Dealing with antimicrobial resistance--the Danish experience

Following the discovery in 1994 and 1995 that use of the glycopeptide antimicrobial avoparcin for growth promotion was associated with the occurrence of vancomycin resistant Enterococcus faecium in food animals and in food, the Danish Minister of Food, Agriculture and Fisheries banned the use of avoparcin in May 1995. The ban was later extended by the European Commission to include all EU member states. In May 1999, the EU Scientific Steering Committee recommended that use for growth promotion of antimicrobials, which are or may be used in human or veterinary medicine should be phased out as soon as possible and ultimately abolished. During the first half of the 1990s the consumption of tetracyclines, mainly in pig production, increased markedly. This was countered by severely reducing through legal means the financial enticement for veterinarians to prescribe medicines and by restricting the availability of tetracycline as non-registered speciality products. The focus on consumption of antimicrobials and on resistance prompted a number of initiatives by Danish authorities to limit the increase in antimicrobial resistance. One such initiative was the implementation of an integrated programme (DANMAP) which monitors resistance among bacteria from food animals, food and humans. A programme to monitor all use of prescription medicine in food animals at the herd level is presently being implemented. Another initiative was the elaboration of a series of practical recommendations to veterinarians on the prudent use of antimicrobials in order to reduce the development of resistance without compromising therapeutic efficacy. Our experience with avoparcin shows that a restrictive policy on the use of antimicrobials can curb the development of resistance. However, the occurrence and persistence of specific resistance phenotypes is the end-result of complex interactions of, among others, antimicrobial co-selection, clonal spread of resistant strains and various herd management factors.