Preventive Veterinary Medicine
|
|
- Ethelbert Parrish
- 6 years ago
- Views:
Transcription
1 Preventive Veterinary Medicine 130 (2016) Contents lists available at ScienceDirect Preventive Veterinary Medicine journal homepage: Quantitative and qualitative antimicrobial usage patterns in farrow-to-finish pig herds in Belgium, France, Germany and Sweden M. Sjölund a,b,, M. Postma c, L. Collineau d,e, S. Lösken f, A. Backhans b, C. Belloc e,g, U. Emanuelson b, E.Gro e Beilage f, K. Stärk d, J. Dewulf c, on behalf of the MINAPIG consortium a Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute, SVA, SE Uppsala, Sweden b Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE Uppsala, Sweden c Veterinary Epidemiology Unit, Department of Reproduction, Obstetrics and Herd Health, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium d SAFOSO AG, Waldeggstrasse 1, CH 3097 Bern Liebefeld, Switzerland e UMR1300 BioEpAR, LUNAM Université, Oniris, INRA, F Nantes, France f Field Station for Epidemiology, University of Veterinary Medicine Hannover, Büscheler Straße 9, D-49456, Bakum, Germany g INRA, UMR1300 Biology, Epidemiology and Risk Analysis in animal health, CS 40706, F Nantes, France a r t i c l e i n f o Article history: Received 25 January 2016 Received in revised form 13 May 2016 Accepted 1 June 2016 Keywords: Pig Antimicrobial consumption Use Treatment incidence Antibiotic a b s t r a c t Data on sales of antimicrobials using a standardised methodology have shown that there are vast differences between countries in amounts of antimicrobials sold for food-producing animals, but these data do not provide insight on how sales are distributed by species and age groups. The aim of this study was to compare herd level antimicrobial usage for pigs by age category, antimicrobial class and administration route for farrow-to-finish herds in four EU countries. A cross-sectional study was conducted among 227 farrow-to-finish pig herds with at least 100 sows and 500 finishing pigs in Belgium (n = 47), France (n = 60), Germany (n = 60) and Sweden (n = 60). Detailed information about the antimicrobial consumption for breeding and growing pigs was collected. Antimicrobial usage was quantified as active substance expressed as mg and then converted to treatment incidence (TI) based on Defined Daily Doses Animal per 1000 pig-days at risk. TIs varied between and within countries, herds and age groups. The Swedish herds had the lowest and the German herds the highest overall use. Most treatments were applied to weaned piglets except in the Swedish herds where treatments of suckling piglets were most frequent. Antimicrobials were most often applied through feed or water except in the Swedish herds where parenteral treatments were most frequent. Aminopenicillins was the antimicrobial class most commonly used. Use of third and fourth generation cephalosporins constituted 11% of use for the Belgian herds, which was higher compared to the other countries. There was a significant (p < 0.01) association between the within-herd antimicrobial use across different age categories. This study has shown that there were large differences in antimicrobial use for pigs between countries, herds and age groups in farrow-to-finish herds of similar size when actual consumption data were compared. Collecting detailed usage data can be used to efficiently target high users in order to reduce antimicrobial consumption Elsevier B.V. All rights reserved. 1. Introduction Antimicrobials are crucial to both veterinary and human medicine but its use is hampered due to the risk of selection for and spread of resistance. Levels of resistance in pathogens varies Corresponding author at: Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute, SVA, SE Uppsala, Sweden. address: marie.sjolund@sva.se (M. Sjölund). between countries (European Food Safety Authority (EFSA, 2015)) and when data on sales of antimicrobials for food-producing animals were compared to data on antimicrobial resistance, a clear association between use and resistance was found (Chantziaras et al., 2014; European Centre for Disease Prevention and Control (ECDC, 2015)) To retain a multitude of treatment options, it is therefore of utmost importance to reduce antimicrobial use to a minimum but without jeopardising animal health. Further, whenever antimicrobials are required to treat infectious diseases in animals, they should be applied prudently in line with the recently / 2016 Elsevier B.V. All rights reserved.
2 42 M. Sjölund et al. / Preventive Veterinary Medicine 130 (2016) issued Guidelines for the prudent use of antimicrobials in veterinary medicine by the European Commission (Commission Notice, 2015). For a number of years, data on sales of antimicrobials using a standardised methodology have been available which has allowed for comparisons between countries and provided valuable information for future work on reducing antimicrobial use (European Surveillance Veterinary Antimicrobial Consumption (ESVAC, 2015)). The ESVAC reports have shown that there are vast differences between countries in amounts of antimicrobials sold for food-producing animals (Grave et al., 2014; ESVAC, 2015), but these data do not provide insight on how sales are distributed by species and age groups. Other sources however have shown that the use of antimicrobials for pigs is higher than for other species (Merle et al., 2012; Bondt et al., 2013; DANMAP, 2013; Hosoi et al., 2013) and use may differ between age groups (Dunlop et al., 1998; Hybschmann et al., 2011; Callens et al., 2012; Jensen et al., 2012; Moreno, 2014; van Rennings et al., 2015). Comparing the sales on species level may change the relation between countries with regards to sales, as size and structure of the pig producing sector varies considerably between the European countries (Eurostat, 2014). Further, sales figures (expressed in kg active substance in relation to a certain measure of biomass produced) are only a crude measurement of actual consumption and do not provide insight into actual use and how use with regards to antimicrobial substance is distributed between different animal species and age categories. Moreover they do not take into account the huge differences in dosage between different antimicrobial compounds. As also suggested by ESVAC (ESVAC, 2015) and others (Bondt et al., 2013), a more detailed data collection of usage on species level would allow for a more in-depth analysis of antimicrobial consumption in different countries with different animal populations and production types. If antimicrobial usage data can be collected on herd level in a standardised manner, benchmarking could be applied across nations to stimulate reduction of antimicrobial use. Benchmarking has previously been shown to be an effective tool in Denmark (Jensen et al., 2014) and the Netherlands (Bos et al., 2013; Autoriteit Diergeneesmiddelen SDa, 2014; Speksnijder et al., 2014), and a similar farm level approach has recently been introduced in Belgium (Antimicrobial Consumption and Resistance in Animals (AMCRA, 2014)). The present study was initiated as a first step for comparing antimicrobial usage on herd level in different countries using a standardised methodology. The specific aim of the study was to compare herd level antimicrobial usage by age category, antimicrobial substance and administration route for farrow-to-finish herds in four different EU countries with different intensities of pig production. Our hypothesis was that usage differs between countries and age groups as well as usage patterns with respect to administration route and choice of active substances. This study was conducted within the European research project MINAPIG (Evaluation of alternative strategies for raising pigs with minimal antimicrobial usage: Opportunities and constraints, eu). 2. Material and methods 2.1. Selection of herds A cross-sectional study was conducted among 227 farrowto-finish pig herds located in Belgium (n = 47), France (n = 60), Germany (n = 60) and Sweden (n = 60) between December 2012 and December Inclusion criterion was the presence of at least 100 sows and 500 finishing pigs. In Belgium, herds located in the Flanders region (representing 90% of the national pig production) were recruited among those subscribing to a professional newsletter regularly issued by the University of Ghent. The newsletter is distributed to 609 subscribing farmers, veterinarians and other herd advisors with a known interest in biosecurity in pig production. In France, a simple random sample of 110 herds was drawn from a technical database maintained by the French Institute for pig and pork industry (IFIP) which on average covers 46% of the French pig herds with more than 50 sows. Inclusion criteria included localization in the North western region (representing 75% of the French pig production), as well as the presence of at least 100 sows and 500 finishing pigs. Eleven herds were excluded from the original sample mostly due to previous refusal to participate in studies. From the remaining sample, 79 herds were contacted to get the sample of 60 herds. German herds were recruited via consultancy circles together with contacts provided by several veterinary practices in the three regions, Mecklenburg-Vorpommern, Niedersachsen and Nordrhein-Westfalen, with the largest pig production constituting 64% of the total German pig production (Statistisches Bundesamt, 2014). Consultancy circles are regional farmers organisations for pig producers as well as agricultural consulting organisations. A consultancy circle consists of a number of chairpersons together with ordinary members. Several, ten to 15, of the study herds belonged to a consultancy circle in Vechta, Kreislandvolkverband Vechta, which represented 2000 members and 1600 active farms. The office in Vechta employed 50 persons. Swedish herds were selected on a willingness to participate basis among herds either affiliated with the Swedish Animal Health Service (SvDHV) with a herd veterinarian working for SvDHV, or were herds with previous contact with researchers at the National Veterinary Institute as previously described (Sjölund et al., 2015) Collection of antimicrobial consumption records Herd visits were undertaken between December 2012 and December During the herd visits, detailed information about the antimicrobial consumption of breeding and growing pigs was collected. In Belgium, France and Germany, all herds were visited by the same investigator within country. These investigators were researchers within MINAPIG except in France where a veterinary student in the final year conducted all data collection for the students graduation project. In Sweden, recruited herds were visited either by the herd veterinarian from SvDHV (46 herds and 15 veterinarians) or by a researcher within MINAPIG (14 herds and 2 veterinarians) if the herd was not affiliated with SvDHV (Sjölund et al., 2015). Antimicrobial consumption data for the participating herds were collected for one year preceding the visit in Belgium, Germany and Sweden and for the last batch in France. Invoices from veterinarians and feed companies combined with information from the farmer were used in Belgium. Dispensing and application forms from the prescribing veterinarian used as treatment records were used for the German herds. In Sweden, antimicrobial consumption data were retrieved from the farmers treatment records. In France, antimicrobial consumption data were retrieved from the farmers treatment records together with farmers directed interview. Data collection was based on a form developed within the MINAPIG Consortium which can be provided by the authors of the article on request. Antimicrobial consumption, expressed as volume or mass, was recorded by product, strength of product, administration route and age category (breeding pigs, piglets, weaners and finishers) Quantification of antimicrobial consumption Antimicrobial usage was quantified using the ABcheck.UGent TM online tool developed by the Unit for Veterinary Epidemiology of the Faculty of Veterinary Medicine, University of Ghent ( The ABcheck converts recorded antimi-
3 M. Sjölund et al. / Preventive Veterinary Medicine 130 (2016) crobial use to active substance expressed as mg and then to treatment incidence (TI) based on Defined Daily Doses Animal (DDDA). The TI is given as the number of DDDAs per 1000 pig-days at risk which is equivalent to how many pigs per 1000 pigs receiving a dose of antimicrobials each day (Timmerman et al., 2006). The TI was calculated for each herd and age group in accordance with Timmerman and co-workers (Timmerman et al., 2006) as follows: Total amount of antimicrobials administered (mg) Total amount of antimicrobials administered (mg) TI = DDDA (mg/kg/day) number of days at risk kg animal at risk 1000 pigs at risk Previously established consensus DDDAs, as described by Postma and co-workers (Postma et al., 2015b), were used. Briefly, DDDAs were established by taking the mean of the recommended dose per kg for all products authorised for pigs with the same active substance and the same administration route. All antimicrobials were classified according to the anatomical therapeutic chemical veterinary (ATCvet) classification system (World Health Organization WHO, 2013 Postma et al., 2015b). TI calculations were performed for each administered antimicrobial product per age category. All TIs for the different products used were then added to each other to reach the overall TI for the particular age category. The number of days at risk for each age category was equal to the rearing period for that category. This is the time period when a pig could receive treatment with antimicrobials. The actual length in days of the rearing periods for the different age categories, i.e. the number of days for the suckling, weaning and fattening periods as defined below, of the individual herds as reported by the farmers were used in the calculations. For breeding pigs (boars, sows, gilts), the time period was set to 365 days. The following age categories were used for the calculation: suckling piglets (birth to weaning); weaners (weaning to an approximate weight of kg), fatteners ( 30 kg to slaughter) and breeding pigs including gilts. The kg animal at risk is the total weight of pigs for that particular age category (in kilograms). Uniform weights agreed on by the MINAPIG consortium were used. These weights represent the assumed average weight at treatment and were: two kg for suckling piglets, seven kg for weaners, 35 kg for fatteners, 60 kg for gilts and 220 kg for adult pigs (boars and sows). They were subsequently multiplied with the average number of pigs in a batch calculated from the total number of pigs produced per year for the respective age groups and then divided by the number of batches in a year. For adult pigs, the average number of gilts, boars and sows in the herd over a one-year period was used. If antimicrobial consumption data were provided as the total amount used in a year, this amount was divided by the number of batches produced so that data for growing pigs could be entered per batch which is the required format of the online tool. The TI of suckling piglets, weaned piglets and fatteners were finally combined and recalculated into a standardised lifespan of 200 days to correct for possible differences in ages at slaughter between herds. The TI200 was calculated by dividing the sum of all TIs from birth to slaughter with the number of days for the actual rearing period and then multiplying the TI per day with 200 which was the agreed-on standardised life span of 200 days used in the equation. The standardised TI is hereafter referred to as TI Statistical analysis After performing descriptive statistics for the relevant variables (TI suckling piglets, TI weaners, TI finishers, TI200, TI breeding pigs), all TI variables were LOG transformed to overcome the problem of a skewed distribution. To overcome the problem of the observations where the TI for a particular age category was 0 (which cannot be log transformed), first a value of 1 was added to all observations and then this data was log transformed. In that way the herds with no reported antimicrobial consumption received a value of 1 in the original scale which then becomes 0 again after log transformation. Differences in TIs between countries were tested by means of ANOVA. Scheffé s method was used for post hoc comparison. To compare TIs for the different age categories, multivariable linear regression was performed including country as independent fixed variable to account for country differences. Normal probability tests and plots were examined to check whether assumptions of normality and homoscedasticity were fulfilled. Furthermore, cross tabulation was used and graphs were prepared to visualize the results. All statistical analyses were performed using SPSS statistics 22 (IBM Corporation, 2013, Armonk, New-York). 3. Results 3.1. Herd characteristics The number of sows enrolled in the study were for the Belgian herds, for the French herds, for the German herds and for the Swedish herds. On a national level, the numbers of sows were , , and for Belgium, France, Germany and Sweden, respectively (Eurostat, 2014). The corresponding figures for the number of fattening pigs produced 1 were for the Belgian herds, for the French herds, for the German herds and for the Swedish herds. On a national level, the numbers of slaughtered pigs were , , and for Belgium, France, Germany and Sweden, respectively (Eurostat, 2014). The median herd sizes were 290, 174, 300 and 188 sows for the Belgian, French, German and Swedish herds, respectively. The median weaning age in the studied herds were 24, 22, 25 and 35 days for the Belgian, French, German and Swedish herds, respectively. The median rearing periods from weaning until allocation in the fattening unit were 49, 49, 56 and 49 days for the Belgian, French, German and Swedish herds, respectively. The median time pigs spent in fattening units before being slaughtered were 125, 130, 112 and 105 days for the Belgian, French, German and Swedish herds respectively. Additional information on herd characteristics can be found in previously published articles by Backhans et al. (2015), Postma et al. (2015a) and Sjölund et al. (2015) Treatment incidences Treatment incidences over a standardised life span of 200 days (TI200), varied considerably between countries as shown in Fig. 1 and Table 1. The lowest average TI200 was observed for the Swedish (SE) herds followed by the French (FR) herds, the Belgian (BE) herds and lastly German (DE) herds which had the highest TI200 (Table 1). French and Belgian herds did not differ from each other (p = 0.1) whereas significant differences were observed between the other countries (p < 0.05). In all countries considerable variations between herds were observed (Fig. 1;Table 1). Frequency distributions of TI200 for the different countries showed a righttailed distribution (Fig. 2). When TIs for growing pigs were split for different age categories, it was observed that weaned piglets received most treatments followed by suckling piglets (Fig. 1; Table 1). However, the reverse situation was observed for the Swedish herds where most treatments were applied to suckling piglets. Treatment incidences for 1 Some herds sold pigs at the end of the weaning period before pigs were allocated to the fattening units. These pigs are not included in the numbers presented.
4 44 M. Sjölund et al. / Preventive Veterinary Medicine 130 (2016) Fig. 1. Antimicrobial treatment incidences (TI), expressed as treatment incidence per 1000 pig-days at risk, for pigs in farrow-to-finish herds in Belgium (n = 47), France (n = 60), Germany (n = 60) and Sweden (n = 60) shown by age category (suckling piglets, weaned piglets (nursery), finishers, growing pigs (TI200) and breeding pigs). TI200 denotes the overall TI for growing pigs with a standardised lifespan of 200 days. Different letters denote significant differences between countries within the respective age categories. Table 1 Antimicrobial treatment incidences (TI) for farrow-to finish pig herds expressed as the TI per 1000 pigs-days at risk shown for different age categories, including a calculated TI for growing pigs from birth to slaughter with a standardised life span of 200 days. Differences in TIs between countries were tested by means of ANOVA. Scheffé s method was used for post hoc comparison. Belgium (n = 47) France (n = 60) Germany (n = 60) Sweden (n = 60) Median Mean Median Mean Median Mean Median Mean Age category (Min Max) (Min Max) (Min Max) (Min Max) Suckling piglets a,c b a c ( ) ( ) ( ) ( ) Weaned piglets a a b c ( ) ( ) ( ) ( ) Fattening pigs a,c b a c ( ) ( ) ( ) ( ) Entire growing period (TI200) a a b c ( ) ( ) ( ) ( ) Breeding pigs a a b a (Boars, sows, gilts) ( ) ( ) ( ) ( ) * Different superscripts within a row indicate significant differences. suckling piglets was lowest among the French herds and was significantly lower than in the other countries (p < 0.01). The Swedish herds had the second lowest TI for suckling piglets followed by the Belgian herds and then the German herds. In addition to the French herds, the Swedish herds differed from the German herds (p < 0.01) but no differences were observed between Belgian and Swedish herds (p = 0.1) and Belgian and German herds (p = 0.4) in TIs for suckling piglets. Average TIs for weaned piglets was lowest for the Swedish herds with a mean TI of 21.4, which differed significantly (p < 0.01) to TIs for weaners in the three other countries (Fig. 1; Table 1). The TIs for the Belgian and French herds were similar to each other (p = 0.9), while the mean TI for weaned piglets of the German herds differed to those for the Belgian and French herds (p < 0.05). For both suckling and weaned piglets there were large variations in TIs between herds in all four countries. For suckling piglets, two herds in Belgium (4%) and four in France (7%) reported that no treatments had been applied to suckling piglets while all herds in Germany and Sweden reported treatment of suckling piglets. For weaned piglets, only Germany reported treatment of weaned piglets in all herds while four of the Belgian herds (8%), six of the French (10%) and five of the Swedish (9%) herds did not report any treatments for this age category. Overall, treatments of finishing pigs were low but also varied between herds and countries with the lowest average TI for the Swedish herds, followed by that of the French herds which was still significantly different to that of the Swedish herds (p < 0.01) (Fig. 1; Table 1). The average TI for the Belgian herds for finishers was only significantly different to the French herds (p < 0.01), whereas the average for the German herds differed to the French and Swedish herds (p < 0.01). Forty-two (70%) of the French herds did not report any use of antimicrobials for their fattening pigs. The corresponding figures for the other three countries were 11 for the Belgian herds (23%), 7 for the German herds (12%) and 3 for the Swedish herds (5%). Overall, it was observed that from birth till slaughter (total TI = ), 26% of all treatments were performed during the suckling phase, 69% during the weaning phase, whereas only 5% during the fattening phase. Also for breeding animals, mainly sows, large variations between herds and also between countries were found (Fig. 1;
5 M. Sjölund et al. / Preventive Veterinary Medicine 130 (2016) Fig. 2. a-da Within-herd associations of log-transformed treatment incidences (TI) per 1000 pig-days at risk for different age categories (suckling piglets sucklers ; weaned piglets nursery ; fattening pigs finishers ; gilts, sows, boars breeding pigs ) for 227 farrow-to-finish pig herds in Belgium (n = 47), France (n = 60), Germany (n = 60) and Sweden (n = 60). Table 1). Swedish herds had the lowest average TI for sows followed by the Belgian herds and not significantly different from the Swedish herds (p = 0.6). The French herds differed from those of Germany and Sweden (p < 0.05). Further exploration of the distribution of TIs for breeding animals showed that TIs for the 10% of the herds which used most were 40.7 (BE), 69.6 (FR), (DE) and 21.4 (SE). For growing pigs, the corresponding TI200 for the 10% of the herds which used most were 315.8, 264.9, and 54.9 for Belgium, France, Germany and Sweden, respectively Associations of treatment incidences between age groups When within-herd TIs were investigated for the different age categories, an association (p < 0.01) was found (Fig. 2a d). This association was observed also when corrected for country effect. The association was strongest for the Swedish herds when TIs for breeding animals were compared to suckling piglets and suckling piglets to fattening pigs, i.e. herds that treated their breeding animals also tended to treat their suckling piglets and fatteners. The association was on the other hand strongest for the German herds when TIs for suckling piglets were compared to weaned piglets and weaned piglets to finishing pigs, i.e. herds that treated their suckling piglets also tended to treat their weaned piglets and fatteners Antimicrobial usage by active substance and administration routes The most commonly used antimicrobials were aminopenicillins followed by polymixins as shown in Table 2. Macrolides were the third most commonly used antimicrobials followed by tetracyclines. When overall use within a country was investigated, different usage patterns were seen. Use in the Belgian herds was similar to that of the overall pattern with aminopenicillins being most common followed by polymixins and macrolides. Third and fourth generation cephalosporins were the fourth most commonly used antimicrobials in the Belgian herds constituting 11% of the overall use. In the French herds, polymixins were most commonly used, tetracyclines were second most commonly used, followed by the aminopenicillins and the macrolides. Aminopenicillins also dominated use in the German herds which was followed by macrolides, tetracyclines and polymixins. The pattern for the Swedish herds was different with benzylpenicillins dominating, followed by the trimethoprim-sulphonamides, macrolides and aminopenicillins only being fourth. The proportion of the total number of antimicrobial treatment incidences per 1000 pig-days at risk shown by antimicrobial class is shown in Fig. 3. Additional information on which antimicrobials and combinations of antimi-
6 46 M. Sjölund et al. / Preventive Veterinary Medicine 130 (2016) Table 2 Proportion of amount of antimicrobials used in 227 farrow-to-finish pig herds in Belgium (n = 47). France (n = 60). Germany (n = 60) and Sweden (n = 60) shown by country, total use and use by age category. Superscript numbers within column denotes rank of amount used. Country Overall Age category Antimicrobial class Belgium France Germany Sweden Total % LA b of total Suckling piglets Weaned piglets Fattening pigs Breeding pigs Aminoglycosides <0.1% 7.9% 1.2% 0.2% 2.4% a 9.8% 89.7% 0.4% <0.0% Aminopenicillins 37.7% % % 1 6.2% % % 15.9% 78.6% 4.7% 0.9% Amphenicols 0.1% 0.5% <0.1% a 0.1% 100.0% 69.1% 10.7% 6.7% 13.5% Benzylpenicillin 0.4% a 1.0% 61.2% 1 4.0% 48.0% 73.8% 8.5% 6.1% 11.6% Benzylpenicillin in combination <0.1% 2.1% 4.6% 0.9% 2.7% a 90.2% 8.6% <0.0% 1.2% 3rd & 4th generation Cefalosporins 10.8% 4 1.2% 1.8% a 3.7% 88.3% 94.2% 4.9% 0.1% 0.7% Colistin c 17.5% % % 4 4.3% 17.7% 2 a 1.6% 98.1% 0.3% 0.1% Fluoroquinolones 5.3% 0.4% 1.3% 1.3% 2.1% 4.3% 58.2% 28.5% 4.4% 9.0% Lincosamides <0.1% 1.5% 0.4% a 0.5% a <0.1% <0.1% 0.1% <0.1% Lincosamides and spectinomycin 1.6% 2.9% 0.5% a 1.2% a 41.2% 37.9% 14.3% 6.6% Macrolides 14.7% % % 2 9.0% % % 56.7% 34.2% 4.7% 4.5% Pleuromutilins 0.1% 0.5% 1.4% 1.0% 0.9% a a 70.9% 15.9% 13.1% Sulfonamides and trimethoprim 5.1% 8.0% 3.4% 13.1% 2 5.4% a 11.2% 74.1% 2.8% 11.9% Tetracyclines 6.8% 18.2% % 3 2.9% 14.1% 4 2.3% 1.8% 77.6% 9.2% 11.5% a The antimicrobial or formulation of the antimicrobial was not used at all. b LA long acting formulation. c Also includes colistin in combination with aminopenicillins constituting less than 0.1% of the overall colistin use. Fig. 3. Proportion of antimicrobial classes of the total number of antimicrobial treatment incidences per 1000 pig-days at risk for 227 farrow-to-finish pig herds in Belgium (n = 47), France (n = 60), Germany (n = 60) and Sweden (n = 60). Colistin combinations constituted less than 0.1% of the overall colistin use and only contained aminopenicillins in addition to colistin. crobials that were used in the herds in the four countries is found in Supplementary Table 1 (Table S1). Further analysis on the use by substance for the different age categories showed that the aminopenicillins were mostly applied to weaned piglets followed by the suckling piglets (Table 2). Also the largest proportion of the polymixins were applied to weaned piglets followed by the suckling piglets. Macrolides were on the other hand most often applied to suckling piglets followed by weaned piglets. Tetracyclines were mostly used for weaned piglets followed by use for breeding animals. Third and fourth generation cephalosporins was mainly applied to suckling piglets followed by use for weaned piglets. Fluoroquinolones was also mainly used for suckling piglets and weaned piglets. On country level, overall use of third and fourth generation cephalosporins constituted 11% (BE), 1% (FR), 2% (DE) and 0% (SE) of total use (Table 2). For fluoroquinolones the corresponding figures were 5% (BE), <1% (FR), 1% (DE) and 1% (SE). Long acting (LA) formulations of injectable products were used to a varying degree for the parenteral treatments in the different countries (Table 2). The majority (88%) of the third and fourth generation cephalosporins used were LA formulations whereas only 4% of the fluoroquinolones used were LA formulations (Table 2). Of the aminopenicillins, 18% were LA formulations and 48% of the benzylpenicillins applied were LA formulations, while 61% of the macrolides used were LA formulations. Antimicrobials were most commonly applied orally through water or feed (Fig. 4). Overall, 71% of the antimicrobials were
7 M. Sjölund et al. / Preventive Veterinary Medicine 130 (2016) Fig. 4. Proportion of the total number of antimicrobial treatment incidences per 1000 pig-days at risk for 227 farrow-to-finish pig herds in Belgium (n = 47), France (n = 60), Germany (n = 60) and Sweden (n = 60) shown by administration route. *Topical treatments constituted <0.05% and <0.01% of the total number of treatment incidences for Belgium and Germany respectively. Topical treatments were not reported for the French and Swedish herds. applied orally and 29% applied parentally also including a few topical (TI = 10 in total) treatments. Differences were however observed between the countries, where Swedish herds applied 13% of the antimicrobials orally whereas the French herds applied 87% orally. Oral administration for the Belgian and German herds was similar, 70% and 71%, respectively. 4. Discussion To our knowledge, this is the first comprehensive investigation of actual antimicrobial use in farrow-to-finish pig herds comprising several countries and using a standardised methodology. We are now able to confirm that antimicrobial usage actually differs a lot between countries, herds and age groups. Previous studies have mostly been conducted at national level and different methods for quantifying antimicrobial use have been used (Stege et al., 2003; Timmerman et al., 2006; Callens et al., 2012; Bos et al., 2013; Moreno, 2014; van Rennings et al., 2015), disabling direct comparisons. These studies have on the other hand shown that there are differences in which antimicrobials (Timmerman et al., 2006; Callens et al., 2012; Bondt et al., 2013) and to which age groups (Dunlop et al., 1998; Hybschmann et al., 2011; Callens et al., 2012; Jensen et al., 2012; Moreno, 2014; van Rennings et al., 2015) antimicrobials have been applied. However, in these national studies, data were collected from different types of herds and production stages which could have influenced consumption and consequently hampers comparability. The highest average overall antimicrobial consumption was found among the German herds and the lowest in Swedish herds when TIs for the entire growing period, TI200, were compared which corresponds with the European sales figures (ESVAC, 2015). There are a number of reasons which may account for these differences. Firstly, the prevalence of different pathogens and consequently presence of subclinical and clinical disease may vary. Farmers and veterinarians enrolled in a British focus group study on antimicrobial use and prescribing behaviours considered health status to be a key factor in antimicrobial consumption (Coyne et al., 2014). This may in part explain the low use in the Swedish herds since Sweden is declared free from PRRS (Carlsson et al., 2009), and in between-herd variations in the other countries since, for example, more severe disease has been observed in pigs concomitantly infected with PRRS and Streptococcus suis (Thanawongnuwech et al., 2000). Secondly, pig and herd density may influence disease transmission between herds within a region and pig density is lower in Sweden compared to the other countries in this study and all of the Belgian, French and German herds originated from pig dense regions (Eurostat, 2014). However, a recent Danish study, which investigated clustering of herds with large amounts of prescribed antimicrobials, found that not only farm density influenced antimicrobial use but other factors also played a role (Fertner et al., 2015b), but further research is required to identify these factors. In addition to the variation between countries, there were also large between-herd variations within the different countries. Biosecurity measures such as all-in all-out production and a single supplier of weaners, all related to reducing disease transmission, have been identified as common practice in herds with low antimicrobial use (Fertner et al., 2015a). The correlation of use between different age categories within herds irrespective of country in our study also support that presence and spread of infections within a herd can influence consumption without ruling out other factors. Another clue to the large differences in antimicrobial use may also lie in how antimicrobials were applied. Group treatment through feed or water was the most common way to treat pigs in the herds in Belgium, France and Germany. However, in the Swedish herds, with the lowest overall use, parenteral treatment was most common. This discrepancy is also seen in sales of antimicrobials (ESVAC, 2015) and could account for some of the differences in consumption. Moreover, it was common practice in many participating herds in Belgium, France and Germany to apply treatments to entire batches of pigs, mainly suckling and weaned piglets, at strategic time points when pigs were judged most likely to contract disease (data not shown). Treatment of entire batches will inherently increase consumption compared to treatment of single individuals within a batch. In addition to the variations between herds and countries, there were also variations to which age group most treatments were applied. Weaned piglets was the age group that received most treatments which is in accordance with several other studies (Hybschmann et al., 2011; Callens et al., 2012; Jensen et al., 2012; Moreno, 2014). Yet again, the Swedish herds differed in that treatment of suckling piglets was more common than treatment of weaned piglets, similar to what was described in Canada (Dunlop et al., 1998) and Germany in another study (van Rennings et al.,
8 48 M. Sjölund et al. / Preventive Veterinary Medicine 130 (2016) ). To determine the cause of these differences requires further investigations. The treatment incidence for fattening and breeding pigs was in general lower in comparison to the younger age categories, but also for these age categories there were apparent differences between the participating countries as well as between herds. Quite many herds reported no treatments at all for fattening pigs and as many as 70% of the French herds did not report any treatment of fatteners. It is possible that treatment incidences could be under- or overestimated since data for the French herds were only collected for one batch and not during an entire year as was done in the other three countries. Thus any seasonal differences in occurrence of clinical disease and unexpected outbreaks of acute disease requiring medication influencing overall treatment incidence could be lacking. This may explain the low reported antimicrobial use in some herds but on the other hand, low use in fatteners and sows has previously been reported for French herds (Hémonic et al., 2013). Further, therapeutic treatments of individual pigs are not always recorded (Callens et al., 2012) and five Belgian herds of the 52 originally enrolled herds were excluded from the analysis due to lacking information on individual therapeutic treatments although these treatments most certainly did not have a large impact on the overall use. For the Swedish herds, where parenteral therapeutic treatments of individual animals were most common, the risk of underestimation of overall use was considered low (Sjölund et al., 2015). However, Swedish data for sows may be underestimated since 19 of the participating herds were satellites to sow pools 2 and, consequently, treatments performed during gestation were not recorded for these herds (Sjölund et al., 2015). Concerning within herd use for different age categories, a positive association in antimicrobial use between the different age categories as well as a positive association between the use for breeding animals and the use for pigs from birth to slaughter was found. This is in contrast to claims that a high antimicrobial use of young animals prevents disease problems further on. The observed associations may reflect a certain attitude/behaviour of the farmer towards regular use of medicines (Visschers et al., 2015). It may also be caused by an overall higher disease pressure in these herds. A final potential explanation might be the deteriorating effect of antimicrobial use at a young age on the bacterial composition of the gut resulting in higher disease susceptibility and treatment needs in later stages of their lives (Callens et al., 2014). Differences were also found regarding the antimicrobial classes that were most commonly used in herds in the four countries in our study. These differences could depend on a number of factors. First of all, there are differences in levels of resistance in bacteria between countries (EFSA, 2015) which may influence treatment choices. Availability of antimicrobials could also influence treatment choices. The number of products available for use for pigs in the four countries has previously been described in detail where Sweden had the fewest number of available products and Germany the most which could in part also explain the differences (Postma et al., 2015b). Tetracyclines have often been shown to be the most common drug for use in pigs (Timmerman et al., 2006; Bondt et al., 2013) but in our study, tetracylines was only the fourth most commonly used antimicrobial class. However, also for tetracyclines we found differences between countries as it was the secondly most common used class in the French herds but not very commonly used in the Belgian and Swedish herds. The introduction of more novel products and long-acting formulations alongside with the develop- 2 Sow pool is a system where pregnant sows are leased from a central herd unit to other herds ( satellite herds). The sows are transported to the satellite herds three weeks before farrowing, and return to the central unit after weaning. ment of resistance may have shifted use away from tetracyclines. Yet the differences may also be due to the applied unit of measurement. When the use is expressed in weight of used active substance rather than in treatment days (as in the current study) the use of tetracycline will likely be over-represented. The frequent use of macrolides and polymixins, mainly colistin and to a much lesser extent colistin in combination with aminopenicillins, indicate that diarrhoea, especially in weaned pigs, continues to be a major challenge in pig production. The frequent use of these antimicrobials is rather worrying since in the recently issued Guidelines for the prudent use of antimicrobials in veterinary medicine (Commission Notice, 2015), the recommendation is to reduce use of both macrolides and colistin. Moreover, these guidelines explicitly state that colistin is a last-resort drug in human medicine which should not be used as a substitute for good management practices. The recent finding of plasmid-mediated polymixin resistance even more so calls for a restrictive use of colistin (Liu et al., 2015). Further, regarding antimicrobials considered to be especially critical to human medicine, we found a relatively frequent use of third and fourth generation cephalosporins, mainly applied to suckling piglets, for the Belgian herds as also previously shown by Callens and co-workers (Callens et al., 2012). Use of third and fourth generation cephalosporins increases the prevalence of extended spectrum -lactamase (ESBL) producing Escherichia coli (E. coli) (Agersø et al., 2012). Within this context, herd veterinarians with the aid of the Center of expertise on antimicrobial consumption and resistance in animals (AMCRA) needs to continue to enforce its work to reduce use of cephalosporins (AMCRA, 2014) in Belgium. The use of fluoroquinolones was more modest but the same pattern was seen where the Belgian herds had the highest use and the French herds used the least (<1%), while the overall use for the four countries was 4%. The low use in the French herds is most likely a result of the voluntary restriction on the use of third and fourth generation cephalosporins adopted by the pig sector in 2010 (ESVAC, 2015). Since 2013, the use of fluoroquinolones and third and fourth generation cephalosporins has also been restricted by law in Sweden (SJVFS 2013:42, 2013). As of yet, there are not restrictions on the use of fluoroquinolones and cephalosporins in Germany. The overall high antimicrobial use for weaners, in many instances consisting of antimicrobials which should be used sparingly, once again points to that improving health in weaned pigs may be most efficient in reducing overall use of antimicrobials. There are also some aspects on the methodology used in this study which need to be discussed. Although much effort was put in the planning of data collection to as far as possible ensure a uniform way for collecting data irrespective of investigator and country, data collection procedures varied. This could have had an impact on the results but as ways of recording treatments varied between countries, it was necessary to adopt to national conditions to retrieve as much data as possible. In Sweden, where several investigators were involved in data collection, all investigators received training by the two principal Swedish investigators in order to harmonise data collection as much as possible. By involving herd veterinarians from SvDHV for data collection, we got access to antimicrobial consumption data retrieved from their central data base used for the mandatory reporting of antimicrobial treatments to the Swedish Board of Agriculture (SJVFS 2013:42, 2013) which would vouch for completeness and accuracy of data. In general, there may also have been a selection bias towards herds where the farmers had a general interest in questions regarding antimicrobials. Moreover, farmers suspecting a high level of antimicrobial use in their herd may have been more reluctant to participate in the study. Thus, overall antimicrobial use in the participating herds may be lower. In fact, the Swedish herds used less when compared to national data on prescriptions for pigs as previously shown
9 M. Sjölund et al. / Preventive Veterinary Medicine 130 (2016) (Sjölund et al., 2015). Whether this is the case for the other participating countries is not known but as only farrow-to-finish herds were enrolled, it is reasonable to assume that trade of pigs was less in these herds compared to more specialized production systems purchasing or selling pigs where the risk of introduction of disease must be considered higher. A clear association between improved biosecurity and reduction in treatments has been previously shown for Belgian farrow-to-finish herds (Laanen et al., 2013). Nevertheless, there were large in-between herd variations in terms of usage with some herds accounting for most of the use. This shows that herds with different levels of use were included in the study sample. Extrapolation to farrow-to-finish herds in general should however be made with caution. It must also be noted that TIs were calculated based on consensus DDDAs adopted for the MINAPIG project (Postma et al., 2015b). DDDA is a technical unit of measurement and should not be assumed to reflect the prescribed or used daily doses. The TIs reported in this study may therefore not accurately reflect the true TI for a particular age group or herd. On the other hand, comparability is not affected and the method allows for comparisons on usage between countries using the same unit of measurement. Comparisons to other studies using TIs based on other DDDAs should however be made with caution as shown by Taverne and co-workers (Taverne et al., 2015). 5. Conclusions The in-between herd differences with respect to antimicrobial consumption both in terms of amounts used and how pharmaceuticals were applied as well as the distribution between age groups show the importance of collecting usage data by country, species, herd, and age group using a standardised methodology. This allows for in-depth comparisons with the aim to improve health and reduce the need for antimicrobials. This study has identified that interventions directed at management of weaned piglets may be of highest priority since most treatments were applied to weaned piglets but further studies are required to identify specific target areas which may reduce the need for antimicrobials in this particular age group. For future studies, it would be interesting to identify common denominators of herds with a low antimicrobial use irrespective of nationality which can be used to provide advice on how to improve health, productivity and subsequently the need for antimicrobials. Conflict of interest None Funding This work was supported by EMIDA ERA-NET. Acknowledgements This project was part of the European MINAPIG project (Evaluation of alternative strategies for raising pigs with minimal antimicrobial usage: Opportunities and constraints, funded by the ERA-NET programme EMIDA (EMIDA19). We would like to thank the MINAPIG consortium for designing the study and for collaborations on the establishment of consensus DDDAs. The MINAPIG consortium consists of the following members, in alphabetical order: Annette Backhans, SLU, Sweden; Catherine Belloc, ONIRIS, France; Lucie Collineau, SAFOSO, Switzerland; Jeroen Dewulf, Ghent University Belgium; Ulf Emanuelson, SLU, Sweden; Elisabeth Grosse Beilage, TiHo Hannover, Germany; Bernd Grosse Liesner, Boehringer Ingelheim, Germany; Christian Alexander Körk, Boehringer Ingelheim, Germany; Ann Lindberg, SVA, Sweden; Svenja Lösken, TiHo, Hannover Germany; Merel Postma, Ghent University, Belgium; Hugo Seemer, Boehringer Ingelheim, Germany; Marie Sjölund, SVA, Sweden; Katharina Stärk, SAFOSO, Switzerland and Vivianne Visschers, ETHZ, Switzerland. We would also like to thank all farmers and their herd veterinarians who participated in this study. Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at References Antimicrobial Consumption and Resistance in Animals (AMCRA), Belpork Pioneers Antibiotic Registration. Pig Farmers Will Soon Be Able to Make Comparisons. november-2014-press-releases-amcra-belpork. Agersø, Y., Aarestrup, F.M., Pedersen, K., Seyfarth, A.M., Struve, T., Hasman, H., Prevalence of extended-spectrum cephalosporinase (ESC)-producing Escherichia coli in Danish slaughter pigs and retail meat identified by selective enrichment and association with cephalosporin usage. J. Antimicrob. Chemother. 67, SDa, Autoriteit Diergeneesmiddelen, In: Werner, F.J.M. (Ed.), Usage of Anitbiotics in Agricultural Livestock in the Netherlands in SDa, Autoriteit Diergeneesmiddelen, Utrecht the Netherlands. Backhans, A., Sjölund, M., Lindberg, A., Emanuelson, U., Biosecurity level and health management practices in 60 Swedish farrow-to-finish herds. Acta Vet. Scand. 57 (14). Bondt, N., Jensen, V.F., Puister-Jansen, L.F., van Geijlswijk, I.M., Comparing antimicrobial exposure based on sales data. Prev. Vet. Med. 108, Bos, M.E., Taverne, F.J., van Geijlswijk, I.M., Mouton, J.W., Mevius, D.J., Heederik, D.J., Netherlands Veterinary Medicines Authority, S., Consumption of antimicrobials in pigs, veal calves, and broilers in the Netherlands: quantitative results of nationwide collection of data in PLoS One 8, e Callens, B., Persoons, D., Maes, D., Laanen, M., Postma, M., Boyen, F., Haesebrouck, F., Butaye, P., Catry, B., Dewulf, J., Prophylactic and metaphylactic antimicrobial use in Belgian fattening pig herds. Prev. Vet. Med. 106, Callens, B., Faes, C., Maes, D., Catry, B., Boyen, F., Francoys, D., de Jong, E., Haesebrouck, F., Dewulf, J., Presence of antimicrobial resistance and antimicrobial use in sows are risk factors for antimicrobial resistance in their offspring. Microb. Drug Resist. 21 (1), Carlsson, U., Wallgren, P., Renstrom, L.H., Lindberg, A., Eriksson, H., Thoren, P., Eliasson-Selling, L., Lundeheim, N., Norregard, E., Thorn, C., Elvander, M., Emergence of porcine reproductive and respiratory syndrome in Sweden: detection, response and eradication. Transbound. Emerg. Dis. 56, Chantziaras, I., Boyen, F., Callens, B., Dewulf, J., Correlation between veterinary antimicrobial use and antimicrobial resistance in food-producing animals: a report on seven countries. The J. Antimicrob. Chemother. 69, Commission Notice, Guidelines for the prudent use of antimicrobials in veterinary medicine. Off. J. Eur. Union 58 (C299/04). Coyne, L.A., Pinchbeck, G.L., Williams, N.J., Smith, R.F., Dawson, S., Pearson, R.B., Latham, S.M., Understanding antimicrobial use and prescribing behaviours by pig veterinary surgeons and farmers: a qualitative study. Vet. Rec. 175, 593. DANMAP, Use of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Bacteria from Food Animals, Food and Humans in Denmark. National Food institute, Statens Serum Institut, Copenhagen danmap.org/ /media/projekt%20sites/danmap/danmap%20reports/ DANMAP%202013/DANMAP% ashx. Dunlop, R.H., McEwen, S.A., Meek, A.H., Black, W.D., Clarke, R.C., Friendship, R.M., Individual and group antimicrobial usage rates on 34 farrow-to-finish swine farms in Ontario, Canada. Prev. Vet. Med. 34, European Centre for Disease Prevention and Control (ECDC), EFSA (European Food Safety Authority), EMA (European Medicines Agency), ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and foodproducing animals. Stockholm/Parma/London: ECDC/EFSA/EMA, EFSA J. 13 (1), 114, (4006). European Food Safety Authority (EFSA), EU Summary Report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in EFSA J. 13 (2), 178, European Surveillance of Veterinary Antimicrobial Consumption (ESVAC), Sales of Veterinary Antimicrobial Agents in 26 EU/EEA Countries in 2013 European Medicines Agency. GB/ document library/report/2015/10/wc pdf.
ESVAC meeting 3 March, 2017 EMA. Presented by Helen Jukes Co-chair RONAFA group, chair of the CVMP s Antimicrobials Working Party
Joint EMA/EFSA scientific opinion of the RONAFA advisory group on measures to reduce the need to use antimicrobial agents in animal husbandry in the EU ESVAC meeting 3 March, 2017 EMA Presented by Helen
More informationANTIMICROBIAL USE WHILST ADOPTING IMPROVED MANAGEMENT STRATEGIES ON FARROW-TO-FINISH
VETERINARY EPIDEMIOLOGY UNIT FARM-ECONOMIC ANALYSIS OF REDUCING ANTIMICROBIAL USE WHILST ADOPTING IMPROVED MANAGEMENT STRATEGIES ON FARROW-TO-FINISH PIG FARMS Prof. Jeroen Dewulf Of the 120 experts that
More informationAntimicrobial resistance (AMR): Presentation on the joint EMA/EFSA RONAFA opinion Harmonisation of SPCs of antimicrobial veterinary medicines
Antimicrobial resistance (AMR): Presentation on the joint EMA/EFSA RONAFA opinion Harmonisation of SPCs of antimicrobial veterinary medicines EMA Veterinary Medicines Info Day 16-17 March 2017, London
More informationSales survey of Veterinary Medicinal Products containing Antimicrobials in France Volumes and estimated exposure of animals to antimicrobials
Sales survey of Veterinary Medicinal Products containing Antimicrobials in France - 2013 Volumes and estimated exposure of animals to antimicrobials October 2014 Scientific Edition Sales survey of Veterinary
More informationFACT SHEETS. On the Danish restrictions of non-therapeutical use of antibiotics for growth promotion and its consequences
12 July 2010 FACT SHEETS On the Danish restrictions of non-therapeutical use of antibiotics for growth promotion and its consequences Denmark is a major livestock producer in Europe, and the worlds largest
More informationSummary of the latest data on antibiotic consumption in the European Union
Summary of the latest data on antibiotic consumption in the European Union ESAC-Net surveillance data November 2016 Provision of reliable and comparable national antimicrobial consumption data is a prerequisite
More informationActivities and achievements related to the reduction in antibiotics use and resistance in veterinary medicine in Belgium in 2016
Activities and achievements related to the reduction in antibiotics use and resistance in veterinary medicine in Belgium in 2016 1 Activities and achievements antibiotics use and resistance among animals
More informationSales survey of veterinary medicinal products containing antimicrobials in France in Annual report
Sales survey of veterinary medicinal products containing antimicrobials in France in 2016 Annual report October 2017 Scientific edition Sales survey of veterinary medicinal products containing antimicrobials
More informationSales survey of Veterinary Medicinal Products containing Antimicrobials in France
Sales survey of Veterinary Medicinal Products containing Antimicrobials in France - 2009 February 2011 Édition scientifique Sales survey of Veterinary Medicinal Products containing Antimicrobials in France
More informationThe epidemiology of antimicrobial resistance and the link between human and veterinary medicine
The epidemiology of antimicrobial resistance and the link between human and veterinary medicine Prof. Dr. Jeroen Dewulf Jeroen.Dewulf@UGent.be Unit for Veterinary Epidemiology, Faculty of Veterinary Medicine
More informationEuropean Medicines Agency role and experience on antimicrobial resistance
European Medicines Agency role and experience on antimicrobial resistance Regional Training Workshop on Antimicrobial Resistance (AMR) Responding to the global challenge of AMR threats: toward a one health
More informationIntegrated Analysis of Data on Resistance and Antimicrobial Consumption from the Human and Animal Sectors in Europe The JIACRA Report
Integrated Analysis of Data on Resistance and Consumption from the Human and Animal Sectors in Europe The JIACRA Report Pierre-Alexandre Beloeil (EFSA), on behalf of the JIACRA expert working group BfR-Symposium
More informationAntimicrobial use and Antimicrobial resistance: chapter 6.7 and 6.8 of the OIE Terrestrial Animal Health
Workshop for OIE national Focal Points for Veterinary Products (2 nd cycle) Vienna (Austria), 20-22 November 2012 Antimicrobial use and Antimicrobial resistance: chapter 6.7 and 6.8 of the OIE Terrestrial
More informationDANMAP Danish Integrated Antimicrobial Resistance Monitoring and Research Programme
DANMAP Danish Integrated Antimicrobial Resistance Monitoring and Research Programme Hanne-Dorthe Emborg Department of Microbiology and Risk Assessment National Food Institute, DTU Introduction The DANMAP
More informationCHOICES The magazine of food, farm and resource issues
CHOICES The magazine of food, farm and resource issues Third Quarter 23 A publication of the American Agricultural Economics Association Lessons from the Danish Ban on Feed- Grade Antibiotics by Dermot
More informationEFSA s activities on Antimicrobial Resistance
EFSA s activities on Antimicrobial Resistance CRL-AR, Copenhagen 23 April 2009 Annual Workshop of CRL - AR 1 Efsa s Role and Activities on AMR Scientific advices Analyses of data on AR submitted by MSs
More informationESVAC (European Surveillance of Veterinary Antimicrobial Consumption)
ESVAC (European Surveillance of Veterinary Antimicrobial Consumption) Present and future activities 60th Meeting of the EFSA advisory forum Presented J. Torren, Scientific Administrator, Animal and Public
More informationLessons from the Danish Ban on Feed-Grade Antibiotics
Lessons from the Danish Ban on Feed-Grade Antibiotics Dermot J. Hayes and Helen H. Jensen Briefing Paper 03-BP 41 June 2003 Center for Agricultural and Rural Development Iowa State University Ames, Iowa
More informationEFSA s activities on antimicrobial resistance in the food chain: risk assessment, data collection and risk communication.
EFSA s activities on antimicrobial resistance in the food chain: risk assessment, data collection and risk communication. Dr. Ernesto Liebana BIOHAZ Team Leader European Food Safety Authority (EFSA) EFSA
More informationBirgitte Borck Høg, Senior Scientific Officer Helle Korsgaard, Senior Scientific Officer Tine Hald, Professor National Food Institute, DTU
Methods and challenges in data and information sharing in the Danish Integrated Surveillance for Antimicrobials and Antimicrobial Resistance system (DANMAP) Birgitte Borck Høg, Senior Scientific Officer
More informationTHE NETHERLANDS VETERINARY MEDICINES AUTHORITY
THE NETHERLANDS VETERINARY MEDICINES AUTHORITY Workshop Lithuania, Oktober 2016 Reducing usage of antimicrobials in livestock: The Dutch approach Hetty van Beers-Schreurs, DVM, PhD SHORT INTRODUCTION Educated
More informationBTSF. Better Training for Safer Food Initiative. Antimicrobial Resistance One Health approach MEASURE UNITS
Better Training for Safer Food Initiative Antimicrobial Resistance One Health approach MEASURE UNITS BTSF This presentation is delivered under contract with the Consumers, Health, Agriculture and Food
More informationInterventions Aimed at Reducing Antimicrobial Usage and Resistance in Production Animals in Denmark
Interventions Aimed at Reducing Antimicrobial Usage and Resistance in Production Animals in Denmark Vibe Dalhoff Andersen, DVM, National Food Institute, Technical University of Denmark; Tine Hald, DVM,
More informationDANMAP and VetStat. Monitoring resistance and antimicrobial consumption in production animals
DANMAP and VetStat Monitoring resistance and antimicrobial consumption in production animals Flemming Bager Head Division for Risk Assessment and Nutrition Erik Jacobsen Danish Veterinary and Food Administration
More informationDraft ESVAC Vision and Strategy
1 2 3 7 April 2016 EMA/326299/2015 Veterinary Medicines Division 4 5 6 Draft Agreed by the ESVAC network 29 March 2016 Adopted by ESVAC 31 March 2016 Start of public consultation 7 April 2016 End of consultation
More informationRUMA: Advocating Prudent Use of Antimicrobial Compounds
RUMA: Advocating Prudent Use of Antimicrobial Compounds John FitzGerald Responsible Use of Medicines in Agriculture (RUMA) Alliance Antimicrobial Resistance: A Whole Food Chain Approach How should Ireland
More informationManaging the risk associated with use of antimicrobials in pigs
Managing the risk associated with use of antimicrobials in pigs Lis Alban DVM, Ph.D., DiplECVPH, DiplECPHM Chief Scientist, Danish Agriculture & Food Council Adjunct professor, University of Copenhagen
More informationUse of Antibiotics in Animals. A European Perspective by a Dutch observer. Dr. Albert Meijering
Use of Antibiotics in Animals A European Perspective by a Dutch observer Dr. Albert Meijering IPPE, Atlanta, January 30, 2013 Use of antibiotics in animal production: Excessive Injudicious Where does it
More informationSummary of the latest data on antibiotic resistance in the European Union
Summary of the latest data on antibiotic resistance in the European Union EARS-Net surveillance data November 2017 For most bacteria reported to the European Antimicrobial Resistance Surveillance Network
More informationEFSA s activities on Antimicrobial resistance in the food chain. Dr. Ernesto Liebana Head of BIOCONTAM Unit. EFSA
EFSA s activities on Antimicrobial resistance in the food chain Dr. Ernesto Liebana Head of BIOCONTAM Unit. EFSA EFSA IS The reference body for risk assessment of food and feed in the European Union. Its
More informationEU strategy to fight against Antimicrobial Resistance
EU strategy to fight against Antimicrobial Resistance OECD workshop on the Economics of Antimicrobial Use in the Livestock Sector and Development of Antimicrobial Resistance Paris, 12 October 2015 Martial
More informationInformation note regarding the Danish and EU restrictions of non-therapeutical use of antibiotics for growth promotion
12.08.2009 Information note regarding the Danish and EU restrictions of non-therapeutical use of antibiotics for growth promotion Denmark is a major animal food producer in Europe, and the worlds largest
More informationOIE initiative establishing a global database on consumption of antimicrobials for animals: state of play
OIE initiative establishing a global database on consumption of antimicrobials for animals: state of play European Surveillance of Veterinary Antimicrobial Consumption stakeholders meeting, London, UK,
More informationThe Responsible and Prudent use of Antimicrobials on Irish Pig Farms. Denis Healy
The Responsible and Prudent use of Antimicrobials on Irish Pig Farms Denis Healy Antimicrobials/ Antibiotics - history Developed from the 1940s Treat Bacterial infections human, animal Intensive farming
More information2 emb-pigs User Guide
User guide 2 emb-pigs User Guide What is emb-pigs? The electronic medicines book for pigs (emb-pigs) was launched in April 2016 by AHDB, with support from the Veterinary Medicines Directorate (VMD) in
More informationAntimicrobial consumption
Antimicrobial consumption Annual Epidemiological Report for 2017 Key facts Twenty-seven countries, comprising 25 EU Member States and two EEA countries (Iceland and Norway) reported data on antimicrobial
More informationRisk management of antimicrobial use and resistance from food-producing animals in Denmark
Risk management of antimicrobial use and resistance from food-producing animals in Denmark A contribution to the joint FAO/WHO/OIE Expert Meeting on Critically Important Antimicrobials, Rome, Italy. 17-21
More informationAntimicrobial resistance I: Situation and strategies in Europe
Antimicrobial resistance I: Situation and strategies in Europe Global Past, Present and Future Challenges in Risk Assessment Strengthening Consumer Health Protection Berlin, November 30th December 1st,
More informationActivities and achievements regarding the reduction in the use of antibiotics and antimicrobial resistance in veterinary medicine in Belgium in 2017
Activities and achievements regarding the reduction in the use of antibiotics and antimicrobial resistance in veterinary medicine in Belgium in 2017 1 Table of contents Context... 2 Summary... 2 Covenant
More informationDutch experiences with reduction of antibiotics and Management XLIII SIPAS 2017 R. Janssen DVM The Swinepractice and Vice-president EAPHM
Dutch experiences with reduction of antibiotics and Management XLIII SIPAS 2017 R. Janssen DVM The Swinepractice and Vice-president EAPHM Content The Swinepractice / De Varkenspraktijk Antibiotic reduction,
More informationData for action The Danish approach to surveillance of the use of antimicrobial agents and the occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark 2 nd edition,
More informationNorwegian policies to address antimicrobial resistance
Norwegian policies to address antimicrobial resistance Frode Forland, Specialist Director, Division of Infectious Control and Environmental Health, Norwegian Institute of Public Health Karianne Johansen,
More informationReduction of Antibiotics in poultry meat production. Dutch action plan. Ben Dellaert Director Avined Buenos Aires, 27th October 2016
Reduction of Antibiotics in poultry meat production Dutch action plan Ben Dellaert Director Avined Buenos Aires, 27th October 2016 Content 1. Results 2. Motives 3. Policy and collaboration 4. Action plan
More informationEMA advice on the impact of the use of antibiotics on public and animal health: Potential impact on the authorisation of antimicrobials
EMA advice on the impact of the use of antibiotics on public and animal health: Potential impact on the authorisation of antimicrobials Helen Jukes, CVMP member EMA/IFAH-Europe Info Day, 12 March 2015
More informationThe Danish risk management strategy for veterinary antimicrobial usage
The Danish risk management strategy for veterinary antimicrobial usage Annette Cleveland Nielsen, DVM, Ph.D. epidemiology Unit for Veterinary Epidemiology and Health Management Danish Veterinary and Food
More informationSummary of the latest data on antibiotic consumption in the European Union
Summary of the latest data on antibiotic consumption in the European Union November 2012 Highlights on antibiotic consumption Antibiotic use is one of the main factors responsible for the development and
More informationECDC-EFSA-EMA Joint Opinion on Outcome Indicators on Surveillance of Antimicrobial Resistance and Use of Antimicrobials
ECDC-EFSA-EMA Joint Opinion on Outcome Indicators on Surveillance of Antimicrobial Resistance and Use of Antimicrobials P.-A. Belœil (EFSA) and D. Monnet (ECDC) One Health Network on Antimicrobial Resistance
More informationGuidance on collection and provision of national data on antimicrobial use by animal species/categories
21 February 2018 EMA/489035/2016 Veterinary Medicines Division Guidance on collection and provision of national data on antimicrobial use by animal Draft agreed by European Surveillance of Veterinary Antimicrobial
More informationEU Action Plan to combat the rising threats from Antimicrobial Resistance: State of play
EU Action Plan to combat the rising threats from Antimicrobial Resistance: State of play Rosa M. Peran i Sala Policy Officer AMR Coordination EC Action Plan against AMR Animal Health Advisory Committee
More informationFrank Møller Aarestrup
Danish Veterinary Laboratory Bacterial populations and resistance development: Intestinal tract of meat animals Frank Møller Aarestrup 12 Antibiotic production 10 Mill. Kg 8 6 4 2 0 50 52 54 56 58 60 62
More informationUpdate on European Agencies activities in the field of AMR
Update on European Agencies activities in the field of AMR R. M. Peran (EMA) D. Plachouras (ECDC) P.-A. Belœil (EFSA) European AMR One Health Network Meeting 26 October 2018, 10:00 17:00 Conference Center
More informationThe Dutch Model (of controlling antibiotic use in animals)
The Dutch Model (of controlling antibiotic use in animals) "Farmers and veterinarians together to tackle antimicrobial resistances Rens van Dobbenburgh Brussels, 23.10 2015 Federation of Veterinarians
More informationUnits of measurement for animals for the collection of data per animal species: Defined Daily Dose (DDDvet) and Defined Course Dose (DCDvet)
for animals for the collection of data per animal species: Defined Daily Dose (DDDvet) and Defined Course Dose (DCDvet) Data collection on consumption of veterinary antimicrobials in Europe achievements,
More informationCIPARS The Canadian Integrated Program for Antimicrobial Resistance Surveillance. Highlights from 2016
CIPARS The Canadian Integrated Program for Antimicrobial Resistance Surveillance Highlights from 2016 Agenda and Presentation Outline Welcome and technical information Meeting objective Program overview
More informationAntimicrobial use in humans
Antimicrobial use in humans Ann Versporten Prof. Herman Goossens OIE Global Conference on the Responsible and Prudent Use of Antimicrobial Agents for Animals - 13 March 2013 - Ann.versporten@ua.ac.be Herman.goossens@uza.be
More informationInitiatives taken to reduce antimicrobial resistance in DK and in the EU in the health care sector
Initiatives taken to reduce antimicrobial resistance in DK and in the EU in the health care sector Niels Frimodt-Møller Professor, MD DMSc Dept. of Clinical Microbiology Hvidovre Hospital, Copenhagen,
More informationBPC Antibiotic Stewardship Report
BPC Antibiotic Stewardship Report JUNE 2017 BIG ACHIEVEMENTS OF THE POULTRY MEAT INDUSTRY STOPPED prophylactic use of antibiotics STOPPED use of Colistin NEW ANTIBIOTIC STANDARDS for Red Tractor Poultry
More informationAmoxicillin trihydrate. Amoxicillin trihydrate. Amoxicillin trihydrate. Amoxicillin trihydrate. Amoxicillin trihydrate. Amoxicillin trihydrate
Annex I List of the names, pharmaceutical form, strength of the veterinary medicinal product, animal species, route of administration, applicant in the Member States Member State EU/EEA Applicant Name
More informationProceedings of. The 15 th Chulalongkorn University Veterinary Conference CUVC 2016: Research in Practice. April 20-22, 2016 Bangkok, Thailand
Proceedings of The 15 th Chulalongkorn University Veterinary Conference CUVC 2016: Research in Practice April 20-22, 2016 Bangkok, Thailand Organized by Faculty of Veterinary Science Chulalongkorn University
More informationMastitis in ewes: towards development of a prevention and treatment plan
SCHOOL OF LIFE SCIENCES, UNIVERSITY OF WARWICK Mastitis in ewes: towards development of a prevention and treatment plan Final Report Selene Huntley and Laura Green 1 Background to Project Mastitis is inflammation
More informationGlobal animal production perspectives and correlated use of antimicrobial agents
Global animal production perspectives and correlated use of antimicrobial agents Barbara Freischem Executive Director, International Federation for Animal Health (IFAH) General Overview Presentation overview
More informationGerman Antimicrobial Resistance Strategy DART 2020
German Antimicrobial Resistance Strategy DART 2020 AMR One Health Network meeting, 26 October 2018 Dr. Alexandra Clarici Division Infectious diseases, AMR, Hygiene, Vaccination Federal Ministry of Health,
More informationFindings at slaughter following a reduction in antimicrobial use
Findings at slaughter following a reduction in antimicrobial use N Dupont 1, H Stege 1 1 Department of Large Animal Sciences, University of Copenhagen Acknowledgement All the contributing veterinarians
More informationSCIENTIFIC REPORT. Abstract
SCIENTIFIC REPORT APPROVED: 28 June 2017 doi: 10.2903/j.efsa.2017.4872 ECDC/EFSA/EMA second joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial
More informationOIE Strategy on Antimicrobial Resistance and the Prudent Use of Antimicrobials in Animals Part I
Dr Elisabeth Erlacher-Vindel Head of the Antimicrobial Resistance and Veterinary Products Department OIE Strategy on Antimicrobial Resistance and the Prudent Use of Antimicrobials in Animals Part I 2nd
More informationAntibiotic usage in the British sheep industry. Dr Peers Davies
Antibiotic usage in the British sheep industry Dr Peers Davies 40% of all livestock biomass in the UK (ESVAC report 2016) Current Estimates and Data Sources No published, quantitative estimates of antimicrobial
More informationSpecial provisions for the reduction of the consumption of antibiotics in pig holdings (the yellow card initiative)
Special provisions for the reduction of the consumption of antibiotics in pig holdings (the yellow card initiative) Background From 2001-2009 the antibiotic consumption in animal production was increasing,
More informationprof. Jozef Bires, DVM, DSc. Chief Veterinary Officer The State Veterinary and Food Administration of the SR
prof. Jozef Bires, DVM, DSc. Chief Veterinary Officer The State Veterinary and Food Administration of the SR Slovakia has a population of over five and a half million inhabitants and an area of about 49,000
More informationfunded by Reducing antibiotics in pig farming
funded by Reducing antibiotics in pig farming The widespread use of antibiotics (also known as antibacterials) in human and animal medicine increases the level of resistant bacteria. This makes it more
More informationANTIMICROBIAL RESISTANCE and causes of non-prudent use of antibiotics in human medicine in the EU
ANTIMICROBIAL RESISTANCE and causes of non-prudent use of antibiotics in human medicine in the EU Health and Food Safety John Paget (NIVEL) Dominique Lescure (NIVEL) Ann Versporten (University of Antwerp)
More informationConsultation meeting with stakeholders
Consultation meeting with stakeholders Request from the European Commission for advice on the impact on public and animal health of the use of antibiotics in animals Presented by: Catry Boudewijn CVMP/EMA
More informationAabo, Søren; Ricci, Antonia; Denis, Martine; Bengtsson, Björn; Dalsgaard, Anders; Rychlik, Ivan; Jensen, Annette Nygaard
Downloaded from orbit.dtu.dk on: Sep 04, 2018 SafeOrganic - Restrictive use of antibiotics in organic animal farming a potential for safer, high quality products with less antibiotic resistant bacteria
More informationAnimal Health and Welfare policies in the EU Status quo and tendencies
Animal Health and Welfare policies in the EU Status quo and tendencies The views expressed here are purely those of the writer and may not in any circumstances be regarded as stating an official position
More informationWHO efforts to reduce the impact on public and animal health of antibiotic use in animals. Dr Danilo Lo Fo Wong Senior Adviser AMR
WHO efforts to reduce the impact on public and animal health of antibiotic use in animals Dr Danilo Lo Fo Wong Senior Adviser AMR Antimicrobial resistance (AMR): a public and animal health issue Widespread
More informationCOMBATING ANTIMICROBIAL RESISTANCE TIME FOR JOINT A CTION
6th EURL-AR Workshop 2012 Presentation of T HE DANISH EU- PRESIDENCY 2012 - CONFERENCE COMBATING ANTIMICROBIAL RESISTANCE TIME FOR JOINT A CTION Copenhagen 14-15 March 2012 and Relevant preliminary DRAFT
More informationAntimicrobial Use and Antimicrobial Resistance in Relation to the Canadian Pork Sector Presented by Jorge Correa Pork Committee Banff May 2013
Antimicrobial Use and Antimicrobial Resistance in Relation to the Canadian Pork Sector Presented by Jorge Correa Pork Committee Banff May 2013 Part of the Slides were extracted from a Paul Dick presentation
More informationAntibiotic Resistance The Global Perspective
Antibiotic Resistance The Global Perspective Scott A. McEwen Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1; Email: smcewen@uoguleph.ca Introduction Antibiotics have been used
More informationEC Workshop on scientific advice from AMEG
EC Workshop on scientific advice from AMEG Brussels, 26 Nov 2015 Session 2: Antibiotic Categorisation AMEG Q2 Karolina Törneke / Helen Jukes Liability disclaimer: The views or positions expressed in this
More informationCVMP activities regarding antimicrobials Ongoing and recent activities
CVMP activities regarding antimicrobials Ongoing and recent activities European Medicines Agency/IFAH-Europe Info Day 2016 Presented by Helen Jukes on 17 March 2016 Chair CVMP Antimicrobials WP An agency
More informationConsumo y venta de antibióticos para uso en animales en Europa
Consumo y venta de antibióticos para uso en animales en Europa Jornada sobre Transmisión de Resistencia entre Humanos y Animales Plan Nacional frente a la Resistencia a los Antibióticos (PRAN) Fundación
More informationCOMMISSION OF THE EUROPEAN COMMUNITIES
COMMISSION OF THE EUROPEAN COMMUNITIES Brussels, 22 December 2005 COM (2005) 0684 REPORT FROM THE COMMISSION TO THE COUNCIL ON THE BASIS OF MEMBER STATES REPORTS ON THE IMPLEMENTATION OF THE COUNCIL RECOMMENDATION
More informationHow is Ireland performing on antibiotic prescribing?
European Antibiotic Awareness Campaign 2016 November Webinar Series on Antibiotic Prescribing How is Ireland performing on antibiotic prescribing? Dr Rob Cunney National Clinical Lead HCAI AMR Clinical
More informationCVMP strategy on antimicrobials
1 2 3 6 November 2015 EMA/CVMP/209189/2015 Committee for Medicinal Products for Veterinary Use (CVMP) 4 5 Draft Adoption by CVMP for release for consultation 6 November 2015 Start of public consultation
More informationReprinted in the IVIS website with the permission of the meeting organizers
Reprinted in the IVIS website with the permission of the meeting organizers FOOD SAFETY IN RELATION TO ANTIBIOTIC RESISTANCE Scott A. McEwen Department of Population Medicine, Ontario Veterinary College,
More informationUsage of antimicrobial drugs in food
Usage of antimicrobial drugs in food producing animals In the Netherlands and some other European countries 62nd EAAP Annual Meeting, Inge van Geijlswijk, j PharmD, PhD Hospital pharmacist / director of
More informationAnimal Antibiotic Use and Public Health
A data table from Nov 2017 Animal Antibiotic Use and Public Health The selected studies below were excerpted from Pew s peer-reviewed 2017 article Antimicrobial Drug Use in Food-Producing Animals and Associated
More informationEUROPEAN COMMISSION DIRECTORATE-GENERAL FOR HEALTH AND FOOD SAFETY REFERENCES: MALTA, COUNTRY VISIT AMR. STOCKHOLM: ECDC; DG(SANTE)/
EUROPEAN COMMISSION DIRECTORATE-GENERAL FOR HEALTH AND FOOD SAFETY Health and food audits and analysis REFERENCES: ECDC, MALTA, COUNTRY VISIT AMR. STOCKHOLM: ECDC; 2017 DG(SANTE)/2017-6248 EXECUTIVE SUMMARY
More informationCeramic: To γουρούνι (The pig). Artist: Yannis Karagkiouzis. Private Collection.
1 Modelling the risks and consequences of residues of antimicrobial drugs in the gut and manure of pigs Maria Eleni Filippitzi (2018) Ceramic: To γουρούνι (The pig). Artist: Yannis Karagkiouzis. Private
More informationVeterinary antimicrobials: state of play and future developments 2013 European Medicines Agency/IFAH- Europe Info Day 7-8 March 2013
Veterinary antimicrobials: state of play and future developments 2013 European Medicines Agency/IFAH- Europe Info Day 7-8 March 2013 Mario Nagtzaam, SANCO D6 Political commitments as to addressing AMR
More informationThe Commission activities on AMR (focus on zoonotic issues)
The Commission activities on AMR (focus on zoonotic issues) R.M. Peran i Sala European Commission, DG SANCO London, 15.09.2011 1. DG SANCO and AMR High priority status given on AMR in DG SANCO EU Commission
More informationEXPERIENCE ON ANTIMICROBIAL USE AND RESISTANCE IN KENYA
EXPERIENCE ON ANTIMICROBIAL USE AND RESISTANCE IN KENYA PRESENTED BY DR. NATHAN K. SONGOK National Focal Point Veterinary Medicinal Products Kenya At the Regional Seminar for OIE National Focal Points
More informationHMA-V Action plan on antimicrobial issues Version for publication (27 January 2011)
HMA-V Action plan on antimicrobial issues Version for publication (27 January 2011) 1. Introduction Antimicrobial resistance (AMR) is considered to be a major global public health concern and a potential
More information2 nd UK-Russia Round Table on AMR. Christopher Teale, Animal and Plant Health Agency. Moscow, st February 2017.
2 nd UK-Russia Round Table on AMR. Christopher Teale, Animal and Plant Health Agency. Moscow, 20-21 st February 2017. Veterinary Approaches and Priorities. Indicator organisms (commensals) E. coli enterococci
More informationManaging the risk associated with use of antimicrobials in pigs
Managing the risk associated with use of antimicrobials in pigs - Effect of the Yellow Card Lis Alban DVM, Ph.D., DiplECVPH, DiplECPHM Chief Scientist, Danish Agriculture & Food Council Adjunct professor,
More informationRESPONSIBLE 39.36% 82% 91% CHAIRMAN S MESSAGE USE OF ANTIBIOTICS BANNED
REPORT 2018 CHAIRMAN S MESSAGE Poultry is half of the meat eaten in the UK and we use less than 9.7% of the total antibiotics licensed for food producing animals. We have successfully reduced our antibiotic
More informationARCH-Vet. Summary 2013
Federal Department of Home Affairs FDHA FSVO ARCH-Vet Report on sales of antibiotics in veterinary medicine and antibiotic resistance monitoring of livestock in Switzerland Summary 2013 Published by Federal
More informationInternational Food Safety Authorities Network (INFOSAN) Antimicrobial Resistance from Food Animals
International Food Safety Authorities Network (INFOSAN) 7 March 2008 INFOSAN Information Note No. 2/2008 - Antimicrobial Resistance Antimicrobial Resistance from Food Animals SUMMARY NOTES Antimicrobial
More informationStratégie et action européennes
Résistance aux antibiotiques : une impasse thérapeutique? Implications nationales et internationales Stratégie et action européennes Dominique L. Monnet, Senior Expert and Head of Disease Programme Antimicrobial
More informationFight against Antimicrobial Resistance Contribution of a private veterinary organization. REMESA, Faro, Portugal Christophe BRARD, 14th June 2013,
Fight against Antimicrobial Resistance Contribution of a private veterinary organization REMESA, Faro, Portugal Christophe BRARD, 14th June 2013, N 2 Organisation de la profession vétérinaire Conseil Supérieur
More informationPossible measures to reduce antimicrobial use in animals: a veterinary perspective
Possible measures to reduce antimicrobial use in animals: a veterinary perspective Jornada del Día Europeo para el Uso Prudente de los Antibióticos Madrid, 18 November 2016 Nancy De Briyne FVE Federation
More information