Spoilt for choice? Drawing up guidelines on prudent use of antimicrobials in human medicine

Looking for technical guidance by the European Centre for Disease Prevention and Control (ECDC), the European Commission feels that now is the right time to act and develop guidelines on prudent use of antimicrobials in human medicine, similar to those that already exist in veterinary medicine. But how specific can they be if they are intended to apply in all of Europe?

What’s the relevance?

At a meeting of Member States and Stakeholders that took place on 25 May 2016 in Luxembourg, Martin Seychell (DG SANTE) presented AMR as a major patient safety issue that has the potential to completely disrupt healthcare delivery while causing unimaginable economic losses at the same time.

Despite its limited competences in human health, in light of growing international recognition the Commission would like to seize the opportunity and display its added value by supporting Member State and stakeholder actions on tackling AMR in human health. These ‘must happen on the ground, all the time’. Contact with the healthcare system is the most common source of infections in individuals, making the health system the biggest driver of AMR in humans.

The Commission believes its effort is best made in areas with a cross-border dimension like surveillance, documenting and exchanging good practices, as well as supporting the development and implementation of National Action Plans based on the One Health concept.

The agony of choice

Effective, evidence-based guidelines in human medicine can be a useful tool because their routine application would contribute to a reduction of infections by supporting healthcare professionals in their daily practice. All relevant actors must be aware of their roles and, crucially, their responsibilities. This can best be achieved by including illustrative good practices in each section in order to demonstrate what works and build up European-wide consensus.

However, as EPHA will be discussing at its 2016 Annual Conference, AMR is rooted in much broader and complex health system problems that go beyond the realm of individuals. These are related as much to healthcare facilities’ resources as to the dominant systems and processes at play. Several Member States stressed that the guidelines must frame AMR as a priority issue in human health so that decision-makers will be urged to implement the right policies and know exactly what needs to be achieved.

They also pointed out that the cultural dimension remains very strong; what works in Northern Europe is not necessarily replicable in other Member States, even if the same principles apply. Hence any recommendations must be accompanied by realistic implementation options for countries and, wherever possible, by indicators.

Moreover, the discussants agreed that the guidelines should cover topics including good prescribing practices, awareness raising, education, surveillance and monitoring, and research. They would need to be broad in scope yet specific enough (e.g. in the area of infection control) in order to stimulate political commitment.

Of course, having guidelines does not mean they will be adhered to. Therefore, it would be particularly valuable if they could be backed up by a powerful ‘peer pressure’ mechanism that would guarantee their take-up across Europe, based on the local resistance situation.

Next steps?

Dominique Monnet (ECDC) explained that, following an internal expert meeting in June at ECDC, a public consultation would be launched in July-August. Preliminary results will be discussed at another stakeholder meeting on 16 September, with the final draft guidelines to be delivered to DG SANTE by 31 October.

EPHA is looking forward to engaging with the ECDC and other stakeholders in this process, and believes that the guidelines on prudent use of antimicrobials in human medicine should become an indispensable building block of the EU’s policy to combat drug-resistant infections and advance antimicrobial stewardship.

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