Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015

1. Hanne Bak Pedersen, Programme Manager
Health Technologies and Pharmaceuticals (HTP)
WHO Regional Office for Europe
Stockholm, 13 February 2015
Antimicrobial Medicines
Consumption (AMC)
Challenges of AMC data collection on national and
regional level in Europe

2. Key priorities of regional implementation
• African region
– Building integrated AMR surveillance
capacity
• Region of the Americas
– Regional integrated AMR surveillance
networks, national programmes on AMR
• Eastern Mediterranean region
– Increased attention, promotion of rational use and infection control
• South-East Asian region
– One health approach emphasized
• Western Pacific region
– AMR surveillance in the health sector
• European Region
– Implemetation of 2011 European strategic action plan on antibiotic
resistance

3. Registers and drug utilisation studies in
Europe
• ATC/DDD - “International language for drug utilization research” -
serve as a tool for presenting drug utilization research in order to
improve quality of drug use
• Experiences and use vary and WHO/Europe am supporting
countries with establishing medicines registers that build on the
ATC/DDD methodology to facilitate retrieval, compare data and
use evidence for policy action
• AMC is in target but with time the registers can expand and be
used to support appropriate use of medicines broadly
• Support from WHO Collaborating Centre for Drug Statistics
Methodology at the Norwegian Institute of Public Health

4. WHO/Europe AMC project
Initial findings: 2011 data in collaboration
with Antwerp University

5. Expanding AM consumption surveillance
throughout Europe
Use methodology
compatible with
ESAC-Net
Enable data
comparison in the
European Region
Lancet Infectious Diseases 2014
Published Online, March 20, 2014
http://dx.doi.org/10.1016/S1473-3099(14)70071-4

6. WHO/Europe AMC project
Preliminary 2013 results in collaboration with
Arno Muller

7. Consumption J01 2013
Total care – DDD per 1000 inh. per day
0
5
10
15
20
25
30
35
40
45
Turkey Montenegro WHO Serbia Ukraine* Belarus Republic of
Moldova
Georgia Bosnia and
Herzegovina
Azerbaijan
DDDper1000inhabitantsperday
Tetracyclines (J01A) Amphenicols (J01B) Penicillins (J01C)
Other beta-lactam antibacterials (J01D) Sulfanomides and trimethoprim (J01E) Macrolides, lincosamides and streptogramins (J01F)
Aminoglycoside antibacterials (J01G) Quinolone antibacterials (J01M) Combinations of antibacterials (J01R)
Other antibacterials (J01X)
* 2012 data

8. 0
5
10
15
20
25
30
35
40
45
2011 2013 2011 2013 2011 2013 2011 2013 2011 2013 2011 2013 2011 2013 2011 2013 2011 2013
Azerbaijan Bosnia and
Herzegovina
Belarus Georgia Republic of
Moldova
Montenegro Serbia Turkey Ukraine*
DDDper1000inhabitantsperday
Tetracyclines (J01A) Amphenicols (J01B) Penicillins (J01C)
Other beta-lactam antibacterials (J01D) Sulfanomides and trimethoprim (J01E) Macrolides, lincosamides and streptogramins (J01F)
Aminoglycoside antibacterials (J01G) Quinolone antibacterials (J01M) Combinations of antibacterials (J01R)
Other antibacterials (J01X) * 2012 data for 2013

9. Consumption J01 in Europe, 2013
Total care – DDD per 1000 inh. per day
0
5
10
15
20
25
30
35
40
45
Turkey
Greece
France
Montenegro
WHO
Belgium
Italy
Romania
Cyprus**
Luxembourg
Serbia
Slovakia*
Ireland
Malta
EUROPE
Spain*
Portugal**
Ukraine**
Belarus
Croatia
EU
RepublicofMoldova
Iceland
UnitedKingdom*
Bulgaria
Finland
CzechRepublic
Lithunia
Poland*
Georgia
Denmark
BosniaandHerzegovina
Norway
Austria*
Slovenia
Latvia
Germany*
Sweden
Hungary*
Estonia
Azerbaijan
TheNetherlands
DDDper1000inhabitantsperday
Tetracyclines (J01A) Amphenicols (J01B) Penicillins (J01C)
Other beta-lactam antibacterials (J01D) Sulfanomides and trimethoprim (J01E) Macrolides, lincosamides and streptogramins (J01F)
Aminoglycoside antibacterials (J01G) Quinolone antibacterials (J01M) Combinations of antibacterials (J01R)
Other antibacterials (J01X) * provided only community data
** 2012 data

10. Consumption of ATC J01 in Europe, 2013
Total care – DDD per 1000 inh. per day

11. Similarities/Differences between EU and
WHO methodologies
• Both methodologies are very similar
• Management of combined products is slightly different.
– WHO follows strictly the ATC/DDD methodology
– ECDC does not follow strictly the ATC/DDD methodology
– However both methods should give the same figures
ex: J01EE01
• WHO: 1 DDD = 4 unit doses (1 unit dose = sulfa: 0.4g, trim: 80mg)
• ESAC-Net: 1 DDD = 1.92g
• Main difference is the data sources and types used by both projects.
– WHO uses mostly wholesales (one country reported reimbursement
data), no clear differentiation between hospital and community
sectors
– ESAC-Net uses either sales or/and reimbursement data, for most of
the countries, it is possible to differentiate between both sectors

12. Member State actions taken examples:
Armenia: Development of national drug register ; MoH activities to increase
awareness on resistance to antibiotics; Development of
Strategy for Containment of Antimicrobial Resistance
Azerbaijan: Development of national drug register
Georgia: Lobbying for new law to stop OTC dispense of antibiotics; Activities to
increase awareness on resistance to antibiotics; Development of national AMR
action plan
Former Yugoslav Republic of Macedonia: MoH activities to increase awareness
on resistance to antibiotics; enforcement of prescription only dispensing
Kyrgyzstan: Development and adoption of national drug policy
Kosovo (in accordance with UN Security Council resolution 1244 (1999)) :Activities to increase awareness on
resistance to antibiotics incl. mass media
Serbia: Development of national drug policy; enforcement of prescription only
dispensing
Turkey: National plan on rational drug use (2013-2017); MoH activities to increase
awareness on resistance to antibiotics incl. mass media; enforcement of
prescription only dispensing

13. Next steps
• Multi-country AMR consultation 24-27 February
including ATC/DDD workshop, consultation on AMC
data from 2012-13 as well as on qualitative follow up
study initially carried out in Albania and Turkey
• Finalise and publish 2011/12/13 AMC data and
continue with 2014 surveillance
• The qualitative research protocol is developed with
the Institute of social pharmacy, Copenhagen
University and we plan to support that studies are
undertaken in all the AMC project group countries

14. Next steps: Responsible use of antimicrobial
medicines
• Regulatory mechanisms for new antibiotics
• Effective low-cost tools for diagnosis and susceptibility
testing – support appropriate use of these in the country
specific context
• Access to medicines accompanied by measures to
protect continued efficacy incl. in line with Good
Distribution Practices, prescription restrictions etc
• Codes of practice; standards for presence of
antimicrobials and antimicrobial residues in the
environment, water supply and food

15. Key messages for shaping and implementing
the Global Action Plan
Support country action:
• Strengthen national intersectoral and interdisciplinary
coordination
• Promote prudent use policies and enforcement
• Building surveillance capacity
• Awareness-raising among all stakeholders

16. Thank you for your attention !
The role of pharmacist in encouraging prudent use of antibiotic medicines
and averting antimicrobial resistance – a review of current policies and
experiences in Europe
http://www.euro.who.int/en/health-topics/Health-
systems/medicines/publications2/2014/the-role-of-pharmacist-in-
encouraging-prudent-use-of-antibiotic-medicines-and-averting-
antimicrobial-resistance-a-review-of-current-policies-and-experiences-in-
europe
Health Technologies and Pharmaceutical web site:
http://www.euro.who.int/en/health-topics/Health-systems/medicines
Programme manager hba@euro.who.int