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antimicrobial resistance and causes of non-prudent use of antibiotics in human medicine 


The ARNA project aims to contribute to a more prudent use of antibiotics in human medicine in Europe, with a specific focus on the use of non-prescribed antibiotics. The overall aim is to assess the non-prudent use of antibiotics in the European Union (EU) and to encourage policies that lead to a more prudent use of antibiotics.

More specifically, the project aims to:

1. Identify key factors that drive the sales and non-prudent use of antibiotics in human medicine obtained without prescription;
2. Assess the level of enforcement of legal prescriptions of antimicrobial agents in the EU;
3. Document good practices aimed at strengthening a more prudent use of antibiotics;
4. Develop policy options for a more prudent use of antibiotics.

The project is a collaboration between Nivel, University of Antwerp and TNS-N​IPO. ARNA started on 1st July, 2014, and will run for 2 years. The project is funded by the European Comm​ission, Health and Consumers Directorate-General.

Problem definition:
The non-prudent use of antibiotics is a major risk for antimicrobial resistance. If antibiotics become ineffective, established and newly emerging infectious diseases will increasingly threaten the health of the population. This will lead to increased morbidity, costs, and health care utilization. It has estimated that antimicrobial resistance causes 25,000 deaths annually in the EU and costs health care systems 1,5 billion euro on extra healthcare costs and productivity losses (see ECDC report)

Non-prudent use of antibiotics has several aspects such as over-use because of the prescription of antibiotics for diagnoses where they are not indicated. Moreover, self-medication with antibiotics can be considered as non-prudent use; for example when it is delivered as over-the-counter without knowing the diagnosis or when a citizen uses leftover antibiotics.

While much is known about the volume of prescribed antibiotic use and the types of antibiotics prescribed (see ECDC Technical report), less is known about cross-national variation into appropriate use, i.e. whether or not antibiotics are prescribed for the right indication. Since this information is lacking, there is need for empirical research.

The ARNA-project consists of six work packages, each with their own methods and products;

WP1 The (non-prudent) use of antibiotics in EU Member States with a special focus on use of non-prescribed antibiotics
WP2 Questionnaire(s) to Ministries of Health and relevant regulatory authorities
WP3 Literature review on good practices aimed at prudent use of antimicrobial agents
WP4 Analysis and policy options
WP5 National workshops and a consensus conference
WP6 Dissemination of results