National Action Plan for combating antimicrobial resistance 2016 – 2021

The National Action Plan for Combating Antimicrobial Resistance has been drafted based on the World Health Organization document on “Global Action Plan on Antimicrobial Resistance 2015”. Respectively, the Plan addresses five main objectives: 1. Increase public awareness and provide education for professionals; 2. Monitor the use of antimicrobial medicines and observe microbial resistance to identify any changes in the resistance; 3. Provide control program to prevent spread of the microorganism’s resistance to antimicrobial agents and drugs; 4. Encourage the proper use of antimicrobial agents and medicines in the fields of health care, livestock production and poultry farming and aquaculture; 5. Conduct research and development plans to combat microbial resistance. Each of the mentioned objectives are based on a number of policies and shall be followed through set of actions. Accordingly, the first objective, public awareness and professional knowledge, addresses different age groups of society, from children to the elderly, vulnerable groups to the excessive use of antimicrobial drugs, related companies as well as health care professionals and academic institutions. In the public awareness aspect, the objective shall be implemented through: establishment of the Microbial Resistance Committee; establishment of the Strategic Committees at national and provincial level; formulation of new law and regulation for prevention and control of antimicrobial resistance; providing educational materials for schools; facilitating access of patients to essential information; use national media and social media to attract public participation in rational use of drugs. To raise the knowledge of professionals in the fields of healthcare, veterinary, agriculture and food production, the Document set a number of necessary actions as follows: constant training about prevention and control of infection diseases and antimicrobial resistance; integrate training courses on microbial resistance within the curriculum of physicians, specialists, pharmacists and dentists; collaborate with centers under the contract with the World Health Organization. The second objective, monitoring and surveillance, is based on the following strategies: strengthen antimicrobial resistance surveillance system in health care centers; control prescribing and use of antimicrobial medicines; increase the surveillance of antimicrobial resistance in veterinary medicine, livestock production, poultry and aquaculture; standardize antimicrobial tests for diagnosis in laboratories; harmonize the health care system for different sectors of human, animals, environment and food. To implement these strategies, the Document require related organizations to: strengthen human resources to monitor the efforts taken to prevent and control of infection; provide on-time response to community-borne epidemics; strengthen national epidemiological surveillance system; prepare guidelines for rational use of antimicrobial drugs; use new technologies to monitor patterns of prescribing antimicrobial drugs; create an evaluation system to inspect the use of antimicrobial drugs in animal husbandry and aquaculture; monitor the targeted antimicrobial resistance genes; provide a comprehensive health care system; collect data and analyze factors involved in the transmission of bacterial resistance in humans, animals and food. The third objective, infection prevention and control, should be achieved through: increase intersectoral cooperation in national and regional level; promote cooperation between laboratories, medical institutions and local governments; increase the coverage of insurance schemes to home care services; promote vaccination and other activities preventing infection; promote use of vaccines for livestock, aquatic animals and pets; decrease antibiotics residual in livestock, poultry and agriculture products; increase the national capacity to respond to large outbreaks. To accomplish objective four, appropriate use of antimicrobial drugs, the Document sets a number of necessary actions, including: publish guidelines and instructions for antimicrobial stewardship; review and revise existing regulation in the field of diagnosis and treatment with respect to antimicrobial resistance; use new system to control the prescription of antibiotics and prevent pharmacies from selling antibiotics without a prescription; evaluate the effects of antibiotics on animal and human health through risk management plans; develop food security plans for microbial resistance bacteria; ensure the proper use of veterinary antibiotics in terms of quality and quantity. The last objective, research and development in the field of antimicrobial resistance, is based on five main strategies: identify patterns of emergence and transmission of microbial resistance and its socioeconomic impacts; increase public awareness and training in the field of microbial resistance, infection control and antimicrobial drugs stewardship; improve existing methods of prevention, diagnosis and treatment of infectious diseases; discover new methods of prevention, diagnosis and treatment of infectious diseases; raise international collaboration in research and development in the relevant fields. The Document also elaborates the critical role of the National Committee on Rational Use of Drugs as an institute to control the excessive use of drugs and combat the growing microbial resistance in the country. To combat the misuse of antimicrobials in livestock production and poultry farming and to prevent the introduction of the chemical and microbial substance to the food cycle, the comprehensive program for the management of health hazards caused by the residues of drugs, toxins, and raw materials have been implemented by the National Veterinary Organization. The program is running in a four-item matrix including milk, meat, eggs and farmed trout.