The document outlines a multi-annual questionnaire aimed at improving the European Centre for Disease Prevention and Control's (ECDC) understanding of antimicrobial use across EU member states. It will cover topics such as prudent use of antimicrobials, changes in regulations, the pharmaceutical market, and epidemiological information, with the aim of gathering detailed data every three years. This initiative seeks to enhance ECDC's ability to interpret consumption data and develop strategic objectives.

1. 3rd Joint Meeting of the Antimicrobial Resistance and
Healthcare-Associated Infections (ARHAI) Networks
Multi-annual questionnaire
Arno Muller (Contractor to ECDC), Klaus Weist for the
ARHAI Programme, European Centre for Disease Prevention and Control
Stockholm, 11‒13 February 2015
Organised jointly with

2. Background
ECDC manages the ESAC-Net database that:
• contains data from all except one EU/EAA countries
• contains 17 years of data
• contains data at the substance level (even product level)
• contains standardised, reliable and comparable data
These are fantastic data!
ECDC can:
• have an online public interactive database
• develop reports showing tables, graphics, maps
• do some statistics with these data

3. But,
ECDC has only to a limited extend knowledge about:
• the pharmaceutical market
• actions taken by the MS to improve the use of antimicrobials
• Additional epidemiological data related to antimicrobial use
at the country level
Thus additional information by the MS would allow ECDC:
• to have a better overview of what is going on in the EU
• to have materials at its disposal for interpreting annual
changes in the consumption data
• to have a more solid base for developing its mid to long
term strategy

4. Objectives
• To invite the MS to provide this important information to
ECDC at a regular interval.
• This would be done in the form of a multi-annual
questionnaire.
• The collected information should help ECDC experts to
better apprehend the situation in the MS.
• It should not be used to draw simple conclusions with
respect to changes in antimicrobial consumption

5. The multi-annual questionnaire
• The questionnaire will be split into the topics:
–prudent use of antimicrobials
–pharmaceutical market
–epidemiological information
• The questions would be mostly open questions to provide
best options for individual answers by the MS
• The frequency would be every three years.
• The MS would be asked on the past three years and what is
planed for the next three years.

6. Prudent use of antimicrobials
This topic is about actions (excluding changes of laws/regulations)
conducted by MS in order to improve the use of antimicrobials.
The main point of this topic is about campaigns.
The gathered information could be related to:
• type of a campaign (national, regional);
• material/media of campaigns (TV, newspapers, posters, technical documents…),
• type of target (public, doctors (GP, specialists, hospital doctors), other healthcare
professionals (dentists, pharmacists);
• duration; is it limited in time or will it be done, e. g. repeatedly;
• frequency; is it repeated every year (how long) or one shot campaign;
• period of the year the campaign will be run;
• main content, aims and justification of the campaign.

7. Laws and regulation related
to antimicrobial use
This topic is about changes in the law or of regulations that
can have a direct impact on the use of antimicrobials.
The sub-topics of interest for ESAC-Net are:
• changes in procedures for authorization / withdrawal of
antimicrobials;
• changes in procedures for prescribing/ delivering
antimicrobials to end users;
• changes in how antimicrobials are reimbursed.

8. The pharmaceutical market
This topic is related to the pharmaceutical market in the
country and focused on antimicrobials.
Information about the actors:
• number of marketing authorization holders
• wholesalers
• import/export of antimicrobials
Information about the antimicrobial products:
• new generics
• new products
• withdrawal (temporary/definitive) of products

9. Epidemiological information
• Information about the dosing of some (main) substances
will be collected.
• The dosing will be collected for specific clinical indications
either from actual data (e. g. surveillance data, audit) or
from national guidelines if no data are available.
• The eligible substances could be selected as the main
substances used from the ESAC-Net database. Selection of
clinical indications should be done on their importance in
term of frequency/burden.

10. Discussion
Would you agree on the principles?
• Multi-annual questionnaire
• Every three years repeated
• Open questions will be used
• The suggested topics
The questionnaire would be further discussed within the ESAC-
Net Coordination Committee.
Finally, the multi-annual questionnaire might also be useful for
the MS to write the annual public comment that is shown in
the country summary sheets in the public interactive database.