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Further measures to promote responsible use of antibiotic medicines

As public concern about the spread of antibiotic resistance grows, further refinements to Denmark’s ‘Yellow Card’ system for the control of usage of veterinary medicines have just been announced.

In 2000, the Danish authorities established VETSTAT, a central database, in which vets and pharmacists register all prescriptions of veterinary medicines issued to individual farmers. It enables a much more accurate picture of the overall use of veterinary medicines for different species of livestock as well as an exact record of medicines used by individual farmers. It has proved a valuable tool in informing strategies to encourage more responsible use of antibiotics.

From 2011, information from the VETSTAT database has been used to issue a Yellow Card to any producers using above average amounts of antibiotics, who are then required to implement measures to reduce their usage

From this month, a new differentiated scheme will be rolled out, which will weight the various types of antibiotics used, according to factors of above and below 1, in making the calculations to determine whether a Yellow Card be issued to an individual producer.

The types of antibiotics that are deemed to be important in the treatment of humans will now carry a higher weighting and count for more in the producers’ veterinary medicine accounts.

For example, fluoroquinolones and 3rd and 4th generation cephalosporins will be weighted by a factor of 10. However, these types are not really used in Denmark today, as their use for treating livestock was banned some years ago due to their widespread use in human medication.

Tetracyclines will be weighted by a factor of 1.2, in line with a strategy to discourage their use in favour of alternative treatments. Their weighting has been reduced from the original factor of 1.5 to 1.2. This makes it possible to reduce consumption while maintaining the possibility of responsible use wherever necessary, without the Yellow Card threshold being exceeded.

The weighting of other classes of antibiotics that are not deemed to be as important in the treatment of humans has been reduced to below factor 1. Simple penicillins, sulphonamides, trimethoprim and pleuromutilins will be weighted at 0.95 and the other antibiotic groups will be weighted at a factor of 1.

Use of antibiotics in pig production in Denmark is low in relation to other major producing countries and fell by a further 5 per cent in 2015. Figures for the 1st Quarter of 2016 show that antibiotic usage continued on a downward trend, with a further reduction of 0.5 per cent.

The more nuanced approach within the Yellow Card system meets a dual objective of eliminating unnecessary use of antibiotics and, when treatment is deemed necessary, of discouraging use of those products judged by the authorities to have greater significance in the treatment in the human population, thus limiting the risk of the spread of antibiotic resistance.