Following the discovery of the bacteria-killing property of penicillin by Alexander Fleming in 1928, antibiotics became the miracle drug of the twentieth century, and a tremendous success story for modern medicine until the beginning of the twenty first century.

But antibiotics are losing their clinical effectiveness at a pace totally unforeseen at the beginning of this century. The fast growing resistance of bacteria to antibiotics seriously impacts morbidity, mortality, length of hospital stay and national budgets for health insurance. It also limits and raises the risk of modern medical interventions such as organ transplants, cancer treatments, intensive care, life-threatening infections or surgery, none of which are possible without effective antibiotics.

The adverse consequences of healthcare-associated infections (HCAI) in the European Union are distressing. Figures from EUROSTAT and the European Centre for Disease Prevention and Control (ECDC) in Stockholm show that the estimated incidence of HCAI affects more than 5% of hospital admissions in the EU and that there are about 37,000 directly attributable deaths and 111,500 indirect deaths per year. Looking at the costs for national health budgets, the same European institutions calculate 16 million extra hospital patient-days, corresponding to €5.5 billion in extra costs.

The first Commission communication on a Community strategy against antimicrobial resistance was published in 2001, since when there have been a large number of EU driven initiatives and campaigns in this field.
In 2002 the Council published a ‘Recommendation on the prudent use of antimicrobial agents in human medicine’. Despite much effort at European level, the problem of antimicrobial resistance is far from under control in the Community. One of the reasons is that the European Union shares the competence in the field of healthcare with the Member State governments. Figures of the European Surveillance of Antimicrobial Consumption (ESAC), a project funded by ECDC, show that outpatient use of antibiotics is still very high in countries like Greece, France, Italy, Belgium, Luxemburg and Poland. A much lower consumption (less than 50% lower than in these five countries) is noted in the United Kingdom, Sweden, Germany, Austria, Latvia, Estonia and the Netherlands. Data collected by the European Antimicrobial Resistance Surveillance System (EARSS) show that resistance of widespread and dangerous micro-organisms against widely used antibiotics is increasingly problematic. To be provided with high-quality and safe healthcare services is one of the most important rights of EU citizens.

Because of the slow progress in the battle against antibiotic resistance, the topic has become a high priority for the current Trio Council Presidency (France-Czech Republic-Sweden). This has resulted in conferences, control programmes, public campaigns and more international exchange and co-operation on the topic

The EU’s policy currently focuses on reducing the use of antibiotics by educating citizens and prescribers on the proper use of antibiotic treatment. The second pillar of the policy is the promotion of Research & Development for new and more effective antibiotics.

ECHAMP believes that a third pillar is still missing: Research on the contribution of complementary medicinal approaches (CAM) as an alternative for the treatment with broad spectrum antibiotics for widespread infections such as respiratory tract and ear infections (e.g. in children).

It should be investigated whether the ‘immunological intelligence’ of the human body should not be considered as the basis for treatment of infections. In many cases, a good diagnosis combined with CAM treatment under the supervision of a competent health care professional will be helpful and probably also more cost-effective.  

It is hoped that one of the countries of the coming Trio Council Presidency (Spain, Belgium, Hungary) will have the intelligence and courage to add this third pillar to the EU policy programme on the growing antimicrobial resistance and the proper use of antibiotic treatment.

Nand De Herdt
ECHAMP President