The concerns about public health consequences of antibiotic usage and resistant organisms in animals to human health have resulted in drastic changes in the policy of the Dutch authorities. In 2008 already the Dutch minister of Agriculture, Nature and Food Quality, installed a task force on Antimicrobial Resistance in Food Animals and demanded the combined stakeholders involved in animal production and the Dutch Royal Veterinary Association (KNMvD) to sign memoranda of understanding in which measures to reduce antibiotic use and antimicrobial resistance are described. After a debate in parliament about ESBLs in poultry, mandatory reduction targets in antibiotic usage in animals in the Netherlands were defined as 20 % reduction in 2011 and 50 % in 2013. In 2012 this target was renewed to 70 % reduction for total livestock production. As reference year 2009 was defined. Different initiatives were taken resulting in a measurable reduction in the use of antibiotics:
An essential element in the approach of the task force was to make antibiotic use on all farms transparent. Since 2012 it is mandatory to register all antibiotics supplied by veterinarians. This was already partially implemented by the private stakeholders in animal production in 2011 in veal calves, broilers and pigs as part of their quality systems. In particular by means of the quality systems acting at the sector level, they were able to implement these policies swiftly and effectively. In 2012 cattle followed. Usage on farms is expressed as animal daily dosages per year (add/y) (Bos et al. 2013), which resembles the Danish system of reporting.Footnote 3 In this way farms and vets can be benchmarked and compared with each other and with independently defined targets (benchmarking). An essential part of this process was to install an independent institute to control the use data, report the data publically and to define targets for use. In spring 2011 the Netherlands Veterinary Medicines Authority (SDa: www.autoriteitdiergeneesmiddelen.nl) was installed for this purpose and the first targets for use in different animal production sectors were published in July 2011.
Because of the concerns about MRSA and ESBLs in food-animals, the Dutch Heath Council was asked to advice the Ministers of Public health Welfare and Sports and the Minister of Economic Affairs about antibiotic usage in animals. The advice included a full ban in usage of any new antibacterial drug in animals and a restriction of the use of 3rd and 4th generation cephalosporins in animals. Moreover, it was advised to restrict the use of colistin, all beta-lactams, aminoglycosides and fluoroquinolones in food-animals. Since this advice lacked detail, the Antibiotics Policy Working Group (WVAB) of the KNMvD, wrote a guideline in which drugs were classified as first, second and third choice drugs for inclusion in treatment plans on farms (http://wvab.knmvd.nl/wvab). Moreover, the animal drug law was changed in 2013, ruling that only first choice drugs are allowed to be present on farms for empiric treatment of infections based on a mandatory treatment plan for each farm. This treatment plan has to be custom made by the veterinarian for each farm, based on treatment guidelines of the KNMvD (formularia: http://wvab.knmvd.nl/wvab/formularia/formularia).
In 2013 the SDa has defined quantitative reduction targets for antibiotic use for each food-animal species (in add/y) including zero add/y as quantitative target for fluoroquinolones and 3rd, and 4th generation cephalosporins. The latter two drugs are only allowed after it has been proven that no alternative treatment options are available. This is also regulated in 2013 by the change in the animal drug law. In the meantime, most animal production sectors have voluntarily decided to stop usage of these third choice drugs in animals on a voluntary basis.
As a result of all these measures taken, sales of antibiotics have decreased in 5 years by 56 % since 2007 and the target of 50 % reduction in 2013 is already reached in 2012 (Fig. 2). Moreover, clear indications exist that the occurrence of antimicrobial resistance in animal bacteria and the load of ESBLs in animals is decreasing (Anonymous 2013). This is a very important result of the governmental targets, the measures initiated by the private parties involved in animal production and the SDa, which can be considered to be critical success factors for the Netherlands.
However, to solve the current and future threats of multi-drug resistant organisms in (food)-animals to human health, a substantial further reduction may be warranted and on the longer term a change in animal production practices cannot be excluded. In 2014 next to livestock farms, veterinarians will also be benchmarked. A system has been developed which describes the use of antimicrobials on the population of farms for which a veterinarian is responsible. To facilitate this approach, regulations were put in place which resulted in unique one on one relations between veterinarians and livestock farmers. Further refinements in the benchmarking system are to be expected.