January 3, 2012

Europe Market Review: EU resolution to tackle antimicrobial resistance
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By Steven Wheatley
A recent report by the European Centre for Disease Prevention and Control (ECDC) has indicated that more and more member states are registering increased numbers of antimicrobial resistance cases in hospitals. The report by the environment, public health and food safety committee has prompted members of the European parliament (MEPs) to call for prudent-use guidelines to avoid a "return to the pre-antibiotic era".
Antimicrobial resistance (AMR) is responsible for 25,000 deaths annually in the EU, Iceland and Norway and causes 2.5 million extra days in hospitals. In addition, the World Health organisation (WHO) stated that there are at least 440,000 cases of multi-drug resistant tuberculosis worldwide, resulting in over 150,000 deaths every year.
"The number of resistant bacteria in Europe in exploding," said Anna Rosbach, a Danish politician and an independent sitting in the European Conservatives and Reformists. "Bacteria travel across borders and are a threat for the whole of the EU. We must ensure that the use of antimicrobials for both humans and animals is reduced. "
Since antibiotics were approved for agricultural use, resistant strains have emerged in samples taken from both humans and livestock. For example, a class of antibiotics used in poultry feed, fluoroquinolones, resulted in the development of resistant Campylobacter strains, which according to the Food Standards Agency, was responsible for more than 371,000 hospitalisations in the UK in 2009 and cost more than £583 million (US$945.87 million) in 2008 alone.
In the US, before fluoroquinolones were approved for use in livestock production, there had been no cases of fluoroquinolones resistance reported in people*.  As a result, fluoroquinolones were banned by the US Food & Drug Administration (FDA) in veterinary use in September 2005. In April 2012, the FDA also ordered a ban on cephalosporins, another class of antibiotics used in veterinary medicine.
The EU resolution, which was passed on December 11, called for practical guidelines that will help to reduce non-essential exposure of antimicrobials in human and veterinary medicine, agriculture and aquaculture. The non-binding resolution, drafted by Rosbach, was adopted by 588 votes to 16 against, with 23 abstentions. 
MEPs have emphasised the need for better education and training among pharmacists, veterinarians and farmers and, in order to avoid creating economic incentives to prescribe, the resolution states that only professional veterinarians should have the right to prescribe antimicrobials for animals. In addition, MEPs have said that the veterinary use of third or fourth generation antimicrobials, which are classified as critically important for humans by the WHO, should also be restricted.
According to business consulting firm, Frost & Sullivan, in Europe the antimicrobial market had sales of €93 million (US$122.19 million) in 2005 and is expected to increase to €102 million (US$134.02 million) by the end of 2012.
The practical use of existing antibiotics, the development of new ones and improving animal husbandry have repeatedly been called for by European Council conclusions and European Parliament resolution during the last decade. Furthermore, individual member states have also taken action in an attempt to limit antimicrobial resistance in animals and humans. 
In 1986, Sweden became the first country in the world to control the reduction of synthetic growth promoters in animal feed production and, by 2009, sales of antibiotics used in agriculture had been reduced by a third. In the following years, Denmark, the United Kingdom and the Netherlands also began to regulate the use of antibiotics in their respective livestock industries.
Despite the gradual reduction of synthetic antibiotic growth promoters from 1992, in Denmark swine and poultry production continued to flourish. According to the BC Medical Journal, between 1992 and 2008 swine production in Denmark increased by 47%, despite reducing antimicrobial use by over 50%. In addition, despite reducing antimicrobial use by 90 per cent, Denmark's production of poultry continued to increase slightly.
These examples show that with the necessary methods, such as improved animal husbandry and practical disease control measures, the use of antimicrobials in agriculture can be significantly reduced without causing substantial disruptions in EU livestock industries.
Moreover, despite the new resolution, many in the livestock and pharmaceutical industries are confident that viable alternatives will be available quickly and the transition to wide-spread usage of natural antimicrobials rather than synthetic versions will be swiftly implemented.  Due to tougher food regulations and increased consumer consciousness over the past decade, there has been substantial growth in the advancement of natural alternatives in lieu of synthetic antimicrobials.
Some of the leading players in the antibiotic market, such as Pfizer and Gillco, are increasingly focused on delivering a platform for new anti-infective products for the livestock industry, which utilise natural and organic growth promoters.
In June this year the Dutch Ministry of Economic Affairs, Agriculture and Innovation financed an exclusive research collaboration programme to the sum of €7.95 million (US$10.45 million). The sum is the largest ever granted in the European Union for this style of holistic research and is evidence of the growing importance and necessity dedicated to this market.  The research will be carried out by, among others, the ASIA Research Consortium, Pfizer Animal Health and the University of Utrecht and aims to curb our dependence on synthetic growth promoters by developing natural antimicrobials that can be used throughout the livestock industry.
*This excludes people that had either previously taken the drug for an illness or had travelled to a country that permitted the use of fluoroquinolines in agriculture.

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