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National antibiotic program in the Czech Republic
NAP-CZ
Vlastimil Jindrák and Subcommitte for antibiotic policy ČLS JEP
Milestones of NAP-CZ…
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1970 – 75
1990
1997
2001 – 02
2003
2003 – 04
2005
2005
2006
2006
2007
2008
2008
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Establishing Antibiotic Centres
Establishing Working Group for AMR surveillance
Subcommittee for antibiotic policy (co-ordinating group)
Preparatory working group for NAP-CZ in MoH
Basic document of NAP-CZ, Committee in MoH
Quality projects focused on AMR
WHO country visit: recommendations to MoH
NAP Action plan – 2005
NAP Action plan – 2006-07, WHO-ECDC co-operation
Committee in MoH cancelled
Negotiations SKAP – MoH: New model of NAP
MoH decision: New model of NAP
AMR: priority for future EU Presidency of CZ
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Subcommittee for Antibiotic Policy (SKAP)
structure of the Czech Medical Association J.E.Purkyně
SKAP structure
SKAP activities
interdisciplinary and intersectoral
principle, confirmation of membership
by professional societies
opponency and guarantee by
professional societies, acceptation by
presidium ČLS JEP
microbiology, epidemiology
guidelines – ATB consensus
pharmacology, pharmacy
guidelines – therapy, prophylaxis
infectious diseases
guidelines – AMR control
paediatrics
SKAP
AP organization, ATB centers
general practice
action plans, interventions
intern. med. (chemotherapy)
internat. co-operation, projects
veterinary medicine
co-operation with veterinarians
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Intersectoral Coordination Mechanism
Local level
National level
Ministry of Health
Antibiotic
centres
Working
groups
National Institute
of Public Health
Subcommitte on ATB Policy
Czech Medical Association
Professional Societies
National Antibiotic
Programme
co-ordinating group
Veterinary
antibiotic
centres
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Ministry of Agriculture
State Veterinary
Administration
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Antibiotic centers
basic operating units of NAP-CZ
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Activities of antibiotic centers
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Local surveillance of AMR in hospitals and community
Local surveillance of ATB use in hospitals and community
Consulting antibiotic use
Improving quality of antibiotic use – local interventions
Categorisation of antibiotics (restricted drugs)
Preparation and updating local guidelines
Education
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Antibiotic consumption in the Czech Republic
trends in ambulatory consumption 1989 - 2000
14 DDD/1000/day (1989)
19 DDD/1000/day
(1999)
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4,5
DDD/1000/day
4
3,5
macrolides
penicillin
aminopenicillins
co-aminopenicillins
cephalosporines
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2,5
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1,5
1
0,5
0
89 90 91 92 93 94 95 96 97 98 99 00
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Intervention in primary paediatric care (ATB consumption – ESAC)
repeated, multicentric ATB prescribing audit 1998-02
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intervention in primary
paediatric care - 2001
30
1998
1999
2000
2001
2002
2003
25
20
15
10
5
0
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CZ
SK
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Resistance S.pneumoniae in Europe - EARSS-2005
penicillin
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Resistance S.pyogenes to erythromycine in CZ
trend 1996 – 2005, data NRL for antibiotics
intervention in primary
paediatric care - 2001
20,0
15,0
10,0
5,0
0,0
1996
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1997
1998
1999
2000
2001
2002
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Invasive MRSA in CZ hospitals
trend in 2000 – 2005 (EARSS data)
60
4.3 %
5.9 %
5.9 %
6.1 %
8.5 %
12.9 %
number of hospitals
50
40
30
51
20
31
10
11
19
21
2001
2002
36
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2000
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Klebsiella pneumoniae – EARSS 2005
resistance to 3rd generation cephalosporins
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AMR problems in CZ hospitals
Potential reasons for increasing trend
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Lack of systematic interventions for improving ATB use
(auditing, feed-back for prescribers and consultants…)
Sub-optimal hospital infection control programmes (lack of
capacities for isolation, missing infection control nurses…)
Performance-oriented hospital care, de-motivating economic
feed-back, sub-optimal organisation of intensive care
Influence of pharmaceutical industry
Need for innovation of local ATB stewardship programmes
Need for improvement of local infection control programmes
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National antibiotic program – Czech experience
Conditions for future developments, benefits and efficiency
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Wide activities realised on the voluntary basis are not
sustainable in long-term perspective and decline efficiency
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Support of government is essential for successful NAP
activities at the national level
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The role of government consists in creating sufficient
conditions for complex professional activities (realizing
action plans), not in direct management of NAP by state
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Organizational structures of low vulnerability by political
changes are necessary for long lasting stability, continuity
and efficiency of NAP
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