Published on 08/01/2019
Antibiotics, Antimicrobials, Veterinary medicinal products, Veterinary drugs, Antibiotic resistance, Antimicrobial resistance
Veterinary antimicrobial sales have been monitored annually by the Agency since 1999. This monitoring 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 animals".
Why should antimicrobial sales be monitored?
Monitoring sales of antibiotics in veterinary medicine enables the authorities to assess their use and monitor changes 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. See the main results for 2017.
How is monitoring conducted?
The monitoring of antimicrobial sales is based on an annual sales declaration by the laboratories that market these products. These data can then be cross-matched with other sources of information (declaration of turnover, prescription surveys, etc.).
The information used to calculate the indicators for monitoring antimicrobial sales is available in the Excel file that can be accessed here.
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 with surveys of veterinary prescription and use by livestock farmers.
How should the results be interpreted?
The data supplied for antimicrobial sales volumes do not include precise details of their use. This is because recent antibiotics are more potent and require administration of lower doses. To assess animal exposure to antibiotics, it is necessary to consider, in particular, the dosage and duration of administration, but also changes in the animal population over time. The ALEA (Animal Level of Exposure to Antimicrobials) estimates the level of exposure of animals to antibiotics. Thus, a decrease in sales volume does not necessarily mean a decrease in the rate of use.
The first Ecoantibio 2012-2016 plan aimed to reduce the use of antibiotics by 25% in five years, with particular attention being paid to the use of antibiotics of critical importance in veterinary and human medicine. The main objective of the first plan was met, with a 37% decrease in animal exposure to antibiotics during this 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 antibiotics of critical importance in human medicine. It thus set a target of a 25% reduction in three years in the use of antibiotics 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 antibiotics is sustained. It provides for communication and training measures, access to alternatives to antibiotics, and improved prevention of animal diseases. A specific objective for colistin is a 50% reduction in exposure to this antibiotic in five years, in the cattle, pig and poultry sectors.
What are the main trends that have been observed?
In 2017, the total sales volume for antimicrobials amounted to 499 tonnes, a fall of 5.9% compared to 2016 (530 tonnes). This was the lowest tonnage recorded since monitoring began in 1999 (1311 tonnes). A 45.2% reduction can thus be observed compared to 2011, the reference year for the first Ecoantibio plan. This change is largely attributable to lower sales of orally administered antibiotics.
Exposure of animals to antimicrobials
In 2017, the indicator used (ALEA: Animal Level of Exposure to Antimicrobials) fell by 3.6% compared to 2016, all animal species combined.
Over the last six years, overall exposure has decreased by 38.9%. Compared with 2011, exposure to antibiotics has fallen by 23.3% for cattle, 43.5% for pigs, 48.7% for poultry, 44.3% for rabbits and 14.0% for cats and dogs.
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. According to European recommendations, these antibiotics should be reserved for second-line therapeutic treatment.
Exposure to newer-generation cephalosporins had decreased by 94.2% in 2017 compared to 2013, all species combined. Over the last four years, the ALEA for this class of antibiotics has fallen for cattle (-94.9%), pigs (‑93.7%), domestic carnivores (-65.5%) and horses (-95.0%).
An 87.8% decrease in exposure to fluoroquinolones was observed in 2017 compared to 2013. Over the last four years, the ALEA for this class of antibiotics has decreased for cattle (-93.1%), pigs (-93.9%), poultry (-50.3%), domestic carnivores (-73.0%) and horses (-93.9%).
The targeted 25% reduction in the use of fluoroquinolones and third- and fourth-generation cephalosporins in three years was achieved in 2016, and this fall in exposure continued in2017. These encouraging results follow publication of a Decree and an Interministerial Order in March 2016 seeking to regulate the prescription and dispensing of drugs used in veterinary medicine and containing one or more antibiotic substances of critical importance.
In addition, the article published in November 2015 describing the first plasmid-mediated mechanism of resistance to colistin led to the establishment of reinforced surveillance for this antibiotic.
In France, in its report on colistin published in October 2016, ANSES recommended a 50% reduction in the use of this antibiotic. Following this opinion, the Ecoantibio2 plan (Action 12) set the goal of a 50% reduction in five years in exposure to colistin in the cattle, pig and poultry sectors, taking as a reference the average ALEA for 2014-15.
In 2017, exposure to colistin had fallen by 48.0% compared to the average exposure calculated for 2014 and 2015. Exposure in 2017 had decreased for cattle (-38.7%), pigs (-60.3%) and poultry (-36.9%) compared to the average exposure for the years 2014-2015. Cumulative exposure for these three species has fallen by 47.6% over this same period. A 61.1% decrease in exposure to colistin was observed compared to 2011 (all species and routes of administration combined).
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 2016, France was ranked as the 12th heaviest consumer of the 30 participating countries (source ESVAC), with consumption well below the average for European countries (71.9 mg/kg vs 124.6 mg/kg).
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