1. European Joint Meeting of AMR National Focal Points and Chief Medical Officers Ljubljana, Slovenia, 14 March 2008 Raising Awareness about Antibiotic Resistance National Public Campaigns on AMR and Rational Antibiotic Use France 2001-2008 Prof. Benoît SCHLEMMER University Paris-VII School of Medicine and St-Louis Hospital, Paris Head of the French National Committee « Keep Antibiotics Working »

2. Preparing for a national policy 1990-98 : An expert growing concern about AMR Following actions to control for in-hospital AMR and hospital-acquired infection (MRSA...) Building a national AMR Network from pre-existing surveillance systems - Raising evidence of increasing resistance rates in common bacterial species –Penicillin-resistant S. pneumoniae in young children AOM and meningitis Evidence of French antibiotic overuse/inappropriate use and questionable quality of care Outdated recommendations for medical practice : –Systematic use of antibiotics in acute sore throat... –People misunderstanding perception about antibiotics... Need for action and political support

3. Moving towards a recognized political issue 1998-2001 The 1998 Copenhagen European Conference French Institute for Public Health Surveillance 1999 Conference on « Control of AMR », on behalf of the French Ministry of Health : monitoring, prevention of transmission, correct antibiotic use, research promotion « Antibiotic Mission » upon request of the French Minister of Health, B. Kouchner : a proposition for a National « antibiotic plan » Autumn 2001 : official announcement of the Plan « Keep Antibiotics Working », as part of the fight against AMR –Primary care medicine : actions towards health professionals and the general public; –Hospitals

4. Antibiotic use in primary care medicine Keypoints of the French Campaign Part of the National Action Plan “Keep Antibiotics Working” Goal of the campaign "Antibiotics, it’s not automatic!" –To increase general public awareness about AMR and knowledge about the role of antibiotics –To decrease outpatient antibiotic use Operator : the French Social Insurance System (Assurance-Maladie) Actions and Agenda : –a yearly autumn-winter 6-month campaign 2002-2007 –TV and radio humorous spots, press releases, information leaflets… Cost = 4 M €/year –Academic detailing of GPs Indicators : –People perceptions about antibiotics –Seasonal antibiotic consumption (Oct-March winter period); data adjusted for epidemic variations –Antibiotic resistance

5. Results of National Public Campaigns in France 2002-2007 People are more aware about antibiotics : –67% agree that resistances appear when antibiotics consumption is too high (+12), –40% agree that antibiotics are active against bacteria only (+10), –Yet 54% agree that antibiotics get you back on your feet more quickly (-10). 23.4% decrease in outpatient antibiotic consumption : - 34 % for children < 15 y.o., - 17.6 % for others 850 M € saved

6. ABT prescriptions from 2001-02 to 2006-07 (Oct-March periods)

7. Antibiotic consumption by age and year 2001-2007 (Yearly October/March periods) Pour les moins de 2 ans, la baisse équivaut à un traitement en moins par hiver Pour les jeunes actifs (26/35 ans) : une baisse qui se maintient (- 5,7 % en moyenne)

8. General population : Regional antibiotic prescriptions (yearly october-march periods, adjusted data) La moyenne nationale pour l’hiver 2006-2007 : 5,1 prescriptions pour 10 habitants contre 6,7 pour l’hiver 2001-2002 *Réalisé à l’aide de Cartes et Données

9. Penicillin resistance (% PSDP) in S. pneumoniae National Reference Center - France 1984-1997, Geslin P. ; 2001-2005, ORP-CNRP, Varon E., Gutmann L. (All-type bacterial samples, all age patients, 48 920 strains studied)

10. Reasons for a success story Agreement between all experts and multidisciplinary approach Political support – Funding of the campaign The Antibiotic Plan : not an official body; just an expert committee to suggest, harmonize, mobilize…, but with an official recognition Help of law and new agencies : –Public Health Law 2004 (the AMR item) –French National Authority for Health + French Institute for Public Health Surveillance

11. Flaws of the campaign and lessons for the future (or for others !!) The difficult fight against cultural and social-medical behaviours Misunderstanding by health professionnals The payor is the main operator : what is the true goal of the campaign ? (Concurrent in-hospital changes)

12. Conclusions Political/official support as a Public Health priority Funding Repeated, long term actions… Mandatory follow-up of : –Antibiotic consumption : which system ? –Bacterial resistance –General public and healthcare professionnals opinions