Transcript EP-ECDC Debate - Brussels Oct 16th 2007 Raising Public

European Joint Meeting of AMR National Focal Points
and Chief Medical Officers
Ljubljana, Slovenia, 14 March 2008
Raising Awareness about
Antibiotic Resistance
National Public Campaigns on
AMR and Rational Antibiotic Use
France 2001-2008
Prof. Benoît SCHLEMMER
University Paris-VII School of Medicine and St-Louis Hospital, Paris
Head of the French National Committee « Keep Antibiotics Working »
Preparing for a national policy
1990-98 : An expert growing concern about AMR
•
Following actions to control for in-hospital AMR and hospital-acquired
infection (MRSA...)
•
Building a national AMR Network from pre-existing surveillance systems Raising evidence of increasing resistance rates in common bacterial species
– Penicillin-resistant S. pneumoniae in young children AOM and meningitis
•
Evidence of French antibiotic overuse/inappropriate use and questionable
quality of care
•
Outdated recommendations for medical practice :
– Systematic use of antibiotics in acute sore throat...
– People misunderstanding perception about antibiotics...
•
Need for action and political support
Moving towards a recognized political issue
1998-2001
• The 1998 Copenhagen European Conference
• French Institute for Public Health Surveillance
1999 Conference on « Control of AMR », on behalf of the French
Ministry of Health : monitoring, prevention of transmission,
correct antibiotic use, research promotion
• « Antibiotic Mission » upon request of the French Minister of
Health, B. Kouchner : a proposition for a National « antibiotic
plan »
• Autumn 2001 : official announcement of the Plan « Keep
Antibiotics Working », as part of the fight against AMR
– Primary care medicine : actions towards health professionals
and the general public;
– Hospitals
Antibiotic use in primary care medicine
Keypoints of the French Campaign
Part of the National Action Plan “Keep Antibiotics Working”
• Goal of the campaign "Antibiotics, it’s not automatic!"
– To increase general public awareness about AMR and knowledge about
the role of antibiotics
– To decrease outpatient antibiotic use
• Operator : the French Social Insurance
System (Assurance-Maladie)
• Actions and Agenda :
– a yearly autumn-winter 6-month campaign 2002-2007
– TV and radio humorous spots, press releases,
information leaflets… Cost = 4 M €/year
– Academic detailing of GPs
• Indicators :
– People perceptions about antibiotics
– Seasonal antibiotic consumption (Oct-March winter period); data adjusted
for epidemic variations
– Antibiotic resistance
Results of National Public Campaigns
in France 2002-2007
• People are more aware about antibiotics :
– 67% agree that resistances appear when antibiotics
consumption is too high (+12),
– 40% agree that antibiotics are active against bacteria
only (+10),
– Yet 54% agree that antibiotics get you back on your
feet more quickly (-10).
• 23.4% decrease in outpatient antibiotic consumption :
- 34 % for children < 15 y.o.,
- 17.6 % for others
• 850 M € saved
ABT prescriptions from 2001-02 to 2006-07
(Oct-March periods)
Antibiotic consumption by age and year 2001-2007
(Yearly October/March periods)
Pour les moins de 2 ans, la baisse équivaut à un traitement en moins par hiver
Pour les jeunes actifs (26/35 ans) : une baisse qui se maintient (- 5,7 % en moyenne)
General population : Regional antibiotic prescriptions
(yearly october-march periods, adjusted data)
La moyenne nationale pour l’hiver 2006-2007 : 5,1 prescriptions pour 10 habitants
contre 6,7 pour l’hiver 2001-2002
*Réalisé à l’aide de Cartes et Données
Penicillin resistance (% PSDP) in S. pneumoniae
National Reference Center - France
52 53
48
48
43
43
38
% PSDP
36
32
25
17
20
4
5
1987
1988
12
7
2005
2004
2003
2002
2001
1997
1996
1995
1994
1993
1992
1991
1990
1989
1986
1985
1984
0,5 0,7 1
1984-1997, Geslin P. ; 2001-2005, ORP-CNRP , Varon E., Gutmann L.
(All-type bacterial samples, all age patients, 48 920 strains studied)
Reasons for a success story
• Agreement between all experts and
multidisciplinary approach
• Political support – Funding of the campaign
• The Antibiotic Plan : not an official body; just
an expert committee to suggest, harmonize,
mobilize…, but with an official recognition
• Help of law and new agencies :
– Public Health Law 2004 (the AMR item)
– French National Authority for Health + French Institute
for Public Health Surveillance
Flaws of the campaign and lessons for
the future (or for others !!)
• The difficult fight against cultural and
social-medical behaviours
• Misunderstanding by health professionnals
• The payor is the main operator : what is
the true goal of the campaign ?
• (Concurrent in-hospital changes)
Conclusions
• Political/official support as a Public Health
priority
• Funding
• Repeated, long term actions…
• Mandatory follow-up of :
– Antibiotic consumption : which system ?
– Bacterial resistance
– General public and healthcare professionnals
opinions