Antimicrobials are medicines that kill or inactivate microbes, small disease-causing organisms. They include antibiotics, which are used against bacteria. After being exposed to an antimicrobial repeatedly, microbes can undergo changes that stop them being killed or inactivated by the treatments. This is known as antimicrobial resistance.
The European Medicines Agency is concerned about the development of antimicrobial resistance, particularly resistance to antibiotics. A well-known example of a bacterium that is resistant to a number of antibiotics is meticillin-resistant Staphylococcus aureus (MRSA), which has caused infections that are difficult to treat across the European Union (EU).
This problem is being made worse by the fact that few new antimicrobials have been authorised over the past few years. This may lead to infections becoming more difficult to treat in the future.
Antimicrobial resistance is a growing problem in humans and in animals. Resistance can also spread from animals to humans through the food chain or direct contact.
The role of the Agency
The Agency works in collaboration with its EU and international partners in a number of initiatives aiming to limit the development of resistance. It is also monitoring and evaluating the risks to human and animal health.
A major such initiative is the Transatlantic Task Force on Antimicrobial Resistance (TATFAR), which was established following the EU-United States summit in November 2009. The Task Force aims to increase levels of communication, coordination and co-operation between the EU and the United States on human and veterinary antimicrobials.
EMA Executive Director, Professor Guido Rasi on how to tackle antimicrobial resistance
In human medicine, the availability of medicines to treat infections with resistant organisms has become a major problem in recent years.
In September 2009, the Agency published a joint report together with the European Centre for Disease Prevention and Control (ECDC) and the international network ReAct - Action on Antibiotic Resistance. This report highlights the gap between infections due to resistant bacteria and the development of new antibiotics.
The report states that at least 25,000 patients in the EU die each year from infections due to bacteria that are resistant to many medicines, and that infections due to these bacteria in the EU result in extra healthcare costs and productivity losses of at least €1.5 billion each year. Although it identified 15 antibiotics under development, most of these were early in development and were targeted against bacteria for which treatment options were already available.
Authorisation of new antibiotics
The Agency plays a key role in the authorisation of new antibiotics, because medicines with a significant therapeutic innovation or that are in the interest of public or animal health are authorised centrally in the EU, on the recommendation of the Agency.
In January 2012, the Agency updated its guidance to companies developing antibiotics, covering how they should carry out studies to test these medicines' benefits and risks:
This is accompanied by an addendum giving information on how to study medicines for specific indications. The final addendum was published in November 2013 following a public consultation:
- Addendum on the note for guidance on the evaluation of medicinal products indicated for treatment of bacterial infections
In November 2013, the Agency hosted a workshop, co-organised with the European Commission, to discuss regulatory options for approval of new antibacterials and actions that could be taken to increase the appropriate use of the current armamentarium:
- Best use of medicines legislation to bring new antibiotics to patients and combat the resistance problem (08/11/2013)
Encouraging new approaches (updated)
EMA supports the exploration of new therapeutic options for difficult-to-treat infections due to multidrug-resistant bacteria. In June 2015, EMA held a workshop on the therapeutic potential of bacteriophages, which are naturally occurring viruses that kill bacteria. A written summary, video recording and meeting presentations are available:
In April 2016, EMA published a reflection on the therapeutic potential of bacteriophages in a scientific journal, highlighting the scientific and regulatory aspects discussed at the workshop.
The Agency is focused on promoting the prudent use of antimicrobials in animals, to limit the development of resistance. This goal is addressed in the Committee for Medicinal Products for Veterinary Use strategy on antimicrobials from 2010 to 2015:
In line with this strategy, the Agency has published a revised CVMP guideline for the demonstration of efficacy for veterinary medicines containing antimicrobial substances:
- Draft guideline for the demonstration of efficacy for veterinary medicinal products containing antimicrobial substances
This second revision provides further information on the use of veterinary antimicrobials in animals that are at risk of being infected (methaphylactic use). The document also clarifies the study requirements for antimicrobials that should be reserved for certain situations only.
On 17 November 2015, the Agency released for public consultation the CVMP strategy on antimicrobials for 2016-2020, which sets clear objectives and course of action for the next five years, based on a 'One Health' approach:
Sales of veterinary antimicrobials
Since early 2010, the Agency has been leading a project collecting information on the sale of veterinary antimicrobials across the EU:
Reports with other European bodies
In January 2015 the European Medicines Agency, together with the European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA) published first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals. The report is the first integrated analysis of data from humans, animals and food in Europe.
- ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals (30/01/2015)
Previous reports published jointly by EMA and other European bodies, including ECDC, EFSA and the European Commission’s Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) have emphasised the need for the prudent use of antibiotics in animals and the role of basic hygiene, and called for strengthened surveillance of resistance, the development of new antimicrobials and new strategies to combat the spread of resistance:
- Joint scientific report of ECDC, EFSA and the European Medicines Agency on MRSA in livestock, companion animals and food (16/06/2009)
- Joint opinion on antimicrobial resistance focused on zoonotic infections (10/2009)
EMA’s scientific advice on the use of antibiotics in animals
In 2013 and 2014, the EMA carried out a large body of work to provide advice to the European Commission on the use of antibiotics in animals and the impact on public health and animal health.
The Committee for Medicinal Products for Veterinary Use (CVMP) has published documents on microbial resistance in animals and its risks for humans.
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