By Miroslav Djuric

European Antibiotic Awareness Day is an annual initiative that aims to raise awareness of the threat of antibiotic resistance to public health and animal health as well as the importance of prudent use of antibiotics.

On the occasion of the 5th European Antibiotic Awareness Day, which was marked on 18 November 2012, the European Centre for Disease Prevention and Control (ECDC) has released new data demonstrating that antibiotic resistance remains a major European and global public health problem. Imprudent use of antibiotics is one of the main factors responsible for the development and increase in antibiotic resistance.

DrugssThe ECDC data show that during the last decade, there has been an increase in antibiotic consumption in the EU. Antibiotic consumption in hospitals is considered as the main source that leads to the development of antibiotic resistance in bacteria, although the vast majority of antibiotic consumption occurs in the community, i.e outside hospitals. National antibiotic consumption data are publicly available from ESAC-Net providing a basis for monitoring progress towards a more prudent use of antibiotics.

Over the last four years there has been a significant increasing trend of resistance to multiple antibiotics, particularly in Klebsiella pneumoniae and Escherichia coli, in more than one-third of the EU/EEA countries. The increase of resistance to third-generation cephalosporins and combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides is of particular concern because this leaves only few therapeutic options for patients infected with these multi-drug resistant bacteria.

Carbapenems are considered as a major last-line defence class of antibiotics against multi-drug resistant bacteria, such as K. pneumoniae and E. coli. However, overuse of carbapenems contributes to the selection of carbapenem-resistant bacteria and prior use of a carbapenem antibiotic is a risk factor for the acquisition of carbapenemase-producing Enterobacteriaceae. From 2007 to 2010, overall consumption of carbapenems increased significantly in EU/EEA countries, with 15 out of 19 EU/EEA countries reporting an increase during that period. Meantime, over 15% of K. pneumonia isolates from several EU countries were found to be resistant to carbapenems in 2011.

The European Medicines Agency (EMA), which is tasked with evaluating applications for the authorisation of antibiotics and ensuring that their use follows official recommendations, is concerned about the increasing levels of resistance to antibiotics in humans and animals.

As far as veterinary antimicrobials are concerned, the EMA has recently published its second report on sales of veterinary antimicrobials based on the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project.

The EMA’s Committee for Medicinal Products for Veterinary Use (CVMP) has also started a procedure to review all veterinary medicines containing enrofloxacin administered via drinking water to chickens and turkeys. The Committee will review the indications, dosages and withdrawal periods due to concerns related to antimicrobial resistance.

In conclusion, the importance of putting an end to unnecessary use of antibiotics and encouraging people to follow their medical practitioner’s instructions cannot be understated. Responsible use of antibiotics by both medical professionals and general public can help stop resistant bacteria from developing and keep antibiotics effective for the use of future generations.

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