Dealing with antimicrobial resistance - the Danish experience

Following the discovery in 1994 and 1995 that use of the glycopeptide antim icrobial avoparcin for growth promotion was associated with the occurrence of vancomycin resistant Enterococcus faecium in food animals and in food, t he Danish Minister of Food, Agriculture and Fisheries banned the use of avo parcin in May 1995. The ban was later extended by the European Commission t o include all EU member states. In May 1999, the EU Scientific Steering Com mittee recommended that use for growth promotion of antimicrobials, which a re or may be used in human or veterinary medicine should be phased out as s oon as possible and ultimately abolished. During the first half of the 1990 s the consumption of tetracyclines, mainly in pig production, increased mar kedly. This was countered by severely reducing through legal means the fina ncial enticement for veterinarians to prescribe medicines and by restrictin g the availability of tetracycline as non-registered speciality products. T he focus on consumption of antimicrobials and on resistance prompted a numb er of initiatives by Danish authorities to limit the increase in antimicrob ial resistance. One such initiative was the implementation of an integrated programme (DANMAP), which monitors resistance among bacteria from food ani mals, food and humans. A programme to monitor all use of prescription medic ine in food animals at the herd level is presently being implemented. Anoth er initiative was the elaboration of a series of practical recommendations to veterinarians on the prudent use of antimicrobials in order to reduce th e development of resistance without compromising therapeutic efficacy. Our experience with avoparcin shows that a restrictive policy on the use of ant imicrobials can curb the development of resistance. However, the occurrence and persistence of specific resistance phenotypes is the end-result of com plex interactions of, among others, antimicrobial co-selection, clonal spre ad of resistant strains and Various herd management factors.