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Key Strategies for Improving Use of Existing and New Antibiotics -the European Experience

Key Strategies for Improving Use of Existing and New Antibiotics -the European Experience. Otto Cars Professor Inf. Diseases, Uppsala University, Sweden Chairman, ReAct – Action on Antibiotic Resistance . www.reactgroup.org. What is the European Union?. 27 Member States

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Key Strategies for Improving Use of Existing and New Antibiotics -the European Experience

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  1. Key Strategies for Improving Use of Existing and New Antibiotics -the European Experience Otto Cars Professor Inf. Diseases, Uppsala University, Sweden Chairman, ReAct– Action on Antibiotic Resistance www.reactgroup.org

  2. What is the European Union? • 27 Member States • 23 official languages • > 500 million inhabitants(per country: 416,333 – 81.7 million) • €25,100 GDP/capita (per country : 10,400 – 69,300) • A patchwork of cultures! 1 € = 0.88 £ = 1.43 US$

  3. AntibioticResistance - the viciouscircle No funding No data No awareness No priority

  4. Key Strategies for Improving Use of Existing and New Antibiotics -the European Experience Data Awareness National coordination Interventions

  5. Klebsiellapneumoniae:proportion of multidrug*-resistant invasive isolates resistant, 2010 European AntibioticResistanceSurveillance: EARS-net *Resistant tothird-generationcephalosporins, fluoroquinolones and aminoglycosides Source: EARS-Net, 2011.

  6. European Surveillance of AntibioticConsumption (ESAC) Outpatient antibiotic (J01) use, by antibiotic class according to ATC classification, 2009 UK Czech Rep. Source: European Surveillance of Antimicrobial Consumption (ESAC). Cyprus and Lithuania: total use, i.e. including inpatients. Spain: reimbursement data, i.e. not including over-the-counter sales without a prescription, Source: ESAC, 2011.

  7. Human burden Economic burden Burden of multidrug-resistant (MDR) bacteria in the EU, Iceland and Norway • Infections (6 most frequent MDR bacteria, 4 main types of infection) approx. 400,000 / year • Attributable deaths approx. 25,000/ year • Extra hospital days approx. 2.5 million / year • Extra in-hospital costs approx. € 900 million / year • Productivity losses approx. € 600 million / year SoLimitation: these are underestimates Source: ECDC, 2009.In:http://ecdc.europa.eu/en/publications/Publications/0909_TER_The_Bacterial_Challenge_Time to_React.pdf

  8. 18 November 2011 http://antibiotic.ecdc.europa.eu

  9. Images from national campaigns on prudent use of antibiotics

  10. Council Recommendation on the prudent use of antimicrobial agents, 2001 Photo: Stuart Chalmers, CC-BY Council Recommendation of 15 November 2001 on the prudent use of antimicrobial agents in human medicine (2002/77/EC)

  11. Implementation of National Intersectoral Coordination Mechanisms on AMR As of 2008, 18 EU Member States and Norway had implemented an Intersectoral Coordination Mechanism Adapted from: European Commission, Directorate - General Health and Consumers, 2010. http://ec.europa.eu/health/antimicrobial_resistance/key_documents/index_en.htm

  12. Antibiotic presciptions/1000 in different age groups in Sweden

  13. Antibiotic Use by Age Group in France http://www.ameli.fr/fileadmin/user_upload/documents/DP_Antibiotiques_10-01-2008.pdf

  14. Decreases in antimicrobial resistance following national media campaigns France Belgium Source: French Nat. Ref. Ctr. for S. pneumoniae (Courtesy: E. Varon, L. Gutmann & B. Schlemmer) & Belgian Nat. Ref. Ctrs. for S. pneumoniae and for S. pyogenes (Courtesy: BAPCOC, H. Goossens)

  15. Cathegory • Community aqcuired? • Hospital acquired? • Surgicalprophylaxis? • Specificindication • Septicemia? • Pneumonia? • Woundinfection? • UTI?

  16. Changing prescribing pattern in pneumonia through real time feedback (DDD defined daily dosages) Implementation of SAI A user friendly system coupling prescriptions to diagnosis in hospitals

  17. We are facing a public healththreat AntibioticResistance DrugDevelopment Morbidity Mortality Costs

  18. Is there a need to change the present market system ? YES !

  19. Innovative Incentives for Effective Antibacterials Aconference during the Swedish Presidency of the EU 2009 focusing on the need to reinvigorate research and development of new antibiotics Governments Academia Pharmacuetical and biotech industry Civil society

  20. Urgent need for new antibiotics Market failure Impending health crisis High health and economic burden from resistance Justifies intervention from the public sector

  21. Urgent need for new antibiotics The overall innovative capacity is low There are major scientific challenges Who is going to do the work? Big Pharma? Small pharma? Academia? New collaborativemodelsneeded

  22. Urgent need for new antibiotics Butwecannotkeep (mis)using them the waywehave for the last 70 years! Marketing and useneeds to be restricted De-linkingreturn of investment from sales ! Weneed a new business logic!

  23. From the EU Commission Action Plan on AntimicrobialResistancelaunched TODAY in Brussels

  24. A new business model must be built on the global needs and secureaccess and affordabilityas well as rationaluse Access Excess Adapted from Källander, 2005

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