Published on 27/11/2020
Antibiotics, Antimicrobials, Veterinary medicinal products, Veterinary drugs, Antibiotic resistance, Antimicrobial resistance
Antimicrobial resistance is a major public health issue concerning both human and veterinary medicine. Monitoring of sales of veterinary antimicrobials is one of the main sources of information used to assess and manage the risks associated with antimicrobial resistance. These sales have been monitored annually by the Agency since 1999, based on the recommendations of the World Organisation for Animal Health (OIE).
In addition, since 2010, ANSES has represented France in the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project launched by the European Medicines Agency (EMA) at the request of the European Commission. Its aim is to collect harmonised data on antimicrobial sales in all countries of the European Union.
Why should antimicrobial sales be monitored?
Monitoring sales of veterinary antimicrobials enables the authorities to assess their use and monitor trends in antimicrobial therapy practices for different animal species.
The information gathered is one of the essential elements, together with monitoring of bacterial resistance, needed for assessing the risks associated with antimicrobial resistance.
These data also make it possible to recommend measures for managing these risks and to monitor the effects of these measures.
How is this monitoring conducted?
The monitoring of sales of veterinary antimicrobials is based on an annual declaration of sales by the pharmaceutical companies marketing these antimicrobials. This covers 100% of authorised veterinary medicinal products and includes a breakdown by species. These data can be combined with other sources of information such as reported turnover, prescription surveys, etc.
The information used to calculate the indicators for monitoring antimicrobial sales is available in this Excel file.
The information collected from the pharmaceutical companies covers 100% of authorised veterinary medicinal products and can be used to estimate which species they have been prescribed for.
How should the results be interpreted?
The data on antimicrobial sales volumes alone do not include exact details of their use. Recent antimicrobials are more potent and require the administration of smaller doses of product. To assess animal exposure to antimicrobials, it is necessary to consider, in particular, the dosage and duration of administration, but also changes in the animal population over time. The ALEA estimates the animal level of exposure to antimicrobials.
The first EcoAntibio 2012-2016 plan aimed to reduce the use of antimicrobials by 25% in five years, with particular attention being paid to the use of antimicrobials of critical importance in veterinary and human medicine. These are used when the antimicrobials first prescribed are ineffective. The main objective of the first plan was met, with a 37% decrease in animal exposure to antimicrobials during the five-year period.
The Act on the future of agriculture, food and forestry (LAAAF2, Act No. 2014-1170 of 13 October 2014) added specific objectives for antimicrobials of critical importance in human medicine.
It thus set a target of a 25% reduction in three years in the use of antimicrobials belonging to the classes of fluoroquinolones and third- and fourth-generation cephalosporins, with 2013 being the reference year. This objective was achieved and even greatly exceeded in 2016.
The new EcoAntibio 2017-2021 plan aims to ensure that the decline in animal exposure to antimicrobials is sustained. It provides for communication and training measures, access to alternatives to antimicrobials, and improved prevention of animal diseases. A specific objective for colistin, an antibiotic used frequently in veterinary medicine but reserved for severe cases in human medicine, is a 50% reduction in exposure to this antimicrobial in five years, in the cattle, pig and poultry sectors.
What are the main trends that have been observed?
In 2019, the total sales volume for antimicrobials amounted to 422 tonnes, a fall of 10.5% compared to 2018. This was the lowest tonnage recorded since monitoring began in 1999 (1311 tonnes). A 53.3% reduction can also be observed compared to 2011, the reference year for the first EcoAntibio plan. This trend is largely attributable to lower sales of orally administered antimicrobials.
Since recent antimicrobials generally require a lower dose, sales volumes alone cannot be used to assess animal exposure to antimicrobials. It is therefore necessary to take the dosage and duration of antimicrobial treatments into account and relate them to the animal population. This provides an estimated animal level of exposure to antimicrobials (ALEA).
Animal exposure to antimicrobials
Overall exposure of animals in France decreased by 10.9% between 2018 and 2019. Over the last year, the change in exposure has varied according to the species: -9.9% for cattle, -16.4% for pigs, -12.8% for poultry, +1.5% for rabbits and +2.1% for domestic carnivores.
After a sharp decline in the ALEA between 2011 and 2016, a relative stabilisation of animal exposure has been observed over the last three years for most classes of antimicrobials, with the exception of tetracyclines and polymyxins.
Are there any changes that justify the implementation of specific measures?
Exposure to critical antimicrobials
Certain "critical" antimicrobials, such as third- and fourth-generation cephalosporins and fluoroquinolones, are considered as particularly important in human medicine because they are an alternative – and sometimes the only alternative – to antimicrobials to which bacteria have become resistant for the treatment of infectious diseases in humans. According to European recommendations, these antimicrobials should be reserved for second-line therapeutic treatment. To preserve their effectiveness, the use of these treatments should be limited and prudent. This is why their use in veterinary medicine is monitored.
After a sharp decline observed between 2013 and 2016, exposure to critical antimicrobials appears to have stabilised over the last three years.
Exposure to newer-generation cephalosporins fell by 94.1% in 2019 compared to 2013, all species combined. Between 2018 and 2019, a decrease in exposure was observed for all species, except for domestic carnivores (+1.5%).
There was an 86.0% decrease in exposure to fluoroquinolones in 2019 compared to 2013. Over the last year, a slight increase of 0.7% was observed: this can be explained by an increase in the use of injections (2.8% for all species combined). Between 2018 and 2019, exposure to fluoroquinolones increased for cattle, domestic carnivores and horses, while it decreased for pigs and poultry.
Since the first transferable colistin resistance mechanism in bacteria was described in 2015, enhanced surveillance has been in place for this antibiotic. Colistin is widely used in veterinary medicine, but in human medicine is reserved only for the treatment of severe infections involving bacteria resistant to any other therapeutic option, mainly because of its high toxicity. Its effectiveness is therefore of critical importance and justifies the enhanced surveillance.
At European level, in July 2016, the Antimicrobial Advice Ad Hoc Expert Group (AMEG) recommended reducing the use of colistin within three to four years to no more than 5 mg/PCU (Population Correction Unit) for European countries that are high or moderate consumers, and no more than 1 mg/PCU for European countries with the lowest use of colistin.
In France, in its report on colistin published in October 2016, ANSES had recommended a 50% reduction. Following this opinion, the EcoAntibio2 plan therefore set a five-year goal of a 50% reduction in exposure to colistin in the cattle, pig and poultry sectors, taking the average ALEA for 2014-2015 as a reference.
By 2019, exposure to colistin had fallen by 64.2% compared to the average exposure calculated for 2014 and 2015. Exposure had decreased for pigs (-73.7%), poultry (-58.1%) and cattle (-52.3%) compared to the average exposure for 2014-2015. The objective set by the EcoAntibio 2017-2021 plan to reduce exposure by 50% has therefore been achieved for these three sectors.
Calculating the results in mg/PCU according to the standards defined by the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) scheme, the value obtained for colistin in 2019 was 1.40 mg/PCU, which is far lower than the 5 mg/PCU threshold advocated by the AMEG.
How does the situation in France compare to that in other European countries?
Coordinated European monitoring of sales of antimicrobials for use in animal health was initiated in 2010 by the European Medicines Agency (EMA).
In 2018, France was ranked as the 14th heaviest consumer of the 31 participating countries (source ESVAC), with consumption well below the European average (64.2 mg/kg vs 103.2 mg/kg).
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