Reducing consumption of antimicrobial agents reduces resistance: DANMAP

Antimicrobial agents are the most important weapons in the fight against bacterial infections in humans and animals, but these agents can lose their potency. When bacteria are exposed to antimicrobial agents they can develop resistance. This would make it more difficult to treat common diseases such as pneumonia and other infections.

In 1995, Denmark introduced the DANMAP surveillance program, which monitors the consumption of antimicrobial agents - from farm to fork to sickbed - and investigates the occurrence of antimicrobial resistance. The DANMAP programme is a joint initiative of the National Food Institute and National Veterinary Institute, both at the Technical University of Denmark, Statens Serum Institut, and the Danish Medicines Agency.

The surveillance programme was the first of its kind in the world, and it has now been emulated in many countries. The surveillance data is used to document problems and document and propose improvements which can be used by the Danish Veterinary and Food Administration and the Danish National Board of Health in their management of resistance.

Reducing consumption of antimicrobial agents reduces resistance

"The results from the Danish monitoring of antimicrobial agent consumption and resistance over the past 15 years have shown that it is possible to reduce the incidence of resistant bacteria by reducing consumption of antimicrobial agents. The results from DANMAP give us knowledge about changes in bacteria resistance, so we can keep one step ahead", says senior researcher Yvonne Agersø from National Food Institute, Technical University of Denmark.

In the 1990s, Danish researchers discovered that routine use of antimicrobial agents as growth promoters for livestock was leading to resistance in bacteria which can be transferred to people and cause disease. Danish agriculture discontinued using certain types of growth promoters, and based on the scientific results, Denmark was the first country in the world to introduce a ban on growth promoters. This was later followed by a ban on the use of growth promoters throughout the EU.

Unlike many other countries, antimicrobial agents may only be sold on prescription in Denmark, and consumption by both livestock and humans is carefully monitored. The focus of the surveillance today is on total consumption, and on antimicrobial agents which are critical to the treatment of serious infections in humans.

The world is looking to Denmark

"We have evidence to show that reducing the consumption of antimicrobial agents prevents the incidence of resistant bacteria. One very effective initiative is that Denmark introduced a ban on veterinarians profiting from writing prescriptions for antimicrobial agents. Consumption of therapeutic antimicrobial agents fell by almost 30% in 1995 when the ban was introduced", says research manager Frank Møller Aarestrup from National Food Institute, Technical University of Denmark.

Several other countries are now looking to the Danish example. The USA in particular is interested in learning from Denmark's experience and the World Health Organisation, WHO, is also monitoring Danish initiatives with great interest.

Antimicrobial agent consumption and resistance is a high priority issue during the Danish EU presidency. The Danish ministries of health and food, agriculture and fisheries are hosting an international conference on resistance on 14-15 March, which Frank Møller Aarestrup has helped to plan.

"We hope that other countries will be inspired by the results we have achieved in Denmark over the past 15 years. We have shown that continually monitoring changes in resistance has an effect - that we document problems and can propose solutions," says Frank Møller Aarestrup.

Source: Technical University of Denmark