Switzerland's antimicrobial strategy

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1 Switzerland's antimicrobial strategy 54th IALB Conference, Dagmar Heim

2 Sales in kg Sales of antimicrobials for intramammary use Drying-off products Lactation D. Heim,

3 Sales in kg Sales of antimicrobials for intramammary use, by active ingredient class % Penicilline Aminoglykoside + 60% D. Heim,

4 Belgium Bulgaria Cyprus Czech Denmark Estonia Finland France Germany Hungary Iceland Ireland Italy Latvia Lithuania Netherla Norway Poland Portugal Slovakia Slovenia Spain Sweden Switzerla United mg/pcu Sales of antimicrobials for intramammary use, by country (Third ESVAC report, 2013) D. Heim,

5 D. Heim,

6 D. Heim,

7 Overall aim To guarantee the long-term effectiveness of antimicrobials in preserving human and animal health D. Heim,

8 Key measures Comprehensive surveillance Reference laboratories and quality assurance Development Nosocomial infections Practical laboratory tests Promotion of vaccination Optimised working procedures on farms Improvements in animal health Advice for animal owners Prescription guidelines Restrictions Recording and spread of resistance etc. Areas of activity Surveillance Prevention Appropriate use of antimicrobials Cooperation Combatting resistance Research and development Framework conditions Information and training Results of consultation (134 opinions) 1% 4% 9% 18% Zustimmung Agreement Zustimmung Agreement with mit recommendations Empfehlungen Neutral Ablehnung Rejection of mit recommendations Empfehlungen Ablehnung Neutral 67% Keine No opinion Stellungnahme D. Heim,

9 Appropriate use Appropriate use of antibiotics Framework conditions Research and development Fewer antimicrobials "as little as possible, as much as necessary" The "right" antimicrobial (fewer critically important antimicrobials) Improving diagnostics (are antimicrobials needed?) Treatment guidelines Improving availability of first-line antimicrobials Restrictions on the sale of antimicrobials Restricting sales of antimicrobials to be used for prophylactic treatment (e.g. drying-off products) Restricting sales of critically important antimicrobials D. Heim,

10 Surveillance Surveillance Measuring which antimicrobials are used in which quantities, and where Verifying effectiveness of measures An antimicrobials consumption database ( AB-DB ) is a basic prerequisite in order to - know which antimicrobials are used, where and why - provide more targeted training, information and advice - increase awareness - assess the effect of measures D. Heim,

11 AB-DB: possible measures Veterinarian prescribing antibiotics AB-DB Data collection Analysis Calculation of benchmark (mean per veterinarian) Report to farmer + veterinarian "AB consumption compared with the average" Identification of "heavy users" D. Heim,

12 AB-DB: possible measures Veterinarian prescribing antibiotics AB-DB Data collection Analysis Calculation of benchmark (mean per veterinarian) Report to farmer + veterinarian "AB consumption compared with the average" Example green orange red Check with veterinarian: Reasons for excessive use of AB Reduction possible? If so, animal owner must see to it Written plan, measures + schedule for AB reduction Specialist Monitoring of enforcement Remedial action order, etc. Gradual measures for "heavy users" D. Heim,

13 Prevention Wide range of options for improving animal health and hence reducing antimicrobial consumption D. Heim,

14 Prevention Information and training Improving the animal's situation 1. Breeding: expanding health/performance testing 2. The right animal in the right place (high-performance animals are not ideal on every farm) D. Heim,

15 Prevention Information and training Research and development Framework conditions Improving the animal's situation 3. Control strategies for major diseases - Development of strategies - Information for participants - Evaluation of incentive systems (programme voluntary, privately supported, state-run, etc.) D. Heim,

16 Prevention Information and training Research and development Framework conditions Optimising the situation on farms 4. Promoting optimised working procedures on farms (improvements in management, feeding, husbandry, hygiene, biosecurity) Highlighting the main weaknesses (management, husbandry conditions and biosecurity) Guidelines for Good Agricultural Practice Information and training (persuasion!) Creation of incentive systems Evaluation of husbandry systems with regard to animal health D. Heim,

17 Prevention Information and training Research and development Framework conditions Optimising the situation on farms 5. Supporting promotion of vaccination Vaccination strategies evaluated and implemented Necessary vaccines available 6. Alternative strategies/complementary medicine to improve animal health D. Heim,

18 Prevention Information and training Research and development Framework conditions Optimising the situation on farms Optimising and promoting coordinated advice and support Evaluating and promoting herd health management Promoting animal health services 75 % of farmers: The veterinarian should speak to me if he suspects a herd problem 85 % of veterinarians: The farmer should speak to me if he suspects a herd problem Diss. Schwendner (survey of 550 farmers, 100 veterinarians) D. Heim,

19 Prevention Information and training Research and development Framework conditions Prevention requires training... D. Heim,

20 Prevention through knowledge - Training Promotion of training: Objective: to make continuing education attractive, creative and practical crucial: to communicate that prevention is a basic prerequisite in order to minimise the need for antibiotics Owner Veterinarian Initial training Agricultural schools Degree in veterinary medicine Further training Continuing education 'Master farmer' Agricultural technician, etc. Various options Specialist veterinarian Official veterinarian, etc. "Life-long duty of continuing education" Various options 59 % of farmers do not know what an antibiotic sensitivity test is Diss. Schwendner (survey of 550 farmers, 100 veterinarians) 79 % of farmers do not know the significance of critically important AB Diss. Schwendner (survey of 550 farmers, 100 veterinarians) D. Heim,

21 Objectives of training Farmers Do not need to, and cannot, know whether antimicrobials are necessary and, if so, which antimicrobials Do need to know how to handle prescribed antimicrobials + the risks associated with noncompliance that preventive measures can significantly reduce antimicrobial use which preventive measures can reduce antimicrobial use Veterinarians and farmers can join forces to work out plans of measures to improve animal health by preventive means and hence to reduce antimicrobial use D. Heim,

22 Framework conditions for the implementation of strategies A good strategy becomes a poor one if it is not implemented. The strategy should be implemented in ALL areas. Implementation cannot work if everyone says: "it doesn't apply to me" if "blame" and responsibility are shifted onto others Implementation in animals will work only if measures are worked out together participants accept that there is room for improvement in every area we rethink our approach preventive rather than therapy medicine we see strategy implementation as an opportunity, and make use of it D. Heim,

23 D. Heim,

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