title: Use of colistin-containing products within the European Union and European Economic Area (EU/EEA): development of resistance in animals and possible impact on human and animal health.
abstract: Since its introduction in the 1950s, colistin has been used mainly as a topical treatment in human medicine owing to its toxicity when given systemically. Sixty years later, colistin is being used as a last-resort drug to treat infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae (e.g., Escherichia coli, Klebsiella pneumoniae), for which mortality can be high. In veterinary medicine, colistin has been used for decades for the treatment and prevention of infectious diseases. Colistin has been administered frequently as a group treatment for animal gastrointestinal infections caused by Gram-negative bacteria within intensive husbandry systems. Given the ever-growing need to retain the efficacy of antimicrobials used to treat MDR infections in humans, the use of colistin in veterinary medicine is being re-evaluated. Despite extensive use in veterinary medicine, there is limited evidence for the development of resistance to colistin and no evidence has been found for the transmission of resistance in bacteria that have been spread from animals to humans. Since surveillance for colistin resistance in animals is limited and the potential for such transmission exists, there is a clear need to reinforce systematic monitoring of bacteria from food-producing animals for resistance to colistin (polymyxins). Furthermore, colistin should only be used for treatment of clinically affected animals and no longer for prophylaxis of diseases, in line with current principles of responsible use of antibiotics.
authors.affiliation: Scientific Institute of Public Health (WIV-ISP), J. Wytsmanstraat 14, 1050 Brussels, Belgium. Electronic address: boudewijn.catry@wiv-isp.be.
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Catry
authors.affiliation: European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Cavaleri
authors.affiliation: Danish Health and Medicines Agency, Axel Heides Gade 1, 2300 Copenhagen S, Denmark.
authors.forename: Keith
authors.initials: K
authors.lastname: Baptiste
authors.affiliation: European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK.
authors.forename: Kari
authors.initials: K
authors.lastname: Grave
authors.affiliation: European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK.
authors.forename: Kornelia
authors.initials: K
authors.lastname: Grein
authors.affiliation: Danish Health and Medicines Agency, Axel Heides Gade 1, 2300 Copenhagen S, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Holm
authors.affiliation: Veterinary Medicines Directorate, Woodham Lane, New Haw, Addlestone, Surrey KT15 3LS, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Jukes
authors.affiliation: European Food Safety Authority (EFSA) , Via Carlo Magno 1A, 43126 Parma, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Liebana
authors.affiliation: Spanish Agency of Medicines and Medical Devices, Parque Empresarial Las Mercedes, Edificio 8, C/Campezo 1, 28022 Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez Navas
authors.affiliation: European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK.
authors.forename: David
authors.initials: D
authors.lastname: Mackay
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11 A, 171 83 Stockholm, Sweden.
authors.forename: Anna-Pelagia
authors.initials: AP
authors.lastname: Magiorakos
authors.affiliation: Universidad Complutense de Madrid, Departamento de Sanidad Animal, Av. Puerta de Hierro s/n, 28040 Madrid, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Moreno Romo
authors.affiliation: ANSES-Agence nationale du médicament vétérinaire-Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail, 8 rue Claude Bourgelat, Parc d'Activités de la Grande Marche, CS 70611, Javené, 35306 Fougères Cedex, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Moulin
authors.affiliation: Spanish Agency of Medicines and Medical Devices, Parque Empresarial Las Mercedes, Edificio 8, C/Campezo 1, 28022 Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Muñoz Madero
authors.affiliation: Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477 Lisbon, Portugal.
authors.forename: Maria Constança
authors.initials: MC
authors.lastname: Matias Ferreira Pomba
authors.affiliation: Medicines and Healthcare Products Regulatory Agency, 151 Buckingham Palace Road, Victoria, London SW1 W 9SZ, UK.
authors.forename: Mair
authors.initials: M
authors.lastname: Powell
authors.affiliation: Faculty of Veterinary Medicines, University of Helsinki, Department of Production of Animal Medicine, 04920 Saarentaus, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Pyörälä
authors.affiliation: Faculty of Veterinary Medicines, University of Helsinki, Department of Production of Animal Medicine, 04920 Saarentaus, Finland.
authors.forename: Merja
authors.initials: M
authors.lastname: Rantala
authors.affiliation: Lithuanian University of Health Sciences, Tilžes g. 18, 47181 Kaunas, Lithuania.
authors.forename: Modestas
authors.initials: M
authors.lastname: Ružauskas
authors.affiliation: ANSES-Agence nationale du médicament vétérinaire-Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail, 8 rue Claude Bourgelat, Parc d'Activités de la Grande Marche, CS 70611, Javené, 35306 Fougères Cedex, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Sanders
authors.affiliation: Animal Health and Veterinary Laboratories Agency (VLA) Shrewsbury, Kendal Road, Harlescott, Shrewsbury, Shropshire SY1 4HD, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Teale
authors.affiliation: Consultant Clinical Scientist, Northwood, Middlesex HA6 3NS, UK.
authors.forename: Eric John
authors.initials: EJ
authors.lastname: Threlfall
authors.affiliation: Läkemedelsverket, Dag Hammarskjölds väg 42, 75237 Uppsala, Sweden.
authors.forename: Karolina
authors.initials: K
authors.lastname: Törneke
authors.affiliation: National Institute for Public Health (RIVM), Centre for Infectious Disease Control (Cib), Laboratory for Zoonoses and Environmental Microbiology, P.O. Box 13720, BA Bilthoven, The Netherlands.
authors.forename: Engeline
authors.initials: E
authors.lastname: van Duijkeren
authors.affiliation: European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK; Departament de Farmacologia, de Terapèutica i de Toxicologia, Facultat de Veterinària, UAB, 08193 Cerdanyola del Vallès, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Torren Edo
mesh_terms: D040981:Acinetobacter baumannii / Q000187:drug effects; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control / Q000662:veterinary*; D018890:Chemoprevention / Q000379:methods; D003091:Colistin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects; D005062:European Union; D006801:Humans; D011550:Pseudomonas aeruginosa / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin
keywords: Colistin; Healthcare-associated infections; Livestock; Resistance