Antibiotics

Changed on: 15.06.2016

Antimicrobial Resistance AMR (including antibiotic resistance)

Antibiotics for the treatment of bacterial infections are among the most frequently used drugs worldwide. Verifiable relationships exist between their use and the accumulation of instances of antimicrobial resistance: the more often antibiotics from a particular group of drugs are used in humans or animals, the more frequently bacterial pathogens are later found to be insensitive to these substances. For World Health Day on 7th April 2011, the World Health Organisation (WHO) chose the theme "Antimicrobial resistance: no action today, no cure tomorrow". In 2012, the Ministers of Health from the EU Member States issued a declaration in which was emphasised that this increasing resistance to antibiotics is an ever more serious health problem for man and animal alike leading to limited or inadequate treatment options and thus reducing quality of life.

Monitoring the resistance situation

Resistant bacteria can be found in the environment, animals, food and in humans. The situation regarding antimicrobial resistance and the use of anti-microbial drugs in human and veterinary medicine and in the food industry in Austria has been published every year since 2005 in the form of the Austrian Antibiotic Resistance Report (AURES).

Tests for the purpose of epidemiological monitoring of transferable and non-transferable infectious diseases are conducted in the AGES Reference Centres. In addition to pathogen detection and typing, data is also collected on antimicrobial resistance. The results of these tests are fed into the AURES Report and are published as part of the annual reports.

In a joint pilot project involving AGES, Austrian Hospitals and Charité Berlin a uniform antibiotic usage reporting process is to be established for the whole of Austria within healthcare facilities and hospitals to provide a statistically reliable basis for the management and prudent use of antibiotics.

Monitoring of the resistance situation in Europe

Bacteria in humans and animals, as well as in foods continue to show resistance to the most commonly used antimicrobial agents, according to the recent European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2014. The level of resistance in Campylobacter to ciprofloxacin is very high. Multi-drug-resistant Salmonella bacteria are continuing to spread further across Europe.

The EFSA and ECDC have warned of increasing antibiotic resistance in the European Union.

Antibiotics for the treatment of bacterial infections are among the most frequently used drugs worldwide. Verifiable relationships exist between their use and the accumulation of instances of antimicrobial resistance: the more often antibiotics from a particular group of drugs are used in humans or animals, the more frequently bacterial pathogens are later found to be insensitive to these substances. For World Health Day on 7th April 2011, the World Health Organisation (WHO) chose the theme "Antimicrobial resistance: no action today, no cure tomorrow". In 2012, the Ministers of Health from the EU Member States issued a declaration in which was emphasised that this increasing resistance to antibiotics is an ever more serious health problem for man and animal alike leading to limited or inadequate treatment options and thus reducing quality of life.

Monitoring the resistance situation

Resistant bacteria can be found in the environment, animals, food and in humans. The situation regarding antimicrobial resistance and the use of anti-microbial drugs in human and veterinary medicine and in the food industry in Austria has been published every year since 2005 in the form of the Austrian Antibiotic Resistance Report (AURES).

Tests for the purpose of epidemiological monitoring of transferable and non-transferable infectious diseases are conducted in the AGES Reference Centres. In addition to pathogen detection and typing, data is also collected on antimicrobial resistance. The results of these tests are fed into the AURES Report and are published as part of the annual reports.

In a joint pilot project involving AGES, Austrian Hospitals and Charité Berlin a uniform antibiotic usage reporting process is to be established for the whole of Austria within healthcare facilities and hospitals to provide a statistically reliable basis for the management and prudent use of antibiotics.

Monitoring of the resistance situation in Europe

Bacteria in humans and animals, as well as in foods continue to show resistance to the most commonly used antimicrobial agents, according to the recent European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2014. The level of resistance in Campylobacter to ciprofloxacin is very high. Multi-drug-resistant Salmonella bacteria are continuing to spread further across Europe.

The EFSA and ECDC have warned of increasing antibiotic resistance in the European Union.

Foodstuff

Foodstuff

Resistant germs in food

Germs are often detectable in fresh food. Only canned, pickled or irradiated foods are germ-free. Due to the slaughter process, fresh meat often has a high germ count: up to 5 million bacteria per gram of poultry meat are permitted in accordance with guidelines issued by the German Society for Hygiene and Microbiology (DGHM). Higher numbers of germs are possible in meat that is aged (matured) longer. Some of these bacteria can be also resistant to certain antibiotics.

To investigate the prevalence of antimicrobial resistant bacteria as part of a research project in 2013, AGES selectively tested 100 samples of each of the following: pork, beef, fish and/or shellfish, lettuce/salad and eggs, purchased in Styrian retail outlets, for MRSA (Methicillin resistant Staphylococcus aureus) and resistant Enterobacteriaceae.

As part of the test it was possible to isolate MRSA in five of the conventional pork samples and in one of the organic pork samples, in seven of the conventional beef samples and in four of the organic beef samples. MRSA was found in three of the fish and seafood samples tested. MRSA could not be isolated in the content of eggs or in the lettuce/salad samples. As part of testing 200 poultry samples in 2012, MRSA was only found in one turkey meat sample.

Classic ESBL producers (ESBL = Extended-Spectrum Beta-Lactamase; Enzymes that are produced by bacteria and which may inactivate a broad spectrum of so-called Beta-Lactamase antibiotics) were detected in 6 % of the conventional pork samples and 18 % of the conventional beef samples. In organic produce the detection rate in pork samples was 18% and for beef 6 %. Ciprofloxacin-resistant Enterobacteriaceae were found in 22 % of conventional pork samples, in 14 % of organic pork samples, in 30 % of conventional beef samples and in 4 % of organic beef samples. ESBL producing or Ciprofloxacin-resistant isolates demonstrated very high cross-resistance rates to other classes of antibiotics.

In the course of foodstuff production, during preparation and on consumption, resistant germs may be transferred from the food to humans. If a person consumes resistant germs via food and these survive the gastric passage, they may then colonise the bowel for a certain period. In most cases there is no resultant infection. However, if these germs reach other regions of the body (e.g. through operations) they may cause illnesses as may non-resistant germs.
 
Resistant germs are no more pathogenic than germs that are sensitive to antibiotics. That means that they do not cause infections any more frequently. However, when there is resultant infection there are fewer antibiotics available for the therapy. It may also be that the first therapy was ineffective due to the resistance and that the course of the illness was prolonged or worsened as a result. In healthy people, testing only makes sense with regard to a few very specific issues (e.g. in certain cases testing for MRSA or carriers of carbapenemase-producing bacteria).

Irrespective of whether germs are resistant or not, when handling uncooked foods of animal origin, special attention should be paid to correct storage and preparation:

  • After purchasing, raw animal foodstuff items should be cooled or only subjected to short transport times
  • Proper storage in the household (refrigerator temperature should be below 5°C)
  • No contact of uncooked meat, fish or seafood with other foodstuffs
  • After handling any raw foodstuffs always wash hands thoroughly
  • Crockery and utensils that were used for working with raw foods, must not come into contact with ready-prepared food
  • Ensure all food is thoroughly heated. This reliably kills micro-organisms (even resistant ones)

Livestock

Livestock

Antibiotic resistance in livestock

In line with EU Directive 2003/99/EC the Federal Ministry of Health in Austria together with the Agency for Health and Food Safety (AGES) and veterinarians in the Austrian states have been conducting annual monitoring programmes in various livestock populations to establish the prevalence and antimicrobial sensitivity of certain zoonoses pathogens and indicator bacteria since 2004.

In line with a randomised sample plan in 2013, the intestinal contents of healthy, slaughtered calves under 8 months of age, young cattle up to 2 years old and cattle over 2 years, as well as from pigs and slaughter batches of broiler chickens were taken and analysed at AGES depending on the type of animal for, amongst other things, the presence of thermo-tolerant Campylobacter and indicator E. coli. All flocks of laying hens, broiler chickens and fattening turkeys were also checked for Salmonella in line with the National Salmonella Control Programme in official veterinary laboratories. The isolates of Campylobacter, E. coli and Salmonella obtained were tested for their antimicrobial sensitivity in the respective AGES National Reference Laboratories.
 
Campylobacter: out of 328 slaughter batches of broiler chickens thermo-tolerant Campylobacter isolates were obtained from 183 (56 %). For Campylobacter jejuni the percentage among broiler chickens of fully sensitive isolates was 26%. Microbiological resistance to ciprofloxacin and nalidixic acid, as well as ampicillin continued to show significantly increasing figures with high to extremely high resistance rates (73 %, 71 % and 34 %), the resistance rates to tetracycline were high at (25%). For Campylobacter coli the isolates from broiler chickens show 97% resistance to at least 1 of 5 representative antibiotics. The highest resistance rates were found to be to tetracycline (84 %) with lower resistance toward quinolones being measured (48%) than for C. jejuni; the remaining resistance rates were similar for both Campylobacter species.

84 % of the E. coli isolates from broiler chickens, 70 % of the isolates from fattening pigs, 31 % of the isolates from calves, 12 % of those from cattle over 2 years of age and 7 % of the isolates from young cattle showed resistance to at least one of nine representative antibiotics. The highest resistance rate to quinolones was found in isolates from hens (65 %), compared to streptomycin and tetracycline (57 % and 53 % respectively) in isolates from pigs and compared to sulfonamides and ampicillin (38%) and streptomycin (35 %) again in hens.

28 % of the Salmonella isolates from laying hens, 49 % of the isolates from broilers and 78% of the isolates from turkeys were found to be antimicrobial resistant.
 
See AURES Report, Antibiotikaresistenz bei ausgewählten Zoonoseerregern und Indikatorbakterien, Daten aus dem Veterinärbereich, 2013 (Antibiotic Resistance in Selected Zoonosis Pathogens and Indicator Bacteria, Data from the Veterinary Sector 2013), page 212 ff.

Antibiotics in livestock farming 

Livestock farming

Livestock farming

Use of antibiotics in livestock farming

In line with animal protection legislation a livestock farmer is obligated - if required - to call upon the assistance of a veterinarian and to have sick animals treated. Treatment of bacterial infections with antibiotics is also carried out in order to avoid more major economic damage (total loss caused by the death of the animal, temporary or permanent output losses, the risk of the diseases spreading to other animals on the farm and beyond into other livestock herds etc. and consequently posing a risk to the health of consumers).

A veterinarian has to establish that a bacterial infection exists. In Austria, antibiotics for the treatment of animals are without exception prescription only veterinary medicines and their use is, as a matter of principal, reserved for vets only. The veterinarian can integrate the animal keepers in subsequent treatment as part of a care relationship within the animal health service.
Antibiotics are also used to prevent the spread of an expected bacterial infection. Examples For this kind of antibiotic usage are the simultaneous treatment of animals that are sick and those that are not sick (yet) but are probably already infected as part of a livestock herd or animal group.

In accordance with EU regulations on organic production, veterinarians may use all veterinary medicinal products in an organic farm setting. If required, antibiotics may also be used for treatment - the consequence being, however, that the statutory waiting period (period of time to wait from the last dose of medicine administered to an animal until production of foodstuff may commence again from said animal) is to be doubled. There are limitations on frequency of treatment for organic livestock. Animals that live for less than one year may be treated a maximum of once. All other animals may receive treatment a maximum of three times in any one year.

Preventive measures may reduce bacterial infection and hence the use of antibiotics. On the one hand these include optimisation of livestock production (animal housing construction and climate), optimisation of management (closed herds/flocks, hygiene measures etc.), and on the other, vaccinations as well.

Bundesministerium für Gesundheit - Antibiotikaresistenz
(Federal Ministry for Health – Antibiotic (Antimicrobial) Resistance - German language only)

Tierärztekammer (Austrian Veterinary Chamber)

Animal Health Services

Veterinary antibiotics

Veterinary antibiotics

Veterinary antibiotics licensed and approved for use on livestock (animals used in food production)

In Austria, 305 veterinary medicinal products are currently approved for use in animals and contain the following antibiotic agents: aminoglycosides ansamycins / rifamycins, 1st and 2nd generation cephalosporins, 3rd and 4th generation cephalosporins, lincosamides, macrolides, penicillins, polymyxins, amphenicols, pleuromutilins, fluoroquinolones, sulfonamides, sulfonamides+trimethoprim, tetracycline.

The AGES Medicines and Medical Devices Agency as part of the national licensing and extension procedures for antibiotics checks the effectiveness, health safety and quality of the medicine and makes decisions on licensing approval and licensing extension based on the available benefit/risk profile. Extensive tests are conducted regarding effectiveness and safety, including the health risks to both humans and animals and the environmental risks that may arise as a result of bacterial resistance.

In the past five years the licenses of more than 80 antimicrobial veterinary medicines for livestock have been withdrawn for reasons such as lack of effectiveness, together with a high risk of spreading resistance, obsolete combinations of active ingredients or defects in manufacturing (quality), as well as for economic reasons.

BASG/AGES-MEA-Austrian-medicinal-product-index

Austrian Federal Ministry of Health - BMG: Information for veterinarians


 

 

Containment

Containment

Measures for the containment of use of antibiotics in livestock farming

Since the percentage of resistant pathogens has increased in recent years, measures have been taken to avoid the further development and spread of antimicrobial resistances and increased efforts concentrated on preventive measures:

  • Ban on antibiotics as growth promoters in the EU since 2006
  • No use of antibiotics as prophylaxis 
  • Restrictions regarding the oral use of antibiotics to treat whole herds/stocks (numerous rescissions of pharmaceutical-premix licensing in recent years)
  • No licensing of antibiotics for particular types of application such as “top dressing” on feedstuff
  • Restrictions on the use of flouroquinolones (no use in salmonella infections in livestock and small animals)
  • Restriction of packaging sizes to the minimum quantities required for Treatment 
  • Inclusion of warnings advocating “prudent-use” of antibiotics in specialist information and instructions for use (for example use on the basis of sensitivity testing)
  • Recommendations in specialist information and instructions for use to simultaneously improve management of animal housing (hygiene, occupancy, ventilation)
  • Approval withdrawal for obsolete antibiotic combination products where there is a widespread risk of development or spread of resistance
  • Withdrawal or rejection of antibiotic licensing for antibiotics with critical resistance status or insufficient effectiveness
  • Increased licensing of vaccines to prevent infectious bacterial diseases

With the National Action Plan on Antibiotic Resistance (NAP-AMR) and the Austrian Resistance Report AURES the Federal Ministry of Health is pursuing a joint concept in both human and animal medicine to contain antimicrobial/antibiotic resistance. The “Guidelines for the prudent use of veterinary medicines with antibacterial effect” are valid for both the treatment of bacterial diseases in agricultural livestock and of individual, small and domestic animals. The guidelines are also valid with respect to antibiotic treatment of animals with reclassified human medicinal products. Since 2015 we have seen the implementation of the Austrian regulation on the distribution of veterinary antibiotics (Federal Law Gazette II No. 83/2014 - Veterinär-Antibiotika-Mengenströme-Verordnung) with the objective of precisely recording the use of antibiotics in livestock farming, as part of which both sales of antimicrobial substances by companies and, from 2016, dispensing by veterinarians are being tracked.

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