To prevent the development of antibiotic-resistant enterobacteriaceae, reducing antimicrobial selection pressure through prudent antibiotic use is of paramount importance.
Several scientific societies have put forward proposals to limit antimicrobial use.
A summary of the French national antibiotic plan can be accessed at :
The initial plan was developed in 2001. However, France remains the third highest antibiotic consumer in Europe, and although two previous plans have reduced consumption by 15% in ambulatory care and by 10% in the hospital setting, the current challenge is the rapid growth of bacterial resistance, including 10-15% of E. coli that are multi-resistant, whether in the community or in the hospital setting. In the absence of new antibiotics in development, these resistant bacteria are currently responsible for increasing morbidity and mortality, as we run out of treatment options.
The proposals put forward in this action plan aiming to promote prudent antibiotic use should thus be taken into consideration as a major public health priority.
There can be no question of depriving a patient of treatment if this is useful or to establish prescription control strictly on economic considerations The objective is to use the right agent, in a suitable form and for a relevant duration, with emphasis on awareness of the particularly selective properties of certain compounds which should thus be prescribed with utmost caution, i.e. cephalosporins, fluoroquinolones and carbapenems. France wishes to move closer to the average level of European consumption, and to achieve this prescriptions should be further reduced by 25% over 5 years.
This plan covers 3 strategic areas:
This includes providing antibiotic protocols, improving their implementation, and advising prescribers. The use in general practice of rapid diagnostic tests (RDT) – the Strep-test or Urine dip-stick – should become widespread.
It also requires informing and raising awareness of all health Professionals, but also of the public at large.
To achieve this requires reducing antibiotic selection pressure (fewer prescriptions and avoidance of broad-spectrum antimicrobials which select for resistant strains) and limiting the spread of multi-resistant bacteria (compliance with standard hygiene precautions, especially hand hygiene through the use of alcohol-based solutions).
Partnerships with pharmacists are essential to supervise prescriptions and monitor consumption.
En parallèle, l’épidémiologie bactérienne et notamment des résistances fait l’objet d’une surveillance par les laboratoires de bactériologie, et d’un retour d’information. Les données françaises sur les résistances bactériennes sont disponibles sur le site http://www.invs.sante.fr/ratb
In parallel, bacterial epidemiology and particularly that of resistant species is monitored by microbiology labs and feedback is provided. French data on bacterial resistance are available at http://www.invs.sante.fr/ratb
Recommendation summaries by the French Society for infectious diseases (SPILF) can be accessed at http://www.infectiologie.com/fr/recommandations.html
New treatment recommendations for community-acquired infections take into account the impact of antibiotics on the microbiota, ie their selection pressure. This is perfectly illustrated by the recommendations published in 2014 concerning treatment of adult community-acquired Urinary tract infections shown below.
In 2010, the Higher Council for Public Health in its report on ESBL Enterobacteriaceae had already insisted on preventing the appearance of resistance by reducing antibiotic use (p.40).