The French “Carlet report” focuses on 4 action pillars to “save
antibiotics” and attempts to emulate the human health proposals
to animal health
The so-called “Carlet report”, named after one if its authors, published by the French
Department of Health on 23 September, is packed with proposals to “preserve the
efficacy of antibiotics”. It is mainly aimed at human medicine, but whenever possible
it attempts to apply the actions envisaged for human health also to animal health.
The report of the special working group (120 ‘experts’, three veterinarians), put together by
the French Ministry of Health and led by professor Jean Carlet, was published on 23
September. The 150-page document (“Together, let’s save the antibiotics”) underlines the
need to raise public awareness on the danger of antimicrobial resistance for public health, but
also to reduce antibiotic use in France by 25% by the end of 2016.
Interdepartmental committee
Four ‘operational’ action pillars are identified, representing “preconditions for the
preservation of antibiotics”. These measures are not just aimed at antibiotics: “it is necessary
to integrate the considerations and recommendations on the use of biocides to those on
antibiotic use.”
The implementation and monitoring of these actions is to be entrusted to an
“interdepartmental committee in charge of antibiotic resistance”, even if the rapporteurs do
not go as far as proposing a name for the “interdepartmental delegate” in charge of this
committee. The four pillars are the following:
National strategy
Pillar 1: “Adopt a national strategy for the research on antibiotic resistance and for the
development of innovative products for the control of bacterial resistance to antibiotics”. This
takes the form of a national intersectoral plan for research and innovation in the field of
antibiotic resistance.
Nine topics have been selected for this plan, two of which refer to animal health: the set-up of
an international standardised monitoring system (which already exists at a European level)
and an understanding of the mechanism of the transfer of resistance between bacterial
populations and the different reservoirs (man, animals, environment...). The report also sets
aside governmental funding for this plan, at least until 2020. It also aims to create a special
status for innovative products for the control of antibiotic resistance (therapeutic, preventive
or diagnostic strategies) in order to “offer a sufficient return on investment with increased
predictability for the company”. It also plans to protect the old antibiotics. For veterinary
medical products, this protection concerns “any innovative data allowing to adapt the
marketing authorisation of ‘old’ antibiotics that are not covered by a protection period.”
Indicators
Pillar 2: “To propose a set of indicators allowing to measure and observe the evolution of
antibiotic resistance, as well as its cost in the different sectors (human, animal,
environmental).”
Regarding the cost, for example, the report expects a price differential of less than 1% for
antibiotics (in human health) in 2020. In animal health, it also plans to set up “national targets
(detailed for each veterinary prescriber, according to the type and size of the practice)”
regarding the amount of antibiotics prescribed. And “if the level of prescription is too high
with regard to [these] targets, the veterinary prescriber and/or the farmer [shall] develop a
detailed action plan”. This will be made possible by the creation of “a national observatory of
antimicrobial resistance”, which shall impose standardised indicators for measuring and
monitoring the level of antibiotic resistance in the main sectors of the environment and the
chains of transmission. Furthermore, “it would be interesting”, suggests the report, “for this
observatory to have access to the list of prescribers” – including veterinarians... However,
there is no mention in the report of applying the maximum 7-day duration of antibiotic
treatment, advanced for human treatment, to the animal health sector.
Charter of the prescriber
Pillar 3: “To improve the prudent use of antibiotics by financing structures in support of
prescription, by making available to the prescribers a set of educational tools, and by
strengthening the individual and collective professional responsibility”. The “Carlet report”
goes further than suggesting that “training in the proper use of antibiotics by human and
animal health professionals, whether or not they are prescribers, is an essential measure”. It
also considers that “all prescribers should demonstrate their commitment to good antibiotic
prescription practices”, by signing “of their free will” a “public commitment charter”
describing these “good practices”. Such a charter is then to be “displayed in the waiting
room”. The expected aim is to display this charter in over 80% of prescribers by 2020.
The report also provides for obligations, regarding “an initial training on the good use of
antibiotics and their resistance” as well as “continuing education (...) on antibiotic therapy, the
good use of antibiotics and bacterial resistance, at a frequency [which remains] to be defined.”
Finally, regarding good practices, the harshest observation concerns the medical community.
But the report also notes that in veterinary medicine, “there is currently no measure targeted at
the ‘big’ prescribers or consumers of antibiotics”. Which might explain the proposal under
pillar 2.
National campaign, starting 2016
Pillar 4: “To increase public awareness of antimicrobial resistance through national and local
targeted long-term actions”. “Provide the fight against antibiotic resistance with the status of
‘Great National Cause 2016’”.
The report calls for the organisation of “a major campaign of information, communication and
education”, to be launched 18 November 2016, with the proposed slogan “Together, let’s save
the antibiotics”. The campaign is to “present antibiotic resistance like a proven danger for the
society as a whole”. Other initiatives are presented in detail, such as a “national competition
of antibiotic resistance” and adequate financing of the European educational programme Ebug, in order to improve “the level of general knowledge on antibiotic resistance from a
young age”.
The report also proposes to “rapidly set up a single website” dedicated to the subject, to
inform all actors, ranging from users to “animal health professionals”. For this component, an
experimental website will be set up in 2016-2017 as part of the Ecoantibio plan 2017.
It should be noted that in the speech of the acceptance of this report, held on 23 September,
the minister of Health did not mention any of the elements concerning veterinary medicine.
It will be interesting to know how the minister of Agriculture will receive this voluminous
report.
Sources:
“Propositions du groupe de travail spécial sur la préservation des antibiotiques”, June 2015,
presented to the minister of Health and published on 23 September 2015, 150 pages (in
French).
http://www.social-sante.gouv.fr/IMG/pdf/rapport_antibiotiques.pdf
Speech of the minister of Health at the occasion of the report’s publication (in French).
http://www.social-sante.gouv.fr/actualite-presse,42/communiques,2322/lutte-contre-lantibioresistance,18061.html