Antimicrobial Resistance – Frequently Asked Questions
What Is Antimicrobial Resistance?
Antimicrobial resistance (AMR) is where the medicines used to treat diseases caused by specific
micro-organisms are no longer effective. Antimicrobial resistance commonly refers to antibiotic
resistance where antibiotics are no longer working effectively to kill or inhibit disease-causing
bacteria. Antimicrobials are a scarce commodity and an essential resource in the treatment of
human and animal disease, particularly when it is unlikely that there will be any new classes of
antimicrobials becoming available for many years. The rise of AMR is seen as a global public health
threat with consequences for animal health, food security
and the environment. The development of resistant
strains of bacteria is a natural phenomenon, which is very
complex and multi-factorial - but excessive or
inappropriate use of antibiotics increases the
development and spread of resistance. Poor infection
control practices, inappropriate food handling practices,
and in particular poor disease prevention strategies
encourage the further spread of AMR.
Demonstration of the presence of ESBL enzymes in Salmonella strains. Double synergy test: The
presence of true ESBL enzymes is demonstrated by inhibition zones that are more or equal 5 mm bigger
around the disk containing Clavulonic Acid (CAZ: ceftazidime, CAZ CV: ceftazidime plus clavulonic
acid, CTX: cefotaxime, CTX CV: cefotaxime plus clavulonic acid). The presence of AmpC enzymes is
proved by resistance to cefoxitin (FOX). The strain here shown is AmpC positive.
How does AMR affect me?
Antimicrobials such as antibiotics are used to treat disease in both humans and animals, and are
essential in maintaining human health, and animal health and welfare. If antimicrobial resistance
occurs in relation to a particular disease or infection, this means a lack of suitable treatment options
for both human and animal diseases because for example the antibiotic used does not kill or inhibit
the bacteria causing the disease. Therefore the increased rate of development of AMR is a societal
issue which impacts on us all regardless of whether we are food producers, keep animals as pets, or
even if we have no regular contact with animals. Global travel of people, animals and food means
that resistant bacteria arising either in humans, animals or the environment may spread from one to
the other as there are no possible border restrictions against the spread of bacteria. Increased
mortality, or prolonged recovery times as well as the economic cost to healthcare system and
productivity losses affect all members of society. In relation to the treatment of animal disease, if
antibiotics are losing their efficacy this compromises the availability of suitable medicines that
farmers and pet owners can avail of to ensure their animals health and welfare, as well as an
increased financial cost to the animal owner.
Statistic:
A recent European Commission report estimated that drug-resistant bacteria
are now responsible for about 25,000 human deaths per annum in the EU
alone, with associated healthcare costs and productivity losses of €1.5b. The
Commission also estimated that approx. 4m patients are estimated to acquire
a health-care associated infection in the EU every year.
What can I do to address the development and spread of AMR?
Antibiotics are a hugely valuable resource to protect both human and animal health. Continued
usage and in particular inappropriate usage will contribute to the development and spread of AMR.
The first step to address the challenge of AMR is to improve the overall health status of the human
and animal population. In relation to improving animal health, disease prevention strategies are vital
components of management practices. Disease prevention strategies include improvements to
biosecurity, adherence to best practice with regard to production and management practices and
implementing integrated disease control programmes. Targets to reduce on farm usage of
antibiotics, increased use of vaccines and alternatives to antibiotics should be considered as part of
an overall strategy to address AMR. Where it is necessary to use antimicrobials to treat a disease,
prudent use is essential to maintain the efficacy of the medicines. Prudent use of antibiotics means
that the antibiotics are both prescribed and administered in a responsible manner.
What is prudent use and its role in addressing AMR?
To use something prudently means to use it in a wise, cautious and economical manner. With regard
to usage of antimicrobials in the agri-food sector, prudent use means that the correct medicine is
used to treat the particular disease that has been accurately diagnosed, and that the medicine is
used at the correct dose rate and correct duration in line with veterinary consultation. In relation to
usage of antibiotics in animals, they should only be used following a veterinary diagnosis of a
bacterial disease, the antibiotics must be prescribed for animal treatment by a registered veterinary
practitioner at a specific dose rate for a specific duration which must be adhered to by the person
administering the medicine.
Remember! If disease is present
What is the Department of Agriculture, Food and Marine doing in relation to addressing the
challenge of AMR?
The Department of Agriculture, food and Marine has recognised that antimicrobial resistance is both
a public health and animal health concern. With regard to preserving the therapeutic efficacy of
antimicrobials in animals it continues to promote the policy of disease prevention, and the prudent
use of antimicrobials when necessary. The Department works to heighten awareness and
understanding of antimicrobial resistance through effective communication and education, and to
encourage best practices amongst the veterinary and farming professions, as well as engaging with
industry stakeholders to highlight the need for availability of effective antibiotics for the future, as
well as other alternative disease treatment options.
In relation to surveillance, the Department has been collating data to monitor AMR development
and spread for several years in line with EU Directives. There is a move towards the collection of
harmonised data, in particular in relation to zoonotic pathogens (disease agents that transmit
naturally between animals and humans), and DAFM has been working to meet the annual EU
requirements with regard to surveillance in animals and food. In relation to the collection of
antibiotic consumption data at veterinary practice or farm level, the Department is reviewing
practices in other countries before deciding on a feasible collection method for Ireland. There was a
pilot project carried out to collect data on antibiotic usage at farm level in the pig sector.
The Department, as the regulator of veterinary medicines, has oversight of the regulatory
framework, and a responsibility to ensure compliance with national legislation in relation to the
supply, distribution and administration of veterinary medicines. Officials from DAFM carry out
veterinary practice and farm inspections to examine prescribing practices, supply, and usage of
antimicrobials. Legislation only permits the prescribing of antibiotics by a registered veterinary
practitioner for animals under his /her care. Antibiotics can only be supplied on foot of a veterinary
prescription, and in the case of food animals specific records are required to be kept.
The key messages, firstly of Disease
Prevention, and secondly of Prudent Use of
Antimicrobials, in tandem with continued
Surveillance of AMR and antibiotic
consumption
are
central
to
the
Department’s AMR strategy.
In 2014, The Department of Health and the Department of Agriculture, Food and Marine jointly
established the National Interdepartmental Antimicrobial Resistance Consultative Committee.
What is the role of the National Interdepartmental Antimicrobial Resistance Consultative
Committee (NIARCC)?
The Committee was established as part of the ‘One Health ‘ initiative, and to advance a holistic
national approach in working together to ensure that effective antibiotics remain available into the
future.
The Committee is an interdepartmental response to the spread of antimicrobial resistance in the
human and animal health sectors. It is part of a co-ordinated approach to improve communication
and cooperation across the Health and Agriculture Departments in relation to AMR. The Committee
serves to provide a forum for sharing of information and engagement with relevant stakeholders
from the agri-food, health and environmental sectors.
What does ‘One Health’ mean?
The ‘One Health’ agenda is a worldwide concept which promotes interdisciplinary collaborations and
sharing of information in relation to all aspects of health care for humans, animals and the
environment. Governments and scientists throughout the world recognised the need for greater
interdisciplinary collaboration with regard to preventing and also controlling disease. The issue of
AMR was included in the ‘One Health’ initiative because of the zoonotic (relating to diseases that can
be passed from animals to human) nature of some disease causing pathogens, for instance where
humans and animals share the same bacteria, which can transfer from one population to the other.
Consequently, the antibiotics used to treat these bacteria in animals, may be the same, or similar, to
those used to treat infectious diseases in the human population. Therefore in order to address the
emergence and spread of AMR, there needs to be a co-ordinated response from the public health,
animal health and environmental sectors, as well as other stakeholders in the private and public
sectors.
The multi-sector harmonisation of strategies and measures to address the challenge of AMR are
necessary at a global, regional, and national level. There has been global intersectoral collaboration
since 2010, with the World Organisation for Animal Health (OIE), the World Health Organisation
(WHO) and the Food and Agriculture Organisation of the United Nations (FAO) establishing tripartite
actions to coordinate strategies to ensure antimicrobials maintain their efficacy and are used
responsibly. The European Commission has also promoted a holistic and multi-sectoral approach
involving many groups such as the public health, food safety, animal health and welfare, research
and innovation, bio-safety and environment sectors.
What are Critically Important Antimicrobials (CIAs)?
All antimicrobials are essential treatment tools for human and animal health and welfare. Both the
human and animal sectors have a shared responsibility to prevent or reduce the development and
spread of antimicrobial resistance. Therefore, it was agreed that both the World Health Organisation
(WHO) and the World Organisation for Animal Health (OIE) would both develop a list of critically
important antimicrobials for human and veterinary medicine. These lists rank the antimicrobials
according to their relative importance in both human and veterinary medicine, and provide guidance
when developing risk management strategies for use of these of these particular classes of
antimicrobials and preserving their efficacy. The use of these lists will help preserve the efficacy of
these medicines, which are in some cases ‘last resort’ treatments in human medicine.
Particular classes of antibiotics such as Flouroquinolones, third and fourth generation
cephalosporins, and macrolides have been classed as being of highest risk priority by the WHO and
should not be used for first line treatment. Carbapenems, lipopeptides and oxazolidinones currently
have no veterinary equivalent and the WHO recommends that these classes as well as any new class
of antimicrobial developed for human treatment should not be used in veterinary medicine. The
latest list published by the OIE states that both Flouroquinolones and third and fourth generation
cephalosporins are critically important for both human and animal health and should not be used as
a preventive treatment in the absence of clinical signs of disease. The OIE also recommends that in
relation to both classes, they should only to be used as a second line treatment and this should be
on the basis of sensitivity testing. This criteria has also been included in the product datasheets and
authorisations which have been amended to take account of AMR concerns.