"Antibiotic resistance could become one of the leading causes of death worldwide"

Prof. Laurence Monnoyer-Smith, Commissioner General for Sustainable Development, Ministry of Ecological and Solidarity Transition

Antibiotics are used worldwide to treat and prevent infections in humans and animals and are found in the environment

In 2017, 759 tons of antibiotics for human health and 499 tons of antibiotics for animal health were sold in France. This ratio of consumption between human and animal health varies significantly from one European country to another. In France, this ratio has reversed in recent years. In animal health, 95% of antibiotics are administered to animals intended for human consumption and 5% to companion animals. In human health, 93% of antibiotics are used in outpatient care and 7% in healthcare facilities. Resistance to third-generation cephalosporins in Enterobacteriaceae continues to rise, particularly in healthcare facilities (2% in 2007 vs. 10.2% in 2017 for E. coli and 10% in 2007 vs. 28.8% in 2017 for K. pneumoniae).

By integrating human health, animal health, and environmental health, this document is fully aligned with the "One Health" approach (" One Health”), recommended since 2015 by the World Health Organization (WHO), as well as the interministerial roadmap for controlling antibiotic resistance, the healthcare-associated infection prevention program (Propias), the Ecoantibio plan, and the national environmental health plan.

Two new features in this edition:

• a presentation of available data on the presence of antibiotics and resistance genes in the environment,

• as well as examples of initiatives aimed at improving the proper use of antibiotics.

Encouraging results in 2017 and areas for improvement in human health

This document reports on the results achieved by successive action plans implemented by France in human and animal health. In 2017, these results are encouraging, but there is still significant room for improvement, particularly in human health.

In environmental health, the challenge lies in better understanding the role of the environment, identifying relevant and shared indicators that can be tracked over time, and ensuring that the “One Health” approach is not limited to the integration of human and veterinary health.

Recent initiatives should help further improve these results, such as the establishment of two new national missions for the prevention and surveillance of antibiotic resistance and consumption in community settings and healthcare facilities, the expansion of the role of antibiotic therapy advisors in human health, and the piloting of similar advisors in human health.

Success depends on the mobilization of all professionals and users across all areas of health (human and animal), all healthcare sectors (community, medical-social sector, and healthcare facilities), and raising public awareness.

For more information:

Santé publique France: thematic dossier "Resistance to Antiinfectives"

ANSM: thematic dossier "Proper Use of Antibiotics"

ANSES: thematic dossier "Antibiotic resistance" and thematic dossier "Monitoring sales of veterinary antibiotics"

Health Insurance: via a search using the term "antibiotics"

Inserm: thematic dossier "Antibiotic resistance"

Ministry of Solidarity and Health: thematic dossier "Antibiotics: Essential Medicines to Preserve"

Ministry of Agriculture and Food: thematic dossier "Ecoantibio"

Ministry of Ecological and Solidarity Transition: thematic dossier "Antibiotic Resistance"

Support Centers for the Prevention of Healthcare-Associated Infections in Healthcare and Medical-Social Facilities: "Antibiotics" dossier

* National Agency for Medicines and Health Products Safety, National Agency for Food, Environmental and Occupational Health & Safety, the Health Insurance Fund, and the INSERM team at the University of Limoges, Limoges University Hospital, RESINFIT, U1092