title: Pleuromutilins: use in food-producing animals in the European Union, development of resistance and impact on human and animal health.
abstract: Pleuromutilins (tiamulin and valnemulin) are antimicrobial agents that are used mainly in veterinary medicine, especially for swine and to a lesser extent for poultry and rabbits. In pigs, tiamulin and valnemulin are used to treat swine dysentery, spirochaete-associated diarrhoea, porcine proliferative enteropathy, enzootic pneumonia and other infections where Mycoplasma is involved. There are concerns about the reported increases in the MICs of tiamulin and valnemulin for porcine Brachyspira hyodysenteriae isolates from different European countries, as only a limited number of antimicrobials are available for the treatment of swine dysentery where resistance to these antimicrobials is already common and widespread. The loss of pleuromutilins as effective tools to treat swine dysentery because of further increases in resistance or as a consequence of restrictions would present a considerable threat to pig health, welfare and productivity. In humans, only one product containing pleuromutilins (retapamulin) is authorized currently for topical use; however, products for oral and intravenous administration to humans with serious multidrug-resistant skin infections and respiratory infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA), are being developed. The objective of this review is to summarize the current knowledge on the usage of pleuromutilins, resistance development and the potential impact of this resistance on animal and human health.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands engeline.van.duijkeren@rivm.nl.
authors.forename: Engeline
authors.initials: E
authors.lastname: van Duijkeren
authors.affiliation: National Veterinary Institute, Uppsala, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Greko
authors.affiliation: National Veterinary Institute, Uppsala, Sweden.
authors.forename: Märit
authors.initials: M
authors.lastname: Pringle
authors.affiliation: Danish Health and Medicines Authority, Copenhagen, Denmark.
authors.forename: Keith Edward
authors.initials: KE
authors.lastname: Baptiste
authors.affiliation: Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Catry
authors.affiliation: Veterinary Medicines Directorate, Addlestone, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Jukes
authors.affiliation: Faculty of Veterinary Medicine, Complutense University, Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Moreno
authors.affiliation: Faculty of Veterinary Medicine, Technical University of Lisbon, Portugal.
authors.forename: M Constança Matias Ferreira
authors.initials: MC
authors.lastname: Pomba
authors.affiliation: Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Pyörälä
authors.affiliation: Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Merja
authors.initials: M
authors.lastname: Rantala
authors.affiliation: Veterinary Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Modestas
authors.initials: M
authors.lastname: Ružauskas
authors.affiliation: Agence Nationale de Sécurité Sanitaire (ANSES), Fougères, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Sanders
authors.affiliation: Veterinary Laboratories Agency, New Haw, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Teale
authors.affiliation: Health Protection Agency, London, UK.
authors.forename: E John
authors.initials: EJ
authors.lastname: Threlfall
authors.affiliation: European Medicines Agency, London, UK.
authors.forename: Jordi
authors.initials: J
authors.lastname: Torren-Edo
authors.affiliation: Läkemedelsverket, Uppsala, Sweden.
authors.forename: Karolina
authors.initials: K
authors.lastname: Törneke
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017401:Brachyspira hyodysenteriae / Q000187:drug effects; D004224:Diterpenes / Q000009:adverse effects / Q000494:pharmacology; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D005062:European Union; D006801:Humans; D008826:Microbial Sensitivity Tests; D009175:Mycoplasma Infections / Q000188:drug therapy; D011083:Polycyclic Compounds; D011200:Poultry; D011201:Poultry Diseases / Q000188:drug therapy*; D011817:Rabbits; D013552:Swine; D013553:Swine Diseases / Q000188:drug therapy*; D000097567:Pleuromutilins
chemical_list: D000900:Anti-Bacterial Agents; D004224:Diterpenes; D011083:Polycyclic Compounds; D000097567:Pleuromutilins; C117845:valnemulin; C014224:tiamulin
keywords: Brachyspira hyodysenteriae; antimicrobial resistance; review; tiamulin; valnemulin