In Denmark, a variety of actions have been implemented to regulate antibiotic use in pig production. For more than a decade, we have compiled detailed information on prescription of antimicrobials. Recording of this kind of information is in its early stages in several other European countries. Comparison of the sales of antimicrobials for treatment of all livestock on national level in 2012 by the European Medicines Agency (Figure 1). Among those countries where such data is recorded, Denmark has one of the lowest levels of veterinary antibiotic use.
The development in the use of antimicrobial in Danish livestock from 1994 to 2013 is shown in Figure 2. Around 80% of the use in livestock production is used for treatment in pig production.
Figure 1. Sales of veterinary antimicrobial agents, expressed as mg sold per population correction unit for 2012 in 26 European countries. The 4rd ESVAC report www.ema.europa.eu
In In 1998, VETSTAT, a system for monitoring the use of antimicrobials, was implemented.
Through collection of prescription records from both veterinary pharmacies, feed mills, veterinarians and private companies, the system ensures that all use of veterinary antimicrobials is recorded. This is done at species level as well as herd level. Data includes information on prescribed drug, age group and the disease.
Veterinarians and producers can draw data for their production sites, and compare them to national or regional average consumption levels measured in defined Animal Daily Doses (ADD). This also makes it possible for the government to take actions based on individual farmers’ use of antimicrobials for a given species.
Ban on use of antimicrobial growth promoters
In 1995, the use of the growth promoter Avoparcin was banned and this was followed in 1998 by a ban on the use of all growth promoters to finishers. In 2000, a total ban on all antimicrobial growth promoters for all age groups of pigs was implemented (Figure 2).
Sources: Human therapeutics: The Danish Mediciine Agency. Veterinary comsumption: Until 2001, data are based on reports from the parmaceutical industry of total annual sales from the Federation of Danish pig production and slaughterhouses (1994-1995) and Danish Medicines Agency and Danish Plant Directorate (1996-2000). Data from 2001-2013 originate from VetStat.
Figure 2. Antimicrobial use for humans and all livestock in Denmark from 1994 to 2013. Since 1996 DANMAP has published an annual report on the occurrence of antimicrobial resistance in zoonotic, indicator, and pathogenic bacteria from animals, food, and humans in Denmark. All reports are available for download in PDF format at www.danmap.org
Bans on antimicrobial growth promoters began as a voluntary industry initiative that was later implemented as regulation by the government. Following the ban, many pig herds suffered from an increased incidence of diarrhoea among weaner pigs leading to an increased therapeutic use of antimicrobials. However, Danish pig producers managed to overcome these challenges by implementing multiple changes to their production practices (e.g. later weaning, improved diet, increased space per weaner pig in the nursery, improved climate).
Strict regulations on veterinary prescriptions
In 1994, veterinary medicine was made prescription only, thereby no longer making it possible for Danish veterinarians to profit on the sales of antimicrobials.
Regulations are enforced by an increased government control of both veterinarians and producers. Thus, in 2005, Denmark implemented policies requiring biennial audits of veterinarians who serve the pig industry, which increased veterinarians’ awareness of their prescription patterns.
Restricted use of fluoroquinolones and cephalosporins
Denmark has developed a policy to reduce the use of antimicrobials classified by the WHO as critically important to human medicine. Thus, in 2002 the veterinary use of fluoroquinolones was restricted to cases where no other antibiotic would be effective. Prescription of fluoroquinolones must be notified to the government regulatory officials. Also, in 2010, an industrial voluntary ban on the use of cephalosporins was implemented by the pig producers themselves.
The Yellow Card initiative
In 2010, a new system – the Yellow Card initiative – was developed by the Danish Veterinary and Food Administration, targeting the highest consumers of antimicrobials in the pig production.
Pig farms exceeding the regulatory limit are subject both to injunctions to reduce their use, to increased monitoring by government officials and to various fees. This initiative targeted the producers directly.
The Danish Veterinary and Food Administration annually issue maximum limits for antibiotic consumption in three age groups of pigs. The consumption of antimicrobials in pigs is evaluated as animal daily doses (ADD) per 100 animals seen over the last 9 months (by age group). The target was to achieve a 10% reduction in the antimicrobial use in 2013 compared to 2009. This target was met as the use (in kilo active compound) in Danish pig production in 2013 was 13% lower than in 2009.
The limits of the Yellow card have been adjusted several times as shown in Table 1.
Table 1. Yellow card limits in animal daily doses (ADD). ADD doses are defined by the Danish Veterinary and Food Administration.
||ADD/100 animal days for sows and piglets
||ADD/100 animal days for weaner pigs (7-30 kg)
||ADD/100 animal days for finishers (30-104 kg)
The Yellow Card initiative has reduced the antibiotic use in Danish pig production to a very low level. A newly published report from the European Medicines Agency, EMA, found Denmark to be among the lowest consumers of veterinary medicine (Figure 1).