Transcript presentation

EPP: Antimicrobial resistance:
urgent need to act in human & veterinary medicine
Implementing the One Health
Concept
22-04-2015
MP-EU
Prof. dr. J.Fink-Gremmels
DVM, PhD, Dip ECVPT
President EAVPT
[email protected]
Veterinay Faculty, Utrecht University
Part of Utrecht Life Sciences
The point of departure:
the global emergence of AMR
Global trade and global mobility
have become major drivers of the
spread of infectious diseases AND
antimicrobial resistance
Humans & animals share the same bacteria
and often also the same resistance genes
Wendlandt et al., 2015
The antibiotic eco-system: need for
a multi-actor approach
Human health care
Community
Animal
health care
&
Hospital (ICU)
Agriculture
Industry
FAO-WHO-OIE Tripartite action plan
Antibiotic use in veterinary medicine
Raising awareness & implementing the an action plan
Human (humane) responsibility
for animal health and wellbeing
Animal health care &
(global) food demands
Urgent need to act in veterinary medicine:
Enforcement of triple R
Reduction – Refinement - Replacement
See also EIP-AGRI Focus Groups
The triple R action plan
Reduction: The use of antimicrobial as herd managment tools is no longer accepted
 Improvement of hygiene programmes  biosecurity
 Improvement of disease prevention  vaccination
 Improvement of health monitoring & diagnostics (sensor based disease monitoring)
 Improvement of immune competence: feed quality – life cycle management
Creating Awareness – improving sustainability
Action points 1 & 2 FAO/WHO/OIE
Reduction of antibiotic use (ADD): the primary target
In the Netherlands between 2009 (reference) and 2013:
a decrease of the antibiotic use by 58% was achieved,
with a further decline in 2014
The point of concern: Extreme reduction without accompanying
measures endangers animal welfare!
The triple R action plan
Refinement: Re-evaluating current prescription attitudes
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Diagnosis-based prescriptions (capacity building)
Pathogen-susceptibility testing (rapid diagnostics)
Onset of treatment (cure rate)
Duration of treatments – need of supportive treatments
Ranking of antibiotics (critical important – specialist oversight)
Meeting expectations?
Expectation of (human) patients
• Expectations of farmers
CONTINUING EDUCATION & COMMUNICATION
CAPACITY BUILDING
Refinement: Avoidance of collateral damage:
Intra-intestinal antibiotics concentrations:
The gut microbiota are an undesirable
target
Long persistence in the intestines
….selecting for resistant bacterial
populations
Impairment of the microbiome
results in immune-mediated diseases
(allergies, diabetes, inflammatory bowel
diseases
1000 000 000 000 000 bacteria; > 500 species
10 x more than body cells
Reservoir for resistant bacteria / resistance genes
The triple R action plan
Replacement:
 Improvement of hygiene programmes  biosecurity
 Improvement of disease prevention  vaccination
 Improvement of health monitoring & diagnostics
 Improvement of immune competence: feed quality – life cycle management
Animal health care
Starts at the 1st day of life
Chang in mind-set: From Cure to Care
From cure to care: options & opportunities
Vaccines
(including PNAG-like surface antigen antibodies)
Bacteriophages
non-antibiotic antibacterials (ZnO)
Prebiotics
Probiotics
Phytobiotics
Bacteriocines
Quorum
sensing
modulators
Peptides
Defensin
inducers
Killing factors
(complement opsonins)
Hygiene programs
Biosecurity
Improvement of animal health – reduces the need for antibiotics
Building strategic cooperation
One health – our responsibility
Food Safety & Food Security
Thank you!