the particular contribution that veterinarians can make in helping to tackle the problem.

Meanwhile, to engage everyone in the fight against resistance, Public Health England is running an online ‘Antibiotic Guardian’ campaign at http://antibioticguardian.com. The campaign invites people to make a simple pledge about how they will make better use of antibiotics to help prevent them from becoming obsolete. It is aimed at human and veterinary health professionals as well as members of the public, and as many vets and veterinary nurses as possible are being invited to sign up. The world has known about the threat of AMR for many years now, and also what needs to be done about it. The awareness-raising must continue, but really it's time to act.

■ The debate ‘Antimicrobial resistance – one health, one problem’ will take place during the BVA Congress at the London Vet Show at 09.30 on November 20. Details of the congress are available at www.bva.co.uk/londonvetshow

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