Presentation given by Mr. Erik de Jonge during the VIV Animal Health Summit Conference at VIV Asia 2013, www.viv.net

1. Antibiotics
Dutch action plan animal production sectors
Erik de Jonge
14-03-13

2. Content
1. Introduction / reasons for action plan on antibiotics
2. Action plan
3. Targets
4. Results and conclusions

3. Introduction /reasons for action plan
• Increasing antibiotic resistance is public health risk.
• The use of antibiotics in animal production sectors is a risk for public health
- Transfer of antibiotic resistent bacteria to humans (ESBLs, MRSA)
- Relations between sectors and public health are becoming more
prominent (ESBLs)
• Relatively high use of antibiotics in animal production sectors compared
to Dutch human use of antibiotics
Conclusion
Animal production sectors have responsibilty to take action.

4. Action plan antibiotics animal production
sectors
• Discussion on antibiotics in Government and Parliament since 2007
• Agreement: sectors take initiative; Government monitors results and if
necessary interveres
• December 2008: official voluntary agreement on antibiotic resistance.
• Participants agreement:
- 4 animal production sectors (cattle, veal calves, pigs, poultry)
- farmers, industry, veterinarians, feed industry
- Facilitated by ministry of Economic Affairs
• Aim: less, better and transparant use of antibiotics
• Installation of an Authority for Veterinary Medicine
• Action plan is a dynamic plan

5. Reduction targets for the use of antibiotics
The Government set targets for the reduction of the use of antibiotics in
2010 and 2012.
Overall targets for the use of antibiotics are set for the animal production
sectors (cattle, pigs, veal calves, broilers)
2011 (2009): -/- 20%
2013 (2009): -/- 50%
2015 (2009): -/- 70%
Poultry sector follows the same targets: broilers, laying hens, turkeys

6. Main activities in the action plan
For all sectors
1. Registration of all delivered antibiotics in central databases
2. One farmer, one vet (contract)
3. Health and treatment plans
4. Guidelines for the prescription of antibiotics
5. Individual feed back with a benchmark to farmers / vets
6. Approach for individual reduction on farms
Specific actions per sector
For example: transparancy, research in certain health issues,
a ban on certain antibiotics in q.a.s. (3/4 gen. cefalosporines).

7. Implementation action plan
1. Antibiotics agreement is implemented through private quality
assurance programs (IKB)
2. IKB – programs: from farm to processing plants
3. Participation rates are very high
4. 90 to 95% of the farmers in the pig sector, dairy sector, broiler
sector and veal sector
Non participants: product board regulation
Approved in boards PPE and PVV mid 2011

8. 1. Registration in central databases
• Every sector has a centrale database.
• Vets have to register the delivered antibiotics in the central database:
type of antibiotic, quantity, dosage, length of treatment, etc.
• In the poultry sector standardised clinical signs and diagnosis are also
registered.
• Antibiotics database is connected with the database for animals and
flocks on the farm (I&R)
• Inspections on farm and incorrect registration is sanctioned
• Starting date of registration: pig sector (01-01-10), veal calves (01-07-
10), broiler (01-01-11), cattle and layer sector (01-01-12).

9. 1. Registration in central databases
Goals of registration of antibiotics in central database
• Monitoring (do the actions have the required results)
• Used for poultry health policies
• Basis for individual feed back (benchmarking)
• Basis for approach for individual reduction on the farm
• Public accountablity (sector, government, public)

10. 2. One farmer, one vet
• Contract between farmer and vet
• One on one relationship
• Only prescriptions for antibiotics from contracted vet
• Minimum frequency of visits (varies per sector and type of farm)
• Poultry: every antibiotic is prescribed after diagnosis on farm
• Health plan and treatment plan
• Vet must use the veterinary guidelines from KNMvD when
prescribing antibiotics
• Replacement and responsibility

11. 3. Health and treatment plans
• Health plan: drawn up by farmer, vet and, preferably, other advisors
- analysis of farm management with respect to animal health - climate,
feed, use of antibiotica, watersystems, welfare – (model)
- write down improvement measures and a target for the use antibiotics
- farmer implements improvements
• Treatment plan: drawn up by vet in cooperation with farmer
- how diseases are tackeled in the next period
- how diagnoses are made on the farm and for instance about the use
of bacteriological tests and sensitivity tests
- based on formularia
• Both plans: at least a yearly evaluation

12. 4. Veterinary guidelines for the use of
antibiotics
• Formularies for the prescription of antibiotics
• Drawn up by expert groups from KNMvD per type of animal
• List of relevant indications per type of animal
• Per indication a first, second and third choise of medicins
• Criteria for choises
- effectivity of antibiotic
- chance on developping or spreading resistance
- minimum use of antibiotics that are important for human health
(fluoroquinolones / cefalosporines are third choise)

13. 5. Individual feed back (benchmark)
• Individual feed back report at least every three months for
farmers
• Poultry: also individual reports for veterinary practises
• Figures compared to colleagues (national average / best farmers)
• Started mid 2011 (broilers, veal calves, pigs).
• Feed back report: the report becomes more and more extended
• Aim: awareness of use of antibiotics
• Feed back reports are used in health and treatment plans

14. 5. Individual feed back with benchmark
Benchmark veterinarian practises: use of antibiotics 2012

15. 5. Individual feed back with benchmark
Example of use of antibiotics in 2012 on a broiler farm

16. 5. Individual feed back with benchmark
Example: weeks in which treatment was started

17. 5. Individual feed back with benchmark
Example: reason for the use of antibiotics

18. 5. Individual feed back with benchmark
Example: which groups of antibiotics are used

19. 6. Approach for individual reduction on farms
Poultry
• Started 01-01-2013
• Four categories: target category, signal category, action category 1 / 2
• Every farm is assessed and categorized every 6 months
• Every farm above target category should reach a lower level in 1 year
• The higher the category, the firmer the measures
Measures
We do not tell the farmer what to do. Farmer decides which measures to take
• Signal category: improvement plan within 4 weeks
• Action category 1: extra mandatory screening of the farm (digital tool)
• Action category 2: use of independent expert at own expense

20. Results: animal production sectors
Dutch veterinairy sales of antibiotics from 1999 - 2012
Antibiotic sales
600
500
kg active substance x 1000
400
300
Antimicrobial growthpromoter
200 Therapeutic sales
100
0
jaar
Source FIDIN: manufacturers and importers of veterinary medicines

21. Results Dutch broiler sector
Use of antibiotics in Dutch broiler sector (daily dosis per animal year)
Use of antibiotics broilersector
40
35
30
25
20
broilersector
15
10
5
0
2009 2010 2011 2012
Source: 2009 / 2010 database VMP (50% of farms) 2011 / 2012 database IKB CRA (98% of farms)

22. Results and conclusions
Conclusions
 Reduction of the use of antibiotics in Dutch animal production
sectors was 32% in 2011. Therefore the target for 2011 (20%) has
been achieved.
 Reduction of the use of antibiotics in Dutch animal production
sectors was 51% in 2012 (first 6 months). Therefore the target
for 2013 (50%) has already been achieved in 2012.
 In the broilersector the reduction was 26% in 2011 and 40% in
2012.
The Dutch broilersector is well on its way to reduce the use of
antibiotitcs. Individual programms on farms should lead to a 50%
reduction for 2013. Then probably verder steps have to be taken.

23. Thanks for your attention

24. Action plan antibiotics animal production
sectors
Actions 2013
2013: focus on critical antibiotics (poultry: fluoroquinolones)
2013: expending benchmarks and feed back reports with feed
supplier, breed and hatcheries.
2013: broilers: new requirements for all chicken meat delivered
to Dutch supermarkets in de period 2015 – 2020 (25%): slower
growing broiler, lower density, maximum use of antibiotics, etc.