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Looking Behind the Figures

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The End of an Antibiotic Era

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Abstract

The Netherlands has had a solid reputation for their moderate use of antibiotics in human medicine, for many years. Doctors there usually think twice before prescribing antimicrobial drugs. The lower the consumption of antibiotics in a country, the less you will encounter antibiotic resistance. So the Dutch perform well in this field, better than almost any country in the world. Consequently, antibiotic resistance is a relatively small problem in the Netherlands. But the restraint in prescribing antibiotics by most Dutch doctors was until quite recently, not shared by veterinarians. On the contrary, the usage of antibiotics in veterinary medicine was sky-high during a long period of time. Not until the last decade a radical change took place, in a typical Dutch way. Not forced by law, but on the basis of mutual agreements between farmers organizations and the authorities, a sharp decrease in the usage of veterinary antibiotics was realized. Although Dutch farmers still use quite a lot of antibiotics compared to many other European countries, the difference with earlier and no-so-distant days is striking.

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Notes

  1. 1.

    Of course, the lowest use of antibiotics is not necessarily the best use. Underdosing is also possible.

  2. 2.

    See also Chap. 5, A thin layer of faeces on everything you touch.

  3. 3.

    A herd is a group of animals that is admitted to a livestock farm at a certain time and looked after as a group.

  4. 4.

    On 1 January 2014 Mevius was succeeded by Jaap Wagenaar, Professor of Clinical Infectious Diseases at Utrecht University and veterinary surgeon.

  5. 5.

    In 2010, the use of antibiotics in the veterinary sector in Belgium decreased to 299.3 tonnes, compared with 304 tonnes in 2009: The use of certain antibiotics important for humans has vastly increased: cephalosporin by 8.8%, quinolone by 2.8% and macrolide by 16.3%. The doses of these antibiotics are also considerably lower (BelVet-SAC 2010).

  6. 6.

    The amounts of veterinary antimicrobial medicines sold in different countries are linked to the animal demographics of each country, among other factors. In this report, the annual sales figures in each country were divided by the total estimated weight of livestock at the time of treatment and of slaughtered animals for the corresponding year, taking into account the import and export of animals to other member states for fattening or slaughter. The population correction unit (PCU) is the term used for the estimated weight. The PCU is purely a surrogate for the animal population at risk, in order to normalise sales by animal population in individual countries: 1 PCU equals 1 kg.

  7. 7.

    A commission set up in 1968 by the British Ministers for agriculture and health, presided over by Professor Swann, was given the task of investigating the use of antibiotics in livestock farming.

  8. 8.

    Many Dutch hospitals had to combat VRE outbreaks in 2012. See Chap. 5 A thin layer of faeces on everything you touch.

  9. 9.

    This section on the change in Danish policy is based on a study carried out by Berenschot (Beemer et al. 2010).

  10. 10.

    According to information supplied by veterinary microbiology expert Jaap Wagenaar at Utrecht University and his Danish colleague Henrik Wegener of the Danish Institute for Food and Veterinary Research in Søborg, the situation in the Nordic countries is exceptional. In other countries veterinary surgeons sell the medicines they prescribe themselves.

  11. 11.

    With or without the Danish model, the sales of antibiotics fell from 495 tonnes in 2009 to 176 tonnes in 2016, which is also a considerable decrease compared to the 150 tonnes sold in 2019 (SDa 2020a).

  12. 12.

    Specific isolation rules apply to pig farmers and their families until it is confirmed that they are not infected with MRSA.

  13. 13.

    The ‘Antibiotic Resistance in Livestock Farming’ task force, presided over by agriculture specialist and former Managing Director of Radboud University Medical Centre Jos Werner, was created in 2008 by Minister of Agriculture Gerda Verburg. Werner was at the time also sitting on the supervisory board of the pharma company Merck, which has a large veterinary medicine department.

  14. 14.

    A bacteriostatic antibiotic from the group of streptogramins, which is isolated from cultures of Streptomyces virginiae.

  15. 15.

    In a hatchery, eggs are artificially hatched using incubators. The female chicks are delivered to breeding farms by the hatcheries.

  16. 16.

    Most of the work of the European Food Safety Authority is done in response to requests from the European Commission, the European Parliament or EU member states, as the EFSA website states (EFSA 2020).

  17. 17.

    The Codex Alimentarius Commission (Codex) is an international forum of 188 member states and one memberorganisation (the European Union) coordinated by the FAO (the UN Food and Agriculture Organisation) and the WHO (World Health Organisation) (Codex Alimentarius 2020).

  18. 18.

    ‘Decolonisation’ is a way of eradicating or reducing considerably the asymptomatic carriage of MRSA. The procedures are carried out for at least 5 days. The nares, the nasopharynx, the skin (especially folds of the skin), the gastrointestinal tract and the perineum are the main sites of colonization by MRSA and, thus, for decolonization. After this, new cultures are taken to see if the treatment has been effective.

  19. 19.

    Data from an oral communication in 2012 of Professor Jan Kluijtmans to the author.

  20. 20.

    According to the Food and Agriculture Organization of the United Nations and the World Health Organization, probiotics are living microorganisms that benefit the host organism’s health if administered in sufficient quantities (FAO/WHO 2002).

  21. 21.

    If a bacterium is resistant to antibiotics of the carbapenem class, there are still two other medicines left that can be used: tigecycline and colistin.

  22. 22.

    If no approved medicine is available for a specific disease the veterinary surgeon must act according to a decision tree, which can lead to their using a medicine approved for humans on animals.

  23. 23.

    For more on this topic see Chap. 7 The end in sight.

  24. 24.

    Besides tigecycline (already mentioned in connection with ESBL-producing bacteria), the commission also includes in this category glycopeptides (e.g. vancomycin), daptomycin, oxazolidinone (linezolid) and mupirocin.

  25. 25.

    These included supermarket chains, abattoirs, farmers’ associations and animal feed suppliers.

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    Rinke van den Brink

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van den Brink, R. (2021). Looking Behind the Figures. In: The End of an Antibiotic Era. Springer, Cham. https://doi.org/10.1007/978-3-030-70723-1_8

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