A collective effort

In France, a report by the National Observatory on Prescriptions and Drug Use in Outpatient and Hospital Settings, published in June 1998, highlighted for the first time the prevalence of inappropriate antibiotic prescriptions for the treatment of respiratory infections in outpatient care. It also highlighted the serious consequences of excessive antibiotic use in terms of bacterial resistance and societal costs (“Study of Antibiotic Prescription and Consumption in Outpatient Care”). This report inspired the first French government programs on the subject. It led Santé publique France (then the Institute for Public Health Surveillance—InVS) to coordinate a group of experts in late 1998 to develop proposals for actions to control bacterial resistance to antibiotics. Several of these proposals were incorporated into the antibiotic action plans (2001–2005 plan / 2007–2010 plan / 2011–2016 plan). On December 22, 2014, the Minister of Health established a special working group on the preservation of antibiotics. This group submitted its report to the Minister on September 23, 2015. In late 2016, an “Antibiotic Resistance” roadmap was established by the Ministry of Health to implement the key measures recommended in this report.

Today, the resources brought together under the umbrella of Santé publique France have equipped France with the capacity to rapidly detect the emergence of new forms of resistance, to identify links with what is observed in animal health for certain bacteria, and to monitor and control an outbreak. Through Santé publique France and its partners, France’s contribution to the European surveillance of antimicrobial resistance in human health (European Antimicrobial Resistance Surveillance Network, EARS-Net) underscores its commitment beyond our borders to controlling antimicrobial resistance.

Finally, in Europe, the European Centre for Disease Prevention and Control (ECDC) established the first “European Antibiotic Awareness Day” on November 18, 2008, centered on the message: “antibiotics only when necessary.” This annual event aims to raise awareness among healthcare professionals and the general public about the risks associated with the overuse or inappropriate use of antibiotics. In France, this event is promoted by the Ministry of Health, Santé publique France, and its partners.

As part of the efforts in France to raise awareness among professionals and the general public, since 2014, a summary document has been published jointly by Santé publique France and the ANSM, compiling data on recent trends in bacterial resistance to antibiotics and antibiotic consumption in France in human healthcare. This document, titled "Antibiotic Use and Antibiotic Resistance in France," is updated annually. Since 2016, it has also included French data on antibiotic resistance and antibiotic use in animal health. It is therefore part of the "One Health" global health approach promoted by the WHO and supported by the interministerial "Antibiotic Resistance" task force, which was implemented in late 2015 following the report titled "Together, Let’s Save Antibiotics!". Antibiotic prescription indicators, derived from monitoring of the Public Health Objective-Based Payment System (ROSP) administered by the French National Health Insurance, were added to this document in 2017. And in 2018, it included, for the first time, data on the presence of antibiotics and antibiotic-resistant bacteria in the environment.