Concerns about antibiotic use and resistance, as full antibiotic course advice challenged

Vytenis Andriukaitis, European Commissioner for Health and Food Safety says: "To contain antibiotic resistance we need to fight on three fronts at the same time: human, animal and the environment. This is exactly what we are trying to achieve in the EU and globally with our recently launched EU Action Plan on antimicrobial resistance. This new report confirms the link between antibiotic consumption and antibiotic resistance in both humans and food-producing animals."

Experts highlight that there are still important differences across the EU in the use of antibiotics in animals and humans. Cutting their unnecessary use will have an impact on the occurrence of resistance.

Overall antibiotic use is higher in food-producing animals than in humans, but the situation varies across countries and classes of antibiotics. In particular, a class of antibiotics called polymyxins (which includes colistin) is used widely in the veterinary sector. It is also increasingly used in hospitals to treat multidrug-resistant infections. Other antibiotics are more often used in humans than in animals. These include third- and fourth-generation cephalosporins and quinolones, antibiotics that are also considered critically important for human health.

Experts note that resistance to quinolones, used to treat salmonellosis and campylobacteriosis in humans, is associated with use of these antibiotics in animals. The use of third- and fourth-generation cephalosporins for the treatment of infections caused by E. coli and other bacteria in humans is associated with resistance to these antibiotics in E. coli found in humans.

The report is the result of close cooperation between the three EU agencies, each drawing on their specific expertise and data from monitoring of antibiotic resistance and antibiotic consumption in animals and humans.

The conclusions are in line with those of the first report published by the three agencies in 2015. However, the availability of better quality data allowed a more sophisticated analysis.

Experts of the three agencies recommend further research to understand better how use of antibiotics and resistance affect one another.

The news comes as a high profile piece was published in the British Medical Journal (BMJ) on Wednesday, where a group of practicing physicians argues that the idea that stopping antibiotics early may be dangerous to the patient and society as a whole is not grounded in strong science and that policymakers, educators and doctors should drop this message.

In an opinion piece in the BMJ Martin J Llewelyn, professor of infectious diseases. “The idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance. Without explicitly contradicting previous advice, current public information materials from the US Centers for Disease Control and Prevention (CDC) and Public Health England have replaced ‘complete the course’ with messages advocating taking antibiotics ‘exactly as prescribed.’ We explore the evidence for antibiotic duration, clinical effectiveness, and resistance, and encourage policy makers, educators, and doctors to stop advocating ‘complete the course’ when communicating with the public. Further, they should publicly and actively state that this was not evidence-based and is incorrect.”

The authors argue: “The concept of an antibiotic course ignores the fact that patients may respond differently to the same antibiotic, depending on diverse patient and disease factors. Currently, we largely ignore this fact and instead make indication specific recommendations for antibiotic duration that are based on poor evidence. This situation is changing in hospital practice, where biomarkers of treatment response such as procalcitonin can guide when to stop antibiotic treatment. Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, in direct contradiction of WHO advice. Of note, a recent clinical trial found that using fever resolution to guide stopping antibiotics in community acquired pneumonia halved the average duration of antibiotic treatment without affecting clinical success. Further similar studies are needed.”

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