What is Antimicrobial Resistance?
The term antimicrobial includes: antibiotic, antiprotozoal, antiviral and antifungal medicines. Antimicrobial drugs have played an important role in managing the health of humans, animals, marine life and plants/crops for more than 60 years. They inhibit the growth or kill micro-organisms that cause bacterial, viral, fungal and parasitical infections. Antimicrobial Resistance arises when some of the micro-organisms that cause infection (pathogens) adapt to survive exposure to a medicine that would normally kill them or stop their growth. This can lead to the development of micro-organisms which can no longer be treated successfully with the range of antimicrobials currently available.
The evolution of some micro-organisms to become resistant to antimicrobials is a natural biological reaction to exposure to antimicrobials. Some of the harmful micro-organisms survive and adapt to become immune to a specific or range of antimicrobials. Increased use of antimicrobials has resulted in an increase and acceleration of antimicrobial resistance. The increasing demand for antimicrobial treatments is being exacerbated by various factors such as misuse of medicines, poor infection control practices and global trade and travel.
Why should I be concerned about Antimicrobial Resistance?
Antimicrobials such as antibiotics are used to treat disease in both humans and animals, and are essential in maintaining human health, and animal health and welfare. If antimicrobial resistance occurs in relation to a particular disease or infection, this means a lack of suitable treatment options for both human and animal diseases because for example the antibiotic used does not kill or inhibit the bacteria causing the disease. Therefore the increased rate of development of AMR is a societal issue which impacts on us all regardless of whether we are food producers, keep animals as pets, or even if we have no regular contact with animals.
Global travel of people, animals and food means that resistant bacteria arising either in humans, animals or the environment may spread from one to the other as there are no possible border restrictions against the spread of bacteria. Increased mortality, or prolonged recovery times as well as the economic cost to healthcare systems and productivity losses affect all members of society. In relation to the treatment of animal disease, if antibiotics are losing their efficacy this compromises the availability of suitable medicines that farmers and pet owners can avail of to ensure their animals health and welfare, as well as an increased financial cost to the animal owner.
In some categories of antimicrobials (particularly antibiotics), very few new drugs have been developed historically, primarily due to the effectiveness of existing established antibiotics. In response to the rising concerns of AMR, pharmaceutical companies have started to research and develop new antimicrobials but this process will take time and the extent and effectiveness of these new antimicrobials is still uncertain. Essentially, the need for new antimicrobial drugs has increased due to increasing resistance to existing treatments in harmful micro-organisms, in particular, bacterial resistance to antibiotics. The research and development of new antibiotics has not yet progressed sufficiently to determine if and to what extent new antimicrobials will be able to address the increasing prevalence of resistant micro-organisms in the future.
What can I do to address the development and spread of Antimicrobial Resistance?
Improve animal health
The first step to address the challenge of AMR is to improve the overall health status of the animals thereby reducing the need for antimicrobials
- Develop a herd health plan in conjunction with your veterinary practitioner - put it into action and review at least annually.
- Implement a vaccination policy as per herd health plan.
- Focus on disease prevention strategies, including farm biosecurity.
- Develop standard operating procedures for each specific disease and for the medications to be administered, in conjunction with your veterinary practitioner
- Record all medications given (legal requirement) and reasons for administration - analyse this data to see where improvements can be made (consider possibility of benchmarking antibiotic use).
Prudent use of antibiotics
Everyone with responsibility for animals has a role to play in helping to reduce AMR. Sick animals need to be treated – antibiotics should be administered if harmful bacteria are deemed to be the causative organism – the right antibiotic given in the right quantity for the right number of doses by the right route of administration, adhering to the correct withdrawal periods.
The mantra, ‘as little as possible, but as much as necessary’ is a very useful strapline to practice as far as antibiotic use is concerned. The focus should be on reducing the need for antibiotics through the reduction of outbreaks of disease, but if disease occurs that is attributable to harmful bacteria, antibiotics should be administered as per veterinary protocol, to ensure the health and welfare of the animal(s) involved.
Case study examples
Resources for livestock professionals
- Responsible use of Antimicrobials in Livestock
- LA-MRSA guidance for people who work with livestock
- Responsible use of animal medicines on the farm
- Handling of manure and slurry to reduce antibiotic resistance
- Responsible antibiotic use under the prescribing cascade
- Veterinary Medicines Directorate (VMD) AMR Guidance
- Veterinary Antimicrobial Resistance and Sales Surveillance
- A number of animal health organisations’ have produced guidelines and guidance on the responsible use of antibiotics.
- Responsible Use of Medicines in Agriculture Alliance (RUMA)
Strategy for tackling Antimicrobial Resistance
Following on from the published 5-Year Antimicrobial Resistance Strategy 2013-2018, the UK Government has published a 20-Year Vision (insert link) and 5-Year National Action Plan (insert link) on 24th January 2019 for how the UK will contribute to containing and controlling AMR by 2040.
A major focus of the plan is to make sure current antibiotics stay effective by reducing the number of resistant infections and supporting veterinarians to prescribe appropriately.
The plans cover animals and the environment as well as human health. The government has committed to working with vets and farmers to further reduce antibiotic use in animals by 25% between 2016 and 2020, with objectives to be refreshed by 2021.
The pharmaceutical industry will also be expected to take more responsibility for antibiotic resistance. The Government will explore a new payment model that pays pharmaceutical companies based on how valuable their medicines are, rather than on the quantity of antibiotics sold.
Antibiotic resistance is predicted to kill 10 million people every year by 2050 if action is not taken now. Without effective antibiotics, straightforward, everyday operations like caesarean sections or hip replacements could become too dangerous to perform.
Since 2014, the UK has cut the amount of antibiotics it uses by more than 7% and sales of antibiotics for use in food-producing animals have dropped by 40%. But the number of drug resistant bloodstream infections have increased by 35% from 2013 to 2017.
The National Action Plan and 20-Year Vision were developed in close collaboration with all the devolved UK administrations.
Northern Ireland Action Plan
Northern Ireland have produced their own 5-Year Action Plan entitled “Changing the Culture 2019-2024 – One Health” which compliments the UK Action Plan and addresses issues which are more specific to Northern Ireland. The Action Plan reflects the priority areas for action from human and animal health, agriculture and the environment perspectives, as well as reflecting the commitments in the new UK 5 Year AMR National Action Plan 2019-2024. It is a collaborative effort between the Department of Health, DAERA and Food Standards Agency NI, with input from external key stakeholders during development.
Changing the Culture 2019-2024 – One Health was published on 16th May 2019.
Implementation of the Action Plan
DAERA are currently putting in place the necessary internal structures to manage the development, prioritisation and delivery of key actions in the NI Action Plan. This will help implement the changes needed to bring the spread of antimicrobial resistance under control.
DAERA will collaborate with a wide range of key stakeholders in the agricultural, education and research sectors. DAERA will also promote and support industry led initiatives, surveillance, novel research, training and dissemination of relevant information and advice to farmers and the wider rural community on AMR.
The actions identified in the 5-Year Action Plan will be reviewed annually and updated as necessary to ensure that the actions being taken are effective and deliverable.
Statutory AMR monitoring
Decision 2013/652/EU on the monitoring and reporting of antimicrobial resistance in zoonotic and commensal bacteria- (2014-2020)
DAERA- Surveillance & AMR section is responsible for the implementation and coordination of antimicrobial resistance in zoonotic and commensal bacteria as outlined in Commission Decision 2013/652/EU in NI.
Surveillance & AMR section works closely with the Veterinary Medicines Directorate (VMD) which is the lead coordinator for this implementation in the United Kingdom.
The Commission Decision requires the monitoring and reporting of AMR zoonotic and commensal bacteria isolated from broilers, fattening turkeys and fattening pigs at slaughter, on a biennial basis for each species.
DAERA Official Veterinarians undertake the collection of samples from approved slaughterhouses participating in the monitoring programme. Samples also collected in slaughterhouses under Regulation 2073/2005 are also used as source of Salmonella isolates for the AMR testing specified in European Commission Decision 2013/652.
Agri-Food and Biosciences Institute (AFBI) is responsible for the testing of samples submitted and the reporting of results to DAERA and VMD.
Further details can be found on the VMD website
The Veterinary Medicines Regulations sets out legal text on the manufacture, authorisation, marketing, distribution and post-authorisation surveillance of veterinary medicines. The code of conduct for veterinary surgeons on veterinary medicines is available on the RCVS website.
In June 2017 the European Commission adopted the EU One Health Action Plan against AMR, It builds on the 2011 action plan, its evaluation, the feedback received on a European Commission Roadmap on AMR and an open public consultation.
International progress to tackle AMR includes a G7 and G20 commitment to the AMR Global Action Plan and resolutions set out by:
An independent review on antimicrobial resistance, led by Lord O’Neill, published its final report in May 2016. The report included recommendations in 10 areas to tackle AMR across the globe.
Make better use of antibiotics to reduce the impact of Antimicrobial Resistance today and in the future. Become an antibiotic guardian at the Antibiotic Guardian Website.