Euroroundup Open Access
Like 1


Unnecessary and inappropriate use of antibiotics in human healthcare is a major driver for the development and spread of antimicrobial resistance; many countries are implementing measures to limit the overuse and misuse of antibiotics e.g. through the establishment of antimicrobial use reduction targets. We performed a review of antimicrobial use reduction goals in human medicine in Transatlantic Taskforce on Antimicrobial Resistance partner countries. On 31 March 2017, the European Centre for Disease Prevention and Control sent a questionnaire to National Focal Points for Antimicrobial Consumption and the National Focal Points for Antimicrobial Resistance in 28 European Union countries, Iceland and Norway. The same questionnaire was sent to the TATFAR implementers in Canada and the United States. Thirty of 32 countries replied. Only nine countries indicated that they have established targets to reduce antimicrobial use in humans. Twenty-one countries replied that no target had been established. However, 17 of these 21 countries indicated that work to establish such targets is currently underway, often in the context of developing a national action plan against antimicrobial resistance. The reported targets varied greatly between countries and can be a useful resource for countries willing to engage in the reduction of antibiotic use in humans.


Article metrics loading...

Loading full text...

Full text loading...



  1. Organisation for Economic Co-operation and Development (OECD). Antimicrobial resistance - policy insights. Paris: OECD; 2016. Available from: http://www.oecd.org/health/health-systems/AMR-Policy-Insights-November2016.pdf
  2. Ministère de la Santé et des Sports [Ministry of Health and Sports]. Public awareness campaigns on the prudent use of antibiotics, European workshop, November 6-7, 2008. Paris: Ministère de la Santé et des Sports; 2009. French. Available from: http://solidarites-sante.gouv.fr/IMG/pdf/Livre_blanc_Ministere.pdf
  3. 2009 EU-U.S. Summit Declaration, 3 November 2009. Available from: https://www.cdc.gov/drugresistance/pdf/nov-3-2009-summit-declaration_en0_508.pdf
  4. Transatlantic Task Force on Antimicrobial Resistance (TATFAR). Presenting a united front: International taskforce convenes to battle increasing resistance to life-saving drugs. Available from: https://www.cdc.gov/drugresistance/tatfar/news/united-front.html
  5. Belgian Antibiotic Policy Coordination Commission (BAPCOC). Note de politique pour la législature 2014-2019. [Policy paper for the 2014-2019 term]. Brussels: BAPCOC; 2014. French. Available from: http://organesdeconcertation.sante.belgique.be/sites/default/files/documents/belgische_commissie_voor_de_coordinatie_van_het_antibioticabeleid-fr/19100224_fr.pdf.
  6. Belgian Antibiotic Policy Coordination Commission (BAPCOC). Policy paper for the 2014-2019 term. Brussels: BAPCOC; 2014. Available from: http://consultativebodies.health.belgium.be/sites/default/files/documents/policy_paper_bapcoc_executive_summary_2014-2019_english.pdf
  7. Global-PPS Antimicrobial Consumption and resistance. Point prevalence survey. A tool for antibiotic stewardship in hospitals. Presentation by Koen Magerman. Working group Hospital Medicine. 2015. Available from: http://overlegorganen.gezondheid.belgie.be/sites/default/files/documents/18nov2015_k.magerman-pps.pdf
  8. Ministère du Travail, de l’Emploi et de la Santé [Ministry of Labour, Employment and Health]. Plan national d’alerte sur les antibiotiques 2011-2016. [National alert plan on antibiotics 2011-2016]. Paris: Ministère du Travail, de l’Emploi et de la Santé; 2011. French. Available from: http://solidarites-sante.gouv.fr/IMG/pdf/plan_antibiotiques_2011-2016_DEFINITIF.pdf
  9. Ministère des Affaires Sociales et de la Santé. [Ministry of Social Affairs and Health]. Arrêté du 20 octobre 2016 portant approbation de la convention nationale organisant les rapports entre les médecins libéraux et l’assurance maladie signée le 25 août 2016. [Decreee of 20 October 2016 on the approval of the national agreement on the relationship between private physicians and health insurance, signed on 25 August 2016]. Paris: Ministère des Affaires Sociales et de la Santé; 2016. French. Available from: http://convention2016.ameli.fr/wp-content/uploads/2016/12/Arrete_du_20-10-16__JO_23-10-16_-convention_medicale.pdf
  10. Ministère des Affaires Sociales et de la Santé [Ministry of Social Affairs and Health]. Avis relatif à l'avenant n° 1 à la convention nationale organisant les rapports entre les médecins libéraux et l'assurance maladie, signée le 25 août 2016 [Opinion on endorsement No. 1 of the national agreement on the relations between private physicians and health insurance]. Paris: Ministère des Affaires Sociales et de la Santé; 2016. French. Available from: https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000034519792&categorieLien=id
  11. Dutch Ministry of Health. Welfare and Sport. Letter to parliament about the approach to antibiotic resistance. The Hague: Dutch Ministry of Health; 2015. Available from: https://www.government.nl/documents/parliamentary-documents/2015/06/24/letter-to-parliament-about-the-approach-to-antibiotic-resistance
  12. Government of the Netherlands. Administrative agreements on antibiotic resistance in healthcare. The Hague: Government of the Netherlands; 2015. Available from: https://www.government.nl/documents/parliamentary-documents/2015/06/24/administrative-agreements-on-antibiotic-resistance-in-healthcare
  13. Debets VE, Verheij TJ, van der Velden AWSWAB’s Working Group on Surveillance of Antimicrobial Use. Antibiotic prescribing during office hours and out-of-hours: a comparison of quality and quantity in primary care in the Netherlands. Br J Gen Pract. 2017;67(656):e178-86.  https://doi.org/10.3399/bjgp17X689641  PMID: 28232364 
  14. Dekker ARJ, Verheij TJM, van der Velden AW. Antibiotic management of children with infectious diseases in Dutch Primary Care. Fam Pract. 2017;34(2):169-74.  https://doi.org/10.1093/fampra/cmw125  PMID: 28122841 
  15. Tyrstrup M, van der Velden A, Engstrom S, Goderis G, Molstad S, Verheij T, et al. Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, the Netherlands and Sweden: use of European quality indicators. Scand J Prim Health Care. 2017;35(1):10-8.  https://doi.org/10.1080/02813432.2017.1288680  PMID: 28277045 
  16. van der Velden AW, Kuyvenhoven MM, Verheij TJ. Improving antibiotic prescribing quality by an intervention embedded in the primary care practice accreditation: the ARTI4 randomized trial. J Antimicrob Chemother. 2016;71(1):257-63.  https://doi.org/10.1093/jac/dkv328  PMID: 26490015 
  17. Norwegian Ministries. National Strategy against Antibiotic Resistance 2015-2020. Oslo: Norwegian Ministry of Health and Care Services; 2015. Available from: https://www.regjeringen.no/contentassets/5eaf66ac392143b3b2054aed90b85210/antibiotic-resistance-engelsk-lavopploslig-versjon-for-nett-10-09-15.pdf
  18. Government Offices of Sweden. Swedish strategy to combat antibiotic resistance 2016. Stockholm: Ministry of Health and Social Affairs; 2016. Available from: http://www.government.se/49bbcf/contentassets/168838e186de455ca7fe868bee92d209/swedish-strategy-to-combat-antibiotic-resistance.pdf
  19. Strama - samverkan mot antibiotikaresistens [Collaboration against antibiotic resistance]. Stramas mål för antibiotikaanvändning inom öppen vård [The targets of Strama for antibiotic use in ambulatory care]. STRAMA; 2016. Swedish. Available from: http://strama.se/wp-content/uploads/2016/04/Stramas-mal-for-antibiotikaanvandningen-beskrivning.pdf
  20. André M, Vernby A, Odenholt I, Lundborg CS, Axelsson I, Eriksson M, et al. Diagnosis-prescribing surveys in 2000, 2002 and 2005 in Swedish general practice: consultations, diagnosis, diagnostics and treatment choices. Scand J Infect Dis. 2008;40(8):648-54.  https://doi.org/10.1080/00365540801932439  PMID: 18979603 
  21. Skoog G, Struwe J, Cars O, Hanberger H, Odenholt I, Prag M, et al. Repeated nationwide point-prevalence surveys of antimicrobial use in Swedish hospitals: data for actions 2003-2010. Euro Surveill. 2016;21(25):1-9.  https://doi.org/10.2807/1560-7917.ES.2016.21.25.30264  PMID: 27367646 
  22. Strama - Samverkan mot antibiotikaresistens [Collaboration against antibiotic resistance]. Verksamhetsplan 2019 för NAG Strama [Action plan 2019 for NAG Strama]. STRAMA; 2019. Swedish. Available from: http://strama.se/wp-content/uploads/2019/02/Verksamhetsplan-NAG-Strama-2019.pdf
  23. UK Department of Health. UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018. London: Department of Health; 2013. Available from: https://www.gov.uk/government/publications/uk-5-year-antimicrobial-resistance-strategy-2013-to-2018
  24. National Health Service England (NHS). Quality Premium guidance 2017-19. London: NHS; 2017. Available from: https://www.england.nhs.uk/resources/resources-for-ccgs/ccg-out-tool/ccg-ois/qual-prem/
  25. National Health Service (NHS) England. 2017-2019 CQUIN Guidance. London: NHS; 2017. Available from: https://www.england.nhs.uk/nhs-standard-contract/cquin/cquin-17-19/
  26. The Health and Social Care Information Centre. Prescribing Measures and their application. Health and Social Care Information Centre: Leeds; 2012. Available from: http://content.digital.nhs.uk/media/10952/Prescribing-Measures/pdf/CHttpHandler.pdf
  27. Johnson AP, Müller-Pebody B, Budd E, Ashiru-Oredope D, Ladenheim D, Hain D, et al. Improving feedback of surveillance data on antimicrobial consumption, resistance and stewardship in England: putting the data at your Fingertips. J Antimicrob Chemother. 2017;72(4):953-6. PMID: 27999049 
  28. Public Health England (PHE). English surveillance programme for antimicrobial utilisation and resistance. London: PHE; 2016. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/570276/ESPAUR_executive_summary_and_recommendations.pdf
  29. Scottish Government. Scottish Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAI) 5 year Strategic Framework. Edinburgh: The Scottish Government; 2016. Available from: http://www.gov.scot/Topics/Health/Services/Preventing-Healthcare-Infections/SARHAI5YrStrategicFramework
  30. National Health Service (NHS) Scotland. Scottish Management of Antimicrobial resistance Action Plan 2014 – 18 (ScotMARAP 2). Edinburgh: NHS Scotland; 2014. Available from: http://www.scottishmedicines.org.uk/files/sapg/ScotMARAP2_final.pdf
  31. The White House. National strategy for combating antibiotic resistant bacteria. Washington D.C.: the White House; 2014. Available from: https://www.cdc.gov/drugresistance/pdf/carb_national_strategy.pdf
  32. The White House. National action plan for combating antibiotic-resistant bacteria. Washington D.C.: The White House; 2015. Available from: https://www.cdc.gov/drugresistance/pdf/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf
  33. Hersh AL, Fleming-Dutra KE, Shapiro DJ, Hyun DY, Hicks LAOutpatient Antibiotic Use Target-Setting Workgroup. Outpatient Antibiotic Use Target-Setting Workgroup. Outpatient Antibiotic Use Target-Setting Workgroup. Frequency of first-line antibiotic selection among US ambulatory care visits for otitis media, sinusitis, and pharyngitis. JAMA Intern Med. 2016;176(12):1870-2.  https://doi.org/10.1001/jamainternmed.2016.6625  PMID: 27775770 
  34. Howard P, Huttner B, Beović B, Béraud G, Kofteridis DP, Paño Pardo J, et al. ESGAP Indicators Working Group. ESGAP inventory of target indicators assessing antibiotic prescriptions: a cross-sectional survey. J Antimicrob Chemother. 2017;72(10):2910-4.  https://doi.org/10.1093/jac/dkx243  PMID: 29091207 
  35. Smieszek T, Pouwels KB, Dolk FCK, Smith DRM, Hopkins S, Sharland M, et al. Potential for reducing inappropriate antibiotic prescribing in English primary care. J Antimicrob Chemother. 2018;73(suppl_2):ii36-43.  PMID: 29490058 

Data & Media loading...

Supplementary data

Comment has been disabled for this content
Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error