With more than 670 000 drug-resistant bacterial infections occurring each year in the European Union/European Economic Area alone, and approximately 33 000 people dying as a direct consequence of these infections, the health burden of antimicrobial resistance (AMR) is comparable to that of influenza, tuberculosis and HIV combined.
While data show that antibiotic use and AMR in Estonia are low compared to other European countries, consumption of broad-spectrum antibiotics is high and rising. About 87% of Estonia’s total consumption of antibiotics in 2019 was in the primary-care sector, indicating that prescribing patterns need to change to address this problem.
Policy built on research and evidence
In Estonia, WHO’s Evidence-informed Policy Network (EVIPNet) supports the systematic use of health research evidence in policy-making as well as country-level partnerships among policy-makers, researchers and civil society. EVIPNet facilitates both policy development and policy implementation through the use of the best scientific evidence available.
The second evidence brief for policy produced in Estonia within the framework of EVIPNet focuses on AMR. It was prepared by the Institute of Family Medicine and Public Health at the University of Tartu in collaboration with the Ministry of Social Affairs of Estonia and the WHO Country Office.
The evidence brief outlines 3 essential policy options to improve the use and prescription of broad-spectrum antibiotics in primary care:
- strengthening postgraduate education and continuing to educate primary-care clinicians about the appropriate use of antibiotics and AMR through educational materials, formal continued medical education activities, outreach visits, small discussion groups or online courses;
- providing support to primary-care clinicians for the prudent use of antibiotics through a system or tool that integrates available clinical, patient and reference information to assist evidence-based decision-making in the flow of patient care; and
- using audits and feedback to improve prescribing behaviour.
Overall, the evidence suggests that the 3 policy options complement each other and that combining them could be the most effective course of action.
One Health action plan
While the options described in the evidence brief primarily focus on the primary-care level, awareness-raising and educational programmes aimed at patients will help to reduce demand for antibiotics. Pursuing any of the options will also require the development of national guidelines on both the prescription and use of antibiotics.
In addition, Estonia needs to ramp up development of its national action plan on AMR for human and environmental health, and finalize the overarching national One Health action plan to address AMR. Close cooperation between the human and animal (domestic and wild) health sectors and the environmental sector is necessary for the effective prevention and control of emerging and re-emerging infectious diseases and to combat AMR. Moreover, AMR itself needs more recognition and prioritization in the country to ensure resource allocation for promoting appropriate prescribing of antibiotics.
Following a presentation of the evidence brief for policy to a wide range of national stakeholders, participants engaged in a policy dialogue to discuss the current situation and agree upon next steps.