The European Agency for the Evaluation of Medicinal Products Veterinary Medicines Evaluation Unit EMEA/CVMP/342/99-Final Antibiotic Resistance in the European Union Associated with Therapeutic use of Veterinary Medicines Report and Qualitative Risk Assessment by the Committee for Veterinary Medicinal Products 14 July 1999 Public 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Switchboard: (+44-171) 418 8400 Fax: (+44-171) 418 8447 E_Mail:
[email protected] http://www.eudra.org/emea.html ãEMEA 1999 Reproduction and/or distribution of this document is authorised for non commercial purposes only provided the EMEA is acknowledged TABLE OF CONTENTS Page 1. INTRODUCTION 1 1.1 DEFINITION OF ANTIBIOTICS 1 1.1.1 Natural antibiotics 1 1.1.2 Semi-synthetic antibiotics 1 1.1.3 Synthetic antibiotics 1 1.1.4 Mechanisms of Action 1 1.2 BACKGROUND AND HISTORY 3 1.2.1 Recent developments 3 1.2.2 Authorisation of Antibiotics in the EU 4 1.3 ANTIBIOTIC RESISTANCE 6 1.3.1 Microbiological resistance 6 1.3.2 Clinical resistance 6 1.3.3 Resistance distribution in bacterial populations 6 1.4 GENETICS OF RESISTANCE 7 1.4.1 Chromosomal resistance 8 1.4.2 Transferable resistance 8 1.4.2.1 Plasmids 8 1.4.2.2 Transposons 9 1.4.2.3 Integrons and gene cassettes 9 1.4.3 Mechanisms for inter-bacterial transfer of resistance 10 1.5 METHODS OF DETERMINATION OF RESISTANCE 11 1.5.1 Agar/Broth Dilution Methods 11 1.5.2 Interpretative criteria (breakpoints) 11 1.5.3 Agar Diffusion Method 11 1.5.4 Other Tests 12 1.5.5 Molecular techniques 12 1.6 MULTIPLE-DRUG RESISTANCE