AMR – There is a lot going on, but not enough One Health, Pete BORRIELLO
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3rd GRF One Health Summit 2015 Keynote V: AMR – There is a lot going on, but not enough One Health Peter BORRIELLO, Professor, Chief Executive Officer, Veterinary Medicines Directorate VMD, Surrey, United Kingdom
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AMR – There is a lot going on, but not enough One Health, Pete BORRIELLO
- 1. AMR - There is a lot going on, but not enough one health. Presented by: Professor Peter Borriello Date: October 2015
- 3. 3
- 5. Recent Global Initiatives 5 WHA resolution WHO action plan OIE resolution FAO resolution GHSA action plan
- 6. 6 AMR Assumptions which are Mostly Reasonable
- 7. The working Hypothesis 7 Antibiotic use Selection for resistance Commensal R genes Pathogen Complicates treatment Human
- 10. The Three Key Pillars of National and International Strategies 10 1.Optimal Stewardship to prolong active life of what we have 2.Prevention of spread of resistance 3.Develop alternatives
- 11. Drivers of Enhanced Selection and Maintenance of Antibiotic Resistance 11 Poor prescribing Counterfeits Globalisation Inappropriate dosing Slow diagnostics Market disincentives Variable regulation/guidance/education
- 12. Key Issues Within and Between Disciplines 12 Methodology Degree of Speciation Break-points Source of Isolates ECoFFs Drug-bug Combinations
- 13. MARAN: Salmonella CipR 2004 0.3% 2005 10.1%
- 14. MARAN: Salmonella CipR 2004 0.3% CBp>2µg/ml 2005 10.1% ECV 0.06µg/ml
- 15. Key Issues Within and Between Disciplines 15 Methodology Degree of Speciation Break-points Source of Isolates ECoFFs Drug-bug Combinations
- 16. High-Level comparison of veterinary and human use of antibiotics. 16 Animal Human Highest Use Lowest Use Livestock (farm) GP (Community) Companion animals (Community) Hospitals
- 17. Article 2
- 18. One Health Reports E.coli, salmonella, campylobacters. Issues: Sample size Incomplete speciation Methodology Dose data (human) Definition of R Sales data (animals) 18
- 19. Escherichia coli and Resistance to Key Antibiotic Classes 19 Cefotaxime/Ceftazidime 10% - Cefotaxime - 11% Ceftazidime - 6% Fluoroquinolones 18% 6% Gentamicin 9% 3% Antibiotic Human Animal
- 20. Salmonella and Resistance to Key Antibiotic Classes 20 Humans 2% 16% Cattle 0% 0% Chickens* 0% 1% (0%) Turkeys* 0% 7% (0%) Pigs* <1% (2%) 0% Sheep 0% 0% Cefotaxime Fluoroquinolones
- 21. Campylobacter and Resistance to key Antibiotic Classes 21 Fluoroquinolones Erythromycin Humans (c.jejuni) 47% 2.5% Chickens (c.jejuni) 31% 0% Humans (c.coli) 47% 8% Chickens (c.coli) 42% 3% Pigs (c.coli) 13% 28%
- 22. 22
- 23. Most commonly used Antibiotics 23 Human Animals 1. Penicillins 64% 1. Tetracylines 43.5% 2. Tetracylines 10% 2. Penicillins 22% 3. Macrolides 9.5% 3. Sulph/Trimeth 14.5% 4. Sulph/Trimeth 3% 4. Macrolides 10% 5. Other 13.5% 5. Other 10%
- 24. Use of Key Critically Important Antibiotics 24 Human Animal 1. Fluoroquinolones 12.3 (2.2%) 2.6 (0.6%) 2. 3rd/4th gen.cephalosporins 3.4 (0.6%) 1.2 (0.3%) 3. Monobactams/Carbapenens 3.5 (0.6%) 0
- 25. Lessons from the UK One Health AMR Report 25 1. Antibiotic use (Sales v prescription) 2. Campylobacter (human) - Routine labs no speciation, but CBPs - Reference lab speciation, but only ECOFFs 3. No adoption of a single standardised method in routine labs 4. No agreed common drug-bug combinations for key zoonotics.
- 28. 28 Thank You There is a lot going on, but not enough one health. https://www.gov.uk/government/publications/uk-one- health-report-antibiotics-use-in-humans-and-animals