Monitoring of sales of antimicrobials for animal use in the eu/eea and switzerland, years 2010 to 2016; a regulatory and statistical analysis

Resumo

The problems caused by bacteria resistant to antibiotics have increased during the last years reducing the therapeutic options to treat multi-drug resistant (MDR) infectious diseases in humans and animals. In order to minimise the onset of antimicrobial resistance (AMR) it is necessary to reduce antimicrobial consumption (AMC). Through a One Health approach, reducing the use of antimicrobials in animals can result in a reduction of AMR in animals and humans. During the studied period, years 2010 to 2016, antimicrobial consumption in animals has been substantially reduced in many European Union/European Economic Area (EU/EEA) countries and Switzerland. This report analyses data from the mentioned years of the European Medicines Agency (EMA) project, the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC). A significant decrease in sales of antimicrobials for food-producing animals for 27 countries between the years 2010 to 2016, was found with a mean decrease of 17.1% when expressed as mg/kg of Population Correction Unit (PCU). Countries that had already had a low AMC in 2010 have continued decreasing AMC by 2016. In the studied period, the reduction of overall AMC has not resulted into a statistically significant reduction of some of the World Health Organisation (WHO) highly critically important antimicrobials (3rd and 4th generation cephalosporins, quinolones and polymyxins), suggesting that further action is required to reduce the use of those important antimicrobials. A strong correlation between overall AMC and sales of polymyxins was found, suggesting that the fewer antimicrobials sold, the fewer polymyxins consumed, and vice versa. High use of oral forms of antimicrobials is correlated to high use of antimicrobials. Countries with high overall sales of antimicrobials have a very strong correlation with the use of premixes, and the contrary. Oral use of antimicrobials might be favoured in countries with high consumption of antimicrobials for economical and practical reasons. The relationship between the antimicrobials expressed as mg/kg PCU and the % of oral sales for group treatment is not linear but exponential, which seems to indicate that very high sales have to be administered mostly orally (in group treatments) to the animals, as individual treatments will not result in such high sales. It also suggests that reducing the % of oral antimicrobials administered orally could result in an exponential reduction of AMU. Countries with historical collection of AMC data (before 2007, pre-ESVAC) have lower AMC than those that started to collect AMC data later. But collecting data by animal species (according to a set criteria) does not result in a lower AMC during the studied period. This seems to suggest that collecting sales data on AMC is correlated with an AMC decrease which could be caused by many reasons including the activities of awareness in countries that collect such data and the required involvement of stakeholders, from animal producers to veterinarians. AMC is linked with temperature in the country, which suggests that those countries with higher environmental temperature might have higher AMC. Countries with high environmental temperature should proactively implement policies to reduce AMC. Sales data on AMC in animals is a powerful tool to raise awareness and knowledge on the use of antimicrobials, but data at farm level allows for the use of better indicators, and implementation of e.g. benchmarking schemas between farms, and better comparison of results on AMC between countries. Multifaceted approaches including; setting targets, improved biosecurity, benchmarking, vaccination and avoiding the routine use of antimicrobials seem to have strongly contributed to the reduction of antimicrobial use in animals. In the EU/EEA a new veterinary Regulation (Regulation (EU) 2019/6) should facilitate a further overall decrease of AMC in the EU/EEA during the following years.