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ANSES - French Agency for Food, Environmental and Occupational Health & Safety

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Updated on 23/02/2017

Monitoring sales of veterinary antimicrobials

Keywords : Antibiotics, Antimicrobials, Veterinary medicinal products, Veterinary drugs, Antibiotic resistance, Antimicrobial resistance

Veterinary microbial sales have been monitored annually by the Agency since 1999. Monitoring of these sales is based on the recommendations in Chapter 6.8 of the OIE's 2016 Terrestrial Animal Health Code "Monitoring of the quantities and usage patterns of antimicrobial agents used in food-producing anima

Why should antimicrobial sales be monitored?

Antimicrobial sales are monitored in order to evaluate their use and the way antimicrobial therapy for different animal species is evolving.
Along with bacterial resistance monitoring, the information gathered through this national monitoring scheme is indispensable for evaluating the risks related to antimicrobial resistance.
This data also make it possible to recommend measures for managing these risks and to monitor the effects of these measures.

 

How is monitoring conducted?

The monitoring of antimicrobial sales is based on an annual sales declaration by the laboratories that market them. This data can be cross-matched with other sources of information (declaration of turnover, prescription surveys, etc.).
The information gathered from laboratories covers 100% of authorised medicinal products. Off-label use of human commercial products and extemporaneous formulations that fall under the provisions of the Cascade approach (Article L. 5143-4 of the French Public Health Code) are not taken into account. Since 2009, laboratories have provided target species distribution data for most of the products declared. For some species, declarations can be confirmed using surveys of veterinary prescriptions and use by livestock farmers.

 

How should the results be interpreted?

The data supplied for antimicrobial sales volumes do not include the details of their use. This is because recent antimicrobials are more potent and require administration of lower doses. To assess the exposure of animals to antimicrobials, it is necessary to take into account the dosage and duration of treatment as well as evolutions in the animal population over time. The ALEA (Animal Level of Exposure to Antimicrobials) estimates the level of exposure of animals to antimicrobials. Consequently, a decrease in sales volume does not necessarily mean a decrease in the use of such products.
The national EcoAntibio plan set up in 2012 for veterinary medicine aims to reduce antimicrobial use (all classes taken as a whole) by 25% in 5 years and to sustainably maintain the available therapeutic arsenal.
French law no. 2014-1170 of 13 October 2014 on the future of agriculture, food and forestry, which establishes several measures such as the termination of price reductions, rebates and discounts as of 1 January 2015, resulted in many of those involved in veterinary drug distribution and prescription amassing antimicrobial medicines in 2014.
Consequently, the data shown below represent an average of the indicators calculated over both 2014 and 2015 in order to play down this “hoarding” effect.


What are the main trends that have been observed?

Sales volumes 

In 2014 and 2015, the average total sales volume for antimicrobials was close to 650 tonnes per year, a reduction of 28.4% as compared to 2011 (the EcoAntibio plan’s year of reference).
In comparison with 1999, antimicrobial sales decreased by about 50.3%. This decrease was mainly due to two classes of antimicrobials, tetracyclines and sulfonamides, and to a drop in oral route administration of antimicrobials.

Exposure of animals to antimicrobials

Since monitoring began in 1999, the Animal Level of Exposure to Antimicrobials (ALEA) dropped by 13.6% in France.

When taking all animal species as a whole, overall exposure dropped by 20.1% in France over the last four years (2014-2015 average as compared to 2011).
A drop in exposure was seen for all species as compared to 2011 (cattle -9.5%, pigs -24.1%, poultry -22.1%, rabbits -17.8%, cats and dogs -9.5%).

 

Are there any changes that justify the implementation of specific measures?

Third- and fourth-generation cephalosporins and fluoroquinolones are considered to be particularly important in human medicine because they are the only, or one of the few, alternatives for treating certain infectious human diseases. In keeping with European recommendations, these antimicrobials should therefore be reserved for second-line therapy only.
Since monitoring began in 1999, the observed overall decrease in the volume of antimicrobial sales can be explained by an increase in the use of these more recent and more potent compounds.
The French law on the future of agriculture, food and forestry has set a goal of a 25% reduction over three years of the use of these classes of antimicrobials, using 2013 as the reference year. Exposure to fluoroquinolones and latest-generation cephalosporins fell by 22.3% and 21.3% respectively over the last two years as compared to 2013.
The November 2015 publication describing the first plasmid-mediated colistin resistance mechanism has led to reinforced surveillance being implemented for this antimicrobial. After an increase in colistin exposure up to 2007, it then remained relatively stable between 2008 and 2011, then dropped over the last four years. Exposure to this antibiotic fell by 25.3% as compared to 2011 (when taking into account all species and administration routes globally).



What is the situation in France as compared to the other European countries?

France began monitoring antimicrobial sales in 1999.
Coordinated monitoring of antimicrobial sales on the European level was initiated in 2010 by the EMA (European Medicines Agency). France participated actively in this process. Six reports have been published to date.
The last report was published in October 2016 and concerns sales in 29 European countries for the year 2014. Sales of antimicrobials, all species considered, are expressed as mg/PCU (Population Correction Unit; 1PCU= 1kg of animal weight).
Sales figures for the 29 European countries range from 3.1 to 418.8 mg/PCU, with 107 mg/PCU for France.