European Joint Meeting of AMR National Focal Points and Chief Medical Officers

Ljubljana, Slovenia, 14 March 2008

Raising Awareness aboutAntibiotic Resistance

National Public Campaigns onAMR and Rational Antibiotic Use

France 2001-2008Prof. Benoît SCHLEMMER

University Paris-VII School of Medicine and St-Louis Hospital, ParisHead of the French National Committee « Keep Antibiotics Working »

Preparing for a national policy

1990-98 : An expert growing concern about AMR

• Following actions to control for in-hospital AMR and hospital-acquired infection (MRSA...)

• Building a national AMR Network from pre-existing surveillance systems - Raising evidence of increasing resistance rates in common bacterial species

– Penicillin-resistant S. pneumoniae in young children AOM and meningitis

• Evidence of French antibiotic overuse/inappropriate use and questionable quality of care

• Outdated recommendations for medical practice :

– Systematic use of antibiotics in acute sore throat...– People misunderstanding perception about antibiotics...

• Need for action and political support

Moving towards a recognized political issue1998-2001

• The 1998 Copenhagen European Conference• French Institute for Public Health Surveillance

1999 Conference on « Control of AMR », on behalf of the French Ministry of Health : monitoring, prevention of transmission, correct antibiotic use, research promotion

• « Antibiotic Mission » upon request of the French Minister of Health, B. Kouchner : a proposition for a National « antibiotic plan »

• Autumn 2001 : official announcement of the Plan « Keep Antibiotics Working », as part of the fight against AMR– Primary care medicine : actions towards health professionals and the

general public; – Hospitals

Antibiotic use in primary care medicineKeypoints of the French Campaign

Part of the National Action Plan “Keep Antibiotics Working”

• Goal of the campaign "Antibiotics, it’s not automatic!"– To increase general public awareness about AMR and knowledge about the

role of antibiotics– To decrease outpatient antibiotic use

• Operator : the French Social Insurance System (Assurance-Maladie)• Actions and Agenda :

– a yearly autumn-winter 6-month campaign 2002-2007– TV and radio humorous spots, press releases, information leaflets… Cost = 4 M €/year– Academic detailing of GPs

• Indicators :– People perceptions about antibiotics– Seasonal antibiotic consumption (Oct-March winter period); data adjusted

for epidemic variations– Antibiotic resistance

Results of National Public Campaigns

in France 2002-2007• People are more aware about antibiotics :– 67% agree that resistances appear when

antibiotics consumption is too high (+12),– 40% agree that antibiotics are active against

bacteria only (+10),– Yet 54% agree that antibiotics get you back on

your feet more quickly (-10).• 23.4% decrease in outpatient antibiotic

consumption : - 34 % for children < 15 y.o.,- 17.6 % for others

• 850 M € saved

ABT prescriptions from 2001-02 to 2006-07(Oct-March periods)

Antibiotic consumption by age and year 2001-2007(Yearly October/March periods)

Pour les moins de 2 ans, la baisse équivaut à un traitement en moins par hiverPour les jeunes actifs (26/35 ans) : une baisse qui se maintient (- 5,7 % en moyenne)

General population : Regional antibiotic prescriptions(yearly october-march periods, adjusted data)

La moyenne nationale pour l’hiver 2006-2007 : 5,1 prescriptions pour 10 habitantscontre 6,7 pour l’hiver 2001-2002

*Réalisé à l’aide de Cartes et Données

Penicillin resistance (% PSDP) in S. pneumoniae National Reference Center - France

0,5 0,7 14 5

7

12

1720

25

3236

43

4852 53

48

43

38

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

2001

2002

2003

2004

2005

% P

SD

P

1984-1997, Geslin P. ; 2001-2005, ORP-CNRP , Varon E., Gutmann L.

(All-type bacterial samples, all age patients, 48 920 strains studied)

Reasons for a success story

• Agreement between all experts and multidisciplinary approach

• Political support – Funding of the campaign• The Antibiotic Plan : not an official body; just

an expert committee to suggest, harmonize, mobilize…, but with an official recognition

• Help of law and new agencies :– Public Health Law 2004 (the AMR item)– French National Authority for Health + French Institute

for Public Health Surveillance

Flaws of the campaign and lessons for the future (or for others !!)

• The difficult fight against cultural and social-medical behaviours

• Misunderstanding by health professionnals

• The payor is the main operator : what is the true goal of the campaign ?

• (Concurrent in-hospital changes)

Conclusions

• Political/official support as a Public Health priority

• Funding• Repeated, long term actions…• Mandatory follow-up of :

– Antibiotic consumption : which system ?– Bacterial resistance– General public and healthcare professionnals

opinions