1. National antibiotic program in the Czech Republic NAP-CZ Vlastimil Jindrák and Subcommitte for antibiotic policy ČLS JEP

2. 14.3.2008EU Conference - Brdo - Slovenia2 Milestones of NAP-CZ… 1970 – 75Establishing Antibiotic Centres 1990Establishing Working Group for AMR surveillance 1997Subcommittee for antibiotic policy (co-ordinating group) 2001 – 02Preparatory working group for NAP-CZ in MoH 2003Basic document of NAP-CZ, Committee in MoH 2003 – 04Quality projects focused on AMR 2005WHO country visit: recommendations to MoH 2005NAP Action plan – 2005 2006NAP Action plan – 2006-07, WHO-ECDC co-operation 2006Committee in MoH cancelled 2007Negotiations SKAP – MoH: New model of NAP 2008MoH decision: New model of NAP 2008AMR: priority for future EU Presidency of CZ

3. 14.3.2008EU Conference - Brdo - Slovenia3 Subcommittee for Antibiotic Policy (SKAP) structure of the Czech Medical Association J.E.Purkyně SKAP structure interdisciplinary and intersectoral principle, confirmation of membership by professional societies SKAP activities opponency and guarantee by professional societies, acceptation by presidium ČLS JEP microbiology, epidemiology pharmacology, pharmacy infectious diseases paediatrics general practice intern. med. (chemotherapy) veterinary medicine SKAP guidelines – therapy, prophylaxis guidelines – ATB consensus guidelines – AMR control AP organization, ATB centers action plans, interventions internat. co-operation, projects co-operation with veterinarians

4. 14.3.2008EU Conference - Brdo - Slovenia4 Intersectoral Coordination Mechanism Local levelNational level Antibiotic centres Working groups Veterinary antibiotic centres National Antibiotic Programme co-ordinating group Ministry of Health Ministry of Agriculture Subcommitte on ATB Policy Czech Medical Association Professional Societies National Institute of Public Health State Veterinary Administration

5. 14.3.2008EU Conference - Brdo - Slovenia5 Antibiotic centers basic operating units of NAP-CZ

6. 14.3.2008EU Conference - Brdo - Slovenia6 Activities of antibiotic centers Local surveillance of AMR in hospitals and community Local surveillance of ATB use in hospitals and community Consulting antibiotic use Improving quality of antibiotic use – local interventions Categorisation of antibiotics (restricted drugs) Preparation and updating local guidelines Education

7. 14.3.2008EU Conference - Brdo - Slovenia7 Antibiotic consumption in the Czech Republic trends in ambulatory consumption 1989 - 2000 14 DDD/1000/day (1989) 19 DDD/1000/day (1999)

8. 14.3.2008EU Conference - Brdo - Slovenia8 Intervention in primary paediatric care (ATB consumption – ESAC) repeated, multicentric ATB prescribing audit 1998-02 intervention in primary paediatric care - 2001

9. 14.3.2008EU Conference - Brdo - Slovenia9 Resistance S.pneumoniae in Europe - EARSS-2005 penicillin

10. 14.3.2008EU Conference - Brdo - Slovenia10 Resistance S.pyogenes to erythromycine in CZ trend 1996 – 2005, data NRL for antibiotics intervention in primary paediatric care - 2001

11. 14.3.2008EU Conference - Brdo - Slovenia11 Invasive MRSA in CZ hospitals trend in 2000 – 2005 (EARSS data) 4.3 %5.9 % 6.1 %8.5 %12.9 %

12. 14.3.2008EU Conference - Brdo - Slovenia12 Klebsiella pneumoniae – EARSS 2005 resistance to 3 rd generation cephalosporins

13. 14.3.2008EU Conference - Brdo - Slovenia13 AMR problems in CZ hospitals Potential reasons for increasing trend Lack of systematic interventions for improving ATB use (auditing, feed-back for prescribers and consultants…) Sub-optimal hospital infection control programmes (lack of capacities for isolation, missing infection control nurses…) Performance-oriented hospital care, de-motivating economic feed-back, sub-optimal organisation of intensive care Influence of pharmaceutical industry Need for innovation of local ATB stewardship programmes Need for improvement of local infection control programmes

14. 14.3.2008EU Conference - Brdo - Slovenia14 National antibiotic program – Czech experience Conditions for future developments, benefits and efficiency Wide activities realised on the voluntary basis are not sustainable in long-term perspective and decline efficiency Support of government is essential for successful NAP activities at the national level The role of government consists in creating sufficient conditions for complex professional activities (realizing action plans), not in direct management of NAP by state Organizational structures of low vulnerability by political changes are necessary for long lasting stability, continuity and efficiency of NAP