Antibiotics are unique medications in that their targets (bacteria) are living organisms capable of adapting by developing mechanisms that confer resistance to antibiotics (e.g., mutations and the acquisition of resistance-gene vehicles). Despite this feature shared by no other medication, antibiotic prescription is viewed as a trivial act, both in humans and in animals. Limited improvements have been achieved, but France remains among the heaviest consumers of antibiotics in Europe.
Clearly, there is a pressing need to protect the effectiveness of antibiotics (and of anti-infectious medications in general) via proactive strategies similar to those used to save endangered species, in keeping with the concept of sustainable development. Antibiotics are unique medications and must be prescribed only with good reason. Each prescription should be thought carefully, and the short-term benefits to the patient (which obviously deserve priority in the event of a bacterial infection) should be weighed against two categories of deleterious effects: short-term adverse effects on the patient – such as manifestations of intolerance or allergies, which are unacceptable if the antibiotic is not indispensable – and negative medium-term effects on bacterial ecology, with selection of MDR organisms. Selected MDR organisms subsequently cause infections in the community, of which the patient is a member. The prescription of antibiotics must be the result of a complex deliberative process, whose components must obey evidence-based rules. This objective of achieving rational antibiotic prescribing practices requires an orchestrated effort by both the healthcare system users and the prescribers. Other strategies should be implemented concomitantly, such as campaigns to promote immunizations known to exert antibiotic-sparing effects (e.g., against influenza, measles, and pneumococcal pneumonia).
The World Alliance against Resistance to antibiotics (WAAR) is a crosscutting action plan designed by a small group of professionals and by the patient-support group LIEN to deal with the current emergency. This plan involves healthcare providers (in hospitals and private practice), veterinary medicine professionals, and the food industry. It is of immediate significance for current and future users of the healthcare system, as well as for all citizens.
The Alliance is a group of about 350 individuals representing all the key stakeholders including healthcare system users (LIEN, CISS, Patients for Patient Safety [WHO], and the Association for the defense of Victims of Nosocomial Infections [ADVIN] in Quebec). The scientific committee is composed of 80 international physicians of considerable renown. The Alliance receives support from 50 learned societies or professional groups in France and throughout the world. It is a nonprofit organization (French law of 1901) open to professionals and users worldwide.
SAFEGUARDING ANTIBIOTICS requires an orchestrated effort carried out jointly by healthcare system users and prescribers (in the broad sense of the term). Therefore, WAAR has chosen as its primary objective to raise awareness among all stakeholders of the urgency and magnitude of the threat. WAAR must lobby actively for antibiotics beyond the circle of insiders in order to raise awareness among policy-makers, international health organizations (WHO, World Organization for Animal Health, European Centre for Disease Prevention and Control), and the entire population. The Alliance, in France is designed to serve as a complement to two French nationwide programs, the Antibiotic Alertness Program for 2011–2016 and the Antibiotic Resistance Minimization in Veterinary Medicine Program. The Alliance has no conflicts of interest.
Some of these measures are part of the Antibiotic Alertness Program for 2011–2016 implemented by the French National Health Agency (Direction Générale de la Santé, DGS) and of the Antibiotic Resistance Minimization in Veterinary Medicine Program. However, the Alliance advocates much stronger measures to be implemented on an emergency basis, most notably regarding the modalities of antibiotic prescription.
This article was published in French in the journal La Revue du Praticien on May ….2012
Members of the Alliance: Laurent Aaron, Jacques Acar, Mansour Adéoti (Secretary of the RIPAQS), Corinne Alberti, Serge Alfandari, Antoine Andremont, François Angouluant, Djillali Annane (Dean of the Paris Ouest University), Gilles Antoniotti, Jean-Pierre Aquino, Anne-Marie Armentera De Saxcé (Director of the Rothschild Foundation), Anne Arnera-Carlet, Pascale Arnould (President of the French Society for Primary Care), Pascal Astagneau (Director of the Paris North CCLIN), Claude Attali, Fréderic Auber, Jean-Pierre Aubert, Elisabeth Autret-Leca, Elie Azoulay, Françoise Ballereau, Gérard Bapt (representative of the Haute Garonne district), Géraldine Bardon, Jean Pierre Bedos, Sibylle Belivacqua, Fethi Bensalem, Nelly Beon André, Patrick Berche (Dean of the Paris 5 University), Frederique Bergheau, Gilles Berrut, Philippe Berthelot (of the French Society for Hospital Hygiene), FrederiqueBeuhourry-Sassus, Edouard Bingen, Jacques Birgé, Sandra Biscardi, Marie-Claude Bongrand, François Bourdillon, Alain Bousquet-Melou, Jean Brami, Stephane Bretagne, Christian Brun-Buisson, Fabrice Bruneel, Yves Bur (representative of the Bas Rhin district), Sandrine Buscail, Christelle Cabon, Emmanuelle Cambau, Philippe Caranco, Camille Carlet, Florian Carlet, Jean Carlet, François Caron (president of the ACAI), Alain-Michel Ceretti, Pascale Chaize, Martin Chalume Allier district), Pierre Charbonneau, Christian Chavanet, Jean Chastre, Jean-Daniel Chiche (president-elect of the European Society of Intensive Care Medicine), Christian Chidiac, Fabrice Chopin, Olivier Chosidow, Patrick Choutet, André Cicollela (in charge of the Health Division of the Green political party), Robert Cohen, Bruno Coignard, Catherine Cordonnier, René Courcol, Aline Creuwels, Vincent Dacquet, Laurent Degos (outgoing president of the French National Authority for Health), Valérie Delbos, Jean-François Delfraissy (Director of the ANRS and of the ITMO for infectious diseases), Pierre Dellamonica, Frederic Delille, Marie-Claude Demachy, Corinne Denis, Marie-Helène Denninger, Jean Claude Desenclos, Nicole Desplaces, Jean-François Dhainaut (Director of the High Commission on Biotechnologies), Isabelle Dijols-Lecuyer, Than Doco-Lecompte, Jean Doucet, Pierre-Louis Druais (president of the College of Primary-Care Physicians), Catherine Dumartin, Marie-Françoise Dumay, Michel Dupon (president of the College of Infectious and Tropical Diseases University Physicians), Jacques Fabry, Bruno Fantin, Albert Faye, Nathalie Floret, Sandra Fournier, Irène Frachon, Bertrand Gachot, Jacques Gaillat, Tatiana Galperine, Karine Gambarotto, Lisa Garcia, Bernard Garo, Anne Gaschet, Remy Gauzit, Gaetan Gavazzi, Louise Gazagne, Chistian Ghasarossian, Jacques Gilquin, Olivier Goeau-Brissonniere (president of the Medical Specialties Organization), Fred Goldstein, Alix Greder, Amandine Grain, Benoit Guery, Catherine Guignabert, Loic Guillevin (president of the French Society for Internal Medicine), Laurent Gutmann, Joseph Hajjar, Rodolphe Halama, Olivier Hanon, Yves Hansmann, Isabelle Hau, Veronique Hentgen, Jean-Pierre Hermet (user), Celine Hernandez, Laurent Hocqueloux, Bruno Housset, Sophie Hubiche, Benoit Huc, Françoise Ichou (writer), Vincent Jarlier, Dominique Jean, Laurent Jouffroy (president of the French Society for Anesthesia and Critical Care), Karine Kadri, Axel Kahn (geneticist, president of the Paris Descartes University), François Kidd, Pierre Kilidjean (user), Serge Kouzan, Jean-Philippe Lacour (president of the French Society for Dermatology), Matthieu Lafaurie, Thierry Lavigne, Olivier Lehiani, Jean-Patrick Lajonchere (director of the Paris St Joseph Hospital Group), Jérome Larché, Gérard Laroussinie, Peggy Larroude, Anne-Marie Lavenaire, Thierry Lavigne, Christine Lawrence, Agnès Lefort, Guy Lefrand (representative of the Eure 1ec district), Hervé Le Louet, Alain Lepape, Joel Leroy, Xavier Lescure, Pierre Lombrail (president of the French Society for Public Health), Matthie Lorrot, Olivier Lortholary, Anne Lotthe, Jean Christophe Lucet, Jean-Yves Madec, Alexandra Mailles, Jacky Maillet, Jean Luc Mainardi, Alain Manuguerra, Carole Marchand, Bruno Marchou, Emmanuelle Martin, Claude-Denis Martin, Alain Martinot, Patrice Massip, Sophie Matheron, Nathalie Maubourget, Thierry May, Olivier Meunier, Noel Milpied (president of the French Society for Bone Marrow Transplantation), Christelle Miquel, Benoit Misset, Jean Michel Molina, Philippe Montravers, Gérard Moulin, Pascale Moulin, Gilbert Mouthon, Cécile Mourlan, Marie-Hélène Nicolas-Chanoine (president of the Onerba), Gérard Nitenberg, Patrice Nordmann, Jocelyne Ouanich, Bernard Page, Pierre Parneix (director of the South-West CCLIN), Olivier Patey, Yves Pean, Martine Peres, Pascal Perez, Christian Perronne (president of the French Federation of Infectiologists), Dominique Peyramond, François Philippart, Marie-Laure Pibarot, Marie-Cecile Ploy, Anny Poursinoff (EELV representative of the Yvelines district), Philippe Pucheu (Director of the Diaconnesses Croix St Simon Hospital), Celine Pulcini, Christian Rabaud (president of the French Society for Infectious Diseases), Claude Rambaud (president of the LIEN), Bernard Régnier, Jean Reignier (president of the Society for French-Speaking Intensivists), Vincent Renard (president of the National College of Teaching Primary-Care Physicians), Jean-Claude Reveil, Patricia Ribaud, Agnès Riche, Jérome Robert, France Roblot, Olivier Romain, Monique Rothan-Tondeur, Willy Rozenbaum, Genevieve Ruault, Laurence Safont, Julien Saison, Marie Christine Saux (president of the French Society for Clinical Pharmacology), Anne Savey (director of the South-East CCLIN), Catherine Schlemmer, Benoit Schlemmer (Dean of the Paris 7 University), Jean-Luc Schmidt, Martine Sinègre, Muriel Soulier-Majidi, Jean-Philippe Tabut, Fabienne Tamion, Pierre Tattevin, Soraya Terzaki, Laurent Thiriet, Jean-François Timsit, François Trémolières, Dominique Trivier, Michel Troadec, Jean-Paul Stahl, Garance Upham (member of the Board of Patients for Patient Safety, WHO), Bruno Valeyre (president of the Society for French-Speaking Pulmonologists), Dominique Valla, Emmanuelle Varon, Homero Vasquez, Nathalie Vauvarin, Agnes Vincent, Daniel Vittecoq (president of the AMM), Pascal Voiriot, Pierre Weinbreck (president of the National College for Infectious Diseases), Michel Wolff, Yazdan Yasdanpanah, Jean-Ralph Zahar, Daniel Zara Goni, and Jean-Marc Ziza
International Scientific Committee: Fekri Abroug (Monastir, Tunisia), Murat Akova (Ankara, Turkey), Fatma Amer (Egypt), Massimo Antonelli (Rome, Italy), Apostolos Armaganidis (Athens, Greece), Antonio Artigas (Barcelona, Spain), Fernando Baquero (Spain), Yaron Bar-Lavie (Tel Aviv, Israel), Thierry Calandra (Lausanne, Switzerland), Abdelfattha Chabib (Casablanca, Morocco), Annie Chalfine (Tel Aviv, Israel), Nathan Clumeck (Brussels, Belgium), Jonathan Cohen (UK), Peter Collignon (Australia), François Clergue (Geneva, Switzerland), George Dimopoulos (Athens, Greece), Georges Ducel (Geneva, Switzerland), Ricardo Durlach (Argentina), Naima Elmdaghri (Casablanca, Morocco), Dan Engelhard (Jerusalem, Israel), Annegret Franf-Karwautz (Austria), Petra Gastmeier (Berlin, Germany), Abdul Ghafar (India), Donald Goldmann (Boston, MA, USA), Herman Goossens (Antwerp, Belgium), Thomas Gottlieb (Concord, Australia), Manuel Guzman (Venezuela), Inge Gyssens (Nijmegen, The Netherlands), Fadi Haddad (Beirut, Lebanon), Stephan Harbarth (Geneva, Switzerland), Hakima Himmich (Casablanca, Marocco), Salih Hoçoglu (Diyarbakir, Turkey), Waleria Hryniewicz (Varsovia, Poland), Namita Jaggi (Haryana, India), Mitsuo Kaku (Sendai City, Japan), Igor Karpov (Belarus), François Kidd (Mons, Belgium), Badreddine Kilani (Tunis, Tunisia), Georges Khalil (Beirut, Lebanon), Oui-Chang Kim (Seoul, South Korea), Gabriel Levy Hara (Argentina), Elisabeth Heisbourg (Luxemburg), Pierre-François Laterre (Louvain, Belgium), Moi-Lin Ling (Singapore), John McGowan (Atlanta, USA), Dimitri Matamis (Salonica, Greece), Kamal Marhoum El Filali (Casablanca, Morocco), Shaheen Mehta (Cape Town, South Africa), Maria-Lisa Moro (Italy), Dilip Natwani (Dundee, Scotland), Babacar N’Doye (Dakar, Senegal), Steve Opal (Providence, RI, USA), Trish Perl (Baltimore, MD, USA), José-Arthur Paiva (Porto, Portugal), Mercedes Palomar (Barcelona, Spain), Didier Pittet (Geneva, Switzerland), Jean-Francois Pittet (city, AL, USA), Peter Pronovost (Baltimore, MD, USA), Jérome Pugin (Geneva, Switzerland), Rosana Richtman (Brazil), Vladimir Rudnov (Russia), Wing-Hong Seto (Hong Kong, China), Evelina Tacconelli (Italy), Falilatou Tchaline (Togo), Jordi Valles (Barcelona, Spain), Christian van Delden (Geneva, Switzerland), Ethan Rubinstein (Winipeg, Canada), Christina Vandenbroucke (The Netherlands), Jos van Der Meer (Nijmegen, The Netherlands), Homero Vasquez (Chile), Jean-Louis Vincent (Brussels, Belgium), Eric Vohr (Baltimore, MD, USA), Andreas Voss (Nijmegen, The Netherlands), Jeanine Wiener-Kronish (Boston, MA, USA), Emile Zein (Beirut, Lebanon), Josephine Zoungrana (Burkina Faso).