Kosovo's national action plan for antimicrobial resistance

Abstract

Antimicrobial resistance is one of the major public health challenges worldwide.1Laxminarayan R Duse A Wattal C et al.Antibiotic resistance—the need for global solutions.Lancet Infect Dis. 2013; 13: 1057-1098Summary Full Text Full Text PDF PubMed Scopus (2547) Google Scholar Antibiotic consumption and related resistance are increasing around the globe, particularly in developing countries. Kosovo is located in southeast Europe and has a population of 1·7 million inhabitants. The main challenges regarding antimicrobial resistance in Kosovo are limited financial and human resources, over-the-counter sale of antibiotics, and scarcity of clinical guidelines authorised by the Ministry of Health. The prevalence of antimicrobial resistance in Kosovo is two to five times higher for the majority of bacteria and corresponding antibiotic groups compared with the means in EU countries.2WHOCentral Asian and eastern European surveillance of antimicrobial resistance: annual report 2017. World Health Organization Regional Office for Europe, Copenhagen2017Google Scholar To address the challenge of antimicrobial resistance, the Ministry of Health has initially completed the National Strategy and Action Plan to Combat Antimicrobial Resistance 2011–15. Surveillance of antibiotic consumption was one of the main success stories during the implementation of the first strategy for antimicrobial resistance. Wholesalers' data suggest that antibacterial use in Kosovo in 2011 was 26·3 defined daily doses per 1000 inhabitants per day.3Versporten A Bolokhovets G Ghazaryan L et al.Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe.Lancet Infect Dis. 2014; 14: 381-387Summary Full Text Full Text PDF PubMed Scopus (199) Google Scholar However, the latest WHO publication on antibiotic consumption in Europe showed a substantial decrease in antibiotic consumption by almost 25%.4WHOWHO report on surveillance of antibiotic consumption: 2016–2018 early implementation. World Health Organization, Geneva2018Google Scholar In all seven hospitals in Kosovo, 56·8% of inpatients were using at least one antibiotic with ceftriaxone as the most prescribed antibiotic. At the primary care level, antibiotic therapy prescription with generic names was noted only in 31% of cases and the most prescribed antibiotic was also ceftriaxone. No systematic monitoring of antibiotic consumption in the veterinary sector has been implemented. Kosovo participated in global surveillance of antimicrobial resistance from sewage in capital cities of Europe. The most common antimicrobial resistance genes identified in sewage of the capital city, Prishtina, were msr(E), blaOXA, and aaDa. On Dec 5, 2018, the Minister of Health signed a new National Action Plan for Antimicrobial Resistance for a period of 3 years. This plan aims to establish the framework of measures and interventions to limit the emergence and spread of antimicrobial resistance in our country. Planned activities of the action plan are in line with the WHO Global Action Plan for Antimicrobial Resistance5WHOGlobal action plan on antimicrobial resistance. World Health Organization, Geneva2016https://www.who.int/drugresistance/global_action_plan/en/Date accessed: December 24, 2018Google Scholar and Council of Europe Conclusions on Antimicrobial Resistance.6European CouncilCouncil conclusions on the next steps under a One Health approach to combat antimicrobial resistance. European Union, BrusselsJune 17, 2016https://www.consilium.europa.eu/en/press/press-releases/2016/06/17-epsco-conclusions-antimicrobial-resistanceDate accessed: December 24, 2018Google Scholar This action plan has five strategic objectives and 47 activities. The cornerstone of this action plan will be antimicrobial stewardship and the One Health approach. Specific objectives of the action plan for antimicrobial resistance are to strengthen intersectoral coordination; empower awareness, education, and training of the population and health-care workers; improve the monitoring capacity; optimise the use of antibiotics in human and veterinary medicine; reduce infections; and promote research and international cooperation. We declare no competing interests. Antibiotic resistance—the need for global solutionsThe causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Full-Text PDF