EMA and EFSA Joint Scientific Opinion on measures to reduce the need to use antimicrobial agents in animal husbandry in the European Union, and the resulting impacts on food safety (RONAFA)

Abstract

EFSA and EMA have jointly reviewed measures taken in the EU to reduce the need for and use of antimicrobials in food-producing animals, and the resultant impacts on antimicrobial resistance (AMR). Reduction strategies have been implemented successfully in some Member States. Such strategies include national reduction targets, benchmarking of antimicrobial use, controls on prescribing and restrictions on use of specific critically important antimicrobials, together with improvements to animal husbandry and disease prevention and control measures. Due to the multiplicity of factors contributing to AMR, the impact of any single measure is difficult to quantify, although there is evidence of an association between reduction in antimicrobial use and reduced AMR. To minimise antimicrobial use, a multifaceted integrated approach should be implemented, adapted to local circumstances. Recommended options (non-prioritised) include: development of national strategies; harmonised systems for monitoring antimicrobial use and AMR development; establishing national targets for antimicrobial use reduction; use of on-farm health plans; increasing the responsibility of veterinarians for antimicrobial prescribing; training, education and raising public awareness; increasing the availability of rapid and reliable diagnostics; improving husbandry and management procedures for disease prevention and control; rethinking livestock production systems to reduce inherent disease risk. A limited number of studies provide robust evidence of alternatives to antimicrobials that positively influence health parameters. Possible alternatives include probiotics and prebiotics, competitive exclusion, bacteriophages, immunomodulators, organic acids and teat sealants. Development of a legislative framework that permits the use of specific products as alternatives should be considered. Further research to evaluate the potential of alternative farming systems on reducing AMR is also recommended. Animals suffering from bacterial infections should only be treated with antimicrobials based on veterinary diagnosis and prescription. Options should be reviewed to phase out most preventive use of antimicrobials and to reduce and refine metaphylaxis by applying recognised alternative measures.

Keywords: alternatives; antimicrobial consumption; antimicrobial resistance; control options; husbandry.

Figure 1

Total sales of veterinary antimicrobials agents for food‐producing species, in mg/PCU, from 2011 to 2014, for 29 European countries (EMA ESVAC, 2016)

1. Correction of sales data and/or PCU data published in ESVAC 2013 report is described in section 1.6 (EMA ESVAC, 2015b). Under‐reported for Bulgaria for 2011 and 2012 as several wholesalers failed to report data. Strength reported as base for most VMPs for 2011‐2012 for the Czech Republic; for 2013 and 2014, strength reported as in the label of the VMPs. Strength reported as base for some VMPs for 2011–2012 for the Netherlands; for 2013 and 2014, strength reported as in the label of the VMPs. For Slovakia, for 2011 and 2012, the data only represents antimicrobial VMPs imported by wholesalers; for 2013 and 2014, data represents all sales from wholesalers to end users (veterinarians, pharmacies, producers of medicated feeding stuffs and farmers, obtained by import and from national manufacturers). For Spain, under‐reporting for the years 2011–2013 has been identified (underestimated). For the UK, high sales of certain tetracycline‐containing products late in 2010 were probably used in 2011 and thus the use has been underestimated for 2011.

Figure 2

Changes in total sales and in sales of fluoroquinolones and 3rd‐ and 4th‐generation cephalosporins, from 2011 to 2014, for 25 EU/EEA countries (Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden and United Kingdom) (source: EMA ESVAC, 2016)

Figure 3

Oral solutions, oral powders and premixes as percentages of total sales, in mg per population correction unit (mg/PCU), of veterinary antimicrobial agents for food‐producing animals, including horses, in 29 European countries for 2014

Figure 4

Antimicrobial veterinary medicinal product sales from 1999–2015 in kg (thousands) in the Netherlands (source: MARAN, 2016)

Figure 5

Consumption of 3rd‐ and 4th‐generation cephalosporins in pigs and cattle in Denmark (source: (DANMAP, 2016))

Figure 6

Change in the estimated number of pigs treated with cephalosporins (source: (ANSES, 2015b))

Figure 7

Evolution of proportions of E. coli isolates non‐susceptible to ceftiofur in cattle, pigs, poultry and turkey (2006–2014) (source: (ANSES, 2016))

Figure 8

Ranking of the four livestock sectors based on total antimicrobial use and antimicrobial –specific resistance in 2014 (source: (SDa, 2016a))

Figure 9

Antimicrobial consumption in the pig production, and the distribution on age groups, Denmark (source: (DANMAP, 2016) – see also original report)

Figure D.1

Scheme representing the salmon production cycle in Norway

Figure D.2

Fish production and use of antimicrobials in fish farming in Norway (1996–2015)