7% of antibiotics in the EU are taken without prescription

A study published today on antimicrobial resistance and the causes of non-prudent use of antibiotics carried out by Nivel (NL) as part of the EU-funded project ARNA, estimates that 7% of antibiotics taken in the EU are taken without a prescription. The highest rates of non-prescription use of antibiotics are in Romania (20%) and Greece (16%) with high rates also found in Cyprus, Hungary, Italy, Romania and Spain. Over the counter selling of antibiotics in pharmacies and the use of leftover antibiotics were found to be the main causes.

The study gives a number of policy recommendations, for example:

  • A multi-faceted approach with interventions and policies that target both patients and healthcare professionals
  • Education and awareness raising, e.g. media campaigns for citizens staring with school children, and education programmes for health professionals
  • Better enforcement of laws in EU countries where antibiotics are available over the counter without prescription.

Read the study on antimicrobial resistance in full on the europe.eu website.

EU Action Plan on AMR

The EU has published its Action Plan to tackle Antimicrobial Resistance (AMR) – a growing threat that is responsible for 25,000 deaths and a loss of €1.5 billion in the EU every year.

The plan includes guidelines for doctors, nurses, pharmacists, hospital administrators and others who play a role in antimicrobial use to promote their prudent use in people. These guidelines complement infection prevention and control guidelines which may exist at national level. In addition, the plan foresees more than 75 actions built on three main pillars:

  • making the EU a best-practice region
  • boosting research, development and innovation
  • shaping the global agenda

For more information on the Action Plan to tackle Antimicrobial Resistance on the ec.europa.eu website

Health care without harm

Pharmaceuticals in the environment represent a global pollution problem – over 631 different pharmaceutical agents (or their metabolites) have been detected in at least 71 countries covering all continents. Pharmaceutical residues have been detected in surface water, sewage effluents, groundwater, drinking water, manure, soil, and other environmental matrices. Antibiotics in the environment can promote the development of antibiotic-resistant pathogens – a major global health threat. Also, little is known about the effects on humans from continuous, long-term exposure to low concentrations of pharmaceuticals. Pharmaceutical substances are often engineered so
that they remain unchanged during their passage through the human body; unfortunately this stability means they also persist outside the human body and, as a consequence, can build up in the environment. Several studies have confirmed that medicines pose environmental risks, and that concentrations found in the environment can have detrimental effects on aquatic systems and wildlife.
The Dutch organisation – health care without harm Europe – has produced a report outlining what steps are being taken in Europe to reduce anti-microbial resistance (AMR) and offers opportunities for countries to work together on this shared problem.
To download the summary report on health care without harm from the ec.europa.eu website

Public consultation on AMR

The European Commission will be launching a ‘One Health’ action plan to support Member States in the fight against antimicrobial resistance  and is currently asking for the views and input of citizens, administrations, associations and other organisations.

Respondents are invited to take part in the consultation by completing an online questionnaire, either the one for administrations, associations and other organisations, or the one for citizens.

To take part in the consultation as an organisation or as a citizen

The consultation period ends on the 28th April 2017

Carbapenem-resistant A. Baumannii

Outbreaks of carbapenem-resistant A. baumannii in healthcare facilities have been reported in Europe and worldwide.

Infections with carbapenem-resistant A. baumannii occur in patients with severe underlying diseases, mainly in intensive care units, and are often related to invasive procedures or indwelling devices. However, such infections are increasingly being reported in patients admitted to conventional medical/surgical wards and A. baumannii is difficult to eradicate once it has become endemic.

While carbapenems traditionally were the antibiotics of choice for treatment of A. baumannii infections, resistance to these drugs has led to increased use of colistin as last-line treatment. Although still rare, resistance to colistin in A. baumannii is also increasingly being reported in Europe.

This is a significant threat to patients and healthcare systems in all EU/EEA countries and the risks need to be reduced through clinical management, prevention of transmission in hospitals and other healthcare settings, prevention of cross-border transmission, and improvement of preparedness of EU/EEA countries.

For more information on Anti-Microbial Resistance on the ecdc.europa.eu website

Resistant bacteria spreading in hospitals across Europe

Antibiotic resistance is widespread across the whole of Europe. High resistance, often seen in the southern and eastern countries of the European Union, is also found in the eastern part of the European Region. In particular, resistant bacteria are spreading in hospitals and health care settings, putting patients at risk of contracting incurable diseases. This is the concerning picture painted by the second Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) report, published by WHO.

The aim of the report is to provide guidance and inspiration to countries that are building or strengthening their national AMR surveillance and to stimulate the sharing of data internationally. 19 non-EU countries are engaged in CAESAR (Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, the Republic of Moldova, the Russian Federation, Serbia, Switzerland, Tajikistan, the former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, Uzbekistan.)

More information about Anti-Microbial Resistance in Europe on the euro.who.int website

Healthcare workers as “Antibiotic Guardians”

Antibiotic resistance presents one of the biggest threats to global health and development today – and the threat is growing. On any given day, about 80,000 patients – or 1 in 18 patients in hospitals – in the EU have at least one health care associated infection according to estimates from the European Centre for Disease Prevention and Control (ECDC) and these are often difficult to treat because the microorganisms that cause them are resistant to antibiotics. These infections are estimated to result in 16 million extra days spent in hospital and 37,000 attributable deaths, as well as contributing to an additional 110,000 deaths a year. Annual financial losses are estimated at approximately €7 billion (direct costs only).

Health professionals – including general practitioners, nurses, hospital prescribers, dentists and pharmacists – can help prevent and control the spread of antibiotic resistance by following five key recommendations from WHO:

  • if you think a patient might need antibiotics, where possible test to confirm and find out which one;
  • only prescribe antibiotics when they are truly needed, according to current guidelines;
  • prescribe and dispense the right antibiotic at the right dose for the right duration;
  • prevent infections by using safe hygiene practices to ensure that your hands, instruments and environment are clean; and
  • keep your patients’ vaccinations up to date.

For more information about Antibiotic resistance on the euro.who.int website

Antimicrobial agents in human medicine

The European Commission has recently published a report on the prudent use of antimicrobial agents in human medicine based on questionnaires completed by EU and EEA member states in 2015.

20 out of the 29 countries providing information had a strategy to promote prudent use and contain antimicrobial resistance (AMR), 6 were in the process of developing strategies and 3 had neither an AMR strategy nor a plan to create one.

In most countries action plans included measures regarding surveillance, prudent use, information and education along with detection and control of outbreaks and the use of rapid diagnostic tests. Nursing homes and long term care facilities were covered by 14 out of the 21 action plans.

Download the full report on antimicrobial agents in human medicine from the ec.europa.eu website

Antibiotic resistance changes treatment for STIs

It is estimated that 131 million people are infected with chlamydia, 78 million with gonorrhoea, and 5.6 million with syphilis every year. These are the three most common sexually transmitted infections (STIs) and the WHO has issued new guidelines for their treatment in response to the growing threat of antibiotic resistance.

Chlamydia, gonorrhoea and syphilis are all caused by bacteria and are generally curable with antibiotics but they often go undiagnosed and are becoming more difficult to treat, with some antibiotics now failing as a result of misuse and overuse.

Resistance of these STIs to the effect of antibiotics has increased rapidly in recent years and has reduced treatment options. Of the 3 STIs, gonorrhoea has developed the strongest resistance to antibiotics. Strains of multidrug-resistant gonorrhoea that do not respond to any available antibiotics have already been detected. Antibiotic resistance in chlamydia and syphilis, though less common, also exists, making prevention and prompt treatment critical.

When left undiagnosed and untreated, these STIs can result in serious complications and long-term health problems for women, such as pelvic inflammatory disease, ectopic pregnancy and miscarriage, and untreated gonorrhoea and chlamydia can cause infertility in both men and women. Infection with chlamydia, gonorrhoea and syphilis can also increase a person’s risk of being infected with HIV two- to three-fold. An untreated STI in a pregnant woman increases the chances of stillbirth and newborn death.

Download the guidance for treating these sexually transmitted infections from the who.int website

China tackles antimicrobial resistance

China, the world’s largest consumer of human and animal antibiotics, has pledged to step up research and development into new antimicrobials and to rein in overuse of existing medicines to counter growing global antimicrobial resistance.

As part of a national action plan unveiled on 26 August, the Chinese central government said that it would mobilize the efforts of 14 ministries and departments including health, food and drugs, and agriculture. By 2020, the government aims to develop new antimicrobials, make sales of the drugs by prescription only, ramp up surveillance of human and veterinary usage, and increase training and education for both medical professionals and consumers on their proper use.

For more information about China and AMR on the sciencemag.org website