Counting antimicrobial sales and use in animals
European surveillance counts the antimicrobials sold for and used in animals, and it has moved from a voluntary project that reported sales to mandatory reporting of sales and use. The European agencies for food safety, medicines and disease prevention set that consumption against resistance in animals and in people in joint analyses.
The ESVAC project
The European Medicines Agency launched the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project in September 2009 at the European Commission's request, and from then on coordinated and supported European countries in establishing standardised, harmonised reporting of the volume of sales of veterinary antimicrobial medicinal products. The project was a voluntary initiative of the agency and national authorities to collect reliable sales data across Europe: it began in 2009 with 9 countries volunteering sales data, had 31 countries in 2022 and ended in 2023 with its report on 2022 data. The ESVAC report was published annually and used as a reference source on antimicrobial resistance by scientists, veterinarians and other health professionals, risk assessors and policy makers in the EU Member States. ESVAC produced reliable data on antimicrobials sold for use in animals, which gave participating countries insight into the impact of their measures to promote prudent use and to set targets for reducing consumption. The agency calls it a European success story of commitment and strong collaboration.
Trends in sales of veterinary antimicrobials
Over the 12 years of the voluntary ESVAC project, sales of veterinary antibiotics in Europe dropped by 50%.
Third- and fourth-generation cephalosporins, polymyxins, fluoroquinolones and other quinolones include antimicrobials used to treat serious infections in humans caused by bacteria resistant to most other antimicrobial treatments. As the Antimicrobial Advice ad hoc Expert Group (AMEG) categorisation indicates, they should be used in animals with restrictions, prudently and responsibly, to preserve their effectiveness and mitigate the potential risk to public health. All antibiotics should be used prudently and responsibly to preserve their effectiveness, and for these classes it is of particular importance, to mitigate the potential risk to public health.
The eleventh ESVAC report, published in November 2021, covered 30 EU/EEA countries, the United Kingdom among them as an EU Member State for the years covered, and Switzerland, all of which reported voluntarily. It presented data for both 2019 and 2020, to give more recent data and to prepare for the reporting timelines that Regulation (EU) 2019/6 requires. In the 25 countries that reported for the whole of 2011–2020, sales of veterinary antimicrobials were 43% lower in 2020 than in 2011, although they rose by 6% from 2019 to 2020, an increase that data from later years are needed to understand. Antimicrobials considered critically important in human medicine made up only 6% of sales in 2020, and between 2011 and 2020 sales of third- and fourth-generation cephalosporins fell by 33%, polymyxins by 76%, fluoroquinolones by 13% and other quinolones by 85%.
The twelfth report, published in November 2022, covered 31 countries (29 EU/EEA countries, Switzerland and the United Kingdom), all of which reported voluntarily. In the 25 countries that reported for the whole of 2011–2021, sales of veterinary antibiotics fell by 47%, to the lowest value ever reported. Antibiotic classes considered critically important in human medicine made up only 5.5% of sales in 2021, and between 2011 and 2021 sales of third- and fourth-generation cephalosporins fell by 38%, polymyxins by 80%, fluoroquinolones by 14% and other quinolones by 83%. The report was the first to include information on progress towards the target of the European Commission's Farm to Fork Strategy to cut sales of antimicrobials for farmed animals and aquaculture in the EU by 50% by 2030: between 2018 and 2021 the 27 EU Member States cut them by 18%, about a third of the target.
The thirteenth report, announced on 20 November 2023, was the last of the series. According to data from 25 countries, sales of veterinary antibiotics fell by 53% between 2011 and 2022, to the lowest level ever reported, a reduction that translates into a lower risk of bacteria becoming resistant in people and animals. Between 2011 and 2022, sales of classes considered critically important in human medicine fell noticeably: third- and fourth-generation cephalosporins by 49%, polymyxins by 81%, fluoroquinolones by 25% and other quinolones by 90%. By 2022 the 27 EU Member States had achieved just over half of the Farm to Fork target of a 50% reduction from 2018 by 2030, which shows that countries are on track to meet the strategy's goals.
Mandatory reporting of sales and use
Regulation (EU) 2019/6 made reporting of sales and use data for antimicrobials in animals a legal obligation for EU Member States and the European Medicines Agency, applying to data from 2023 onwards. The ESVAC initiative was considered so successful that its concept was formalised and expanded in EU legislation, which makes the collection of data on the sales of veterinary antimicrobials and on the use of antimicrobials in animals mandatory for all EU countries. The first report on sales and use data from 2023 was due in 2025.
In January 2024 the agency launched the Antimicrobial Sales and Use (ASU) Platform. From January 2024, every EU and EEA Member State must submit data on the sales of veterinary antimicrobials and the use of antimicrobials in animals to the platform each year, an obligation that Regulation (EU) 2019/6, the Veterinary Medicinal Products Regulation, introduced as one of the measures against antimicrobial resistance. The ESVAC project served as the platform's blueprint. Member States report their data to the agency through the platform, a centralised system that requires the data in a standardised format and is designed to streamline their submission. The agency planned annual reports, the first expected in March 2025, and a public interactive database to spread the results further. Reporting of use by animal species is to be phased in gradually.
Collecting data on the sales and use of antimicrobials in animals has always been critical in the fight against antimicrobial resistance. The data collected through the platform and presented in the annual reports will strengthen the analysis and identification of trends in antimicrobial consumption in animals across the EU and EEA, more accurately and in more detail, so that decision-makers can address the increasing complexity of antimicrobial resistance and take appropriate measures to protect both animal and human health in Europe. Reliable data give participating countries insight into the impact of their measures to promote prudent use of antimicrobials in animals, and could help to identify potential actions at national and international level to support an overall decrease in antimicrobial resistance.
Sales and use in 2023
The first European Sales and Use of Antimicrobials for Veterinary Medicine (ESUAvet) annual surveillance report, announced in March 2025, presented data on both the sales and the use of antimicrobials in animals in 2023 from all 27 EU countries together with Iceland and Norway. It builds on the ESVAC project. It marked the beginning of a regular exercise that is to result in yearly reports. Sales of antibiotics for food-producing animals made up 98% of total EU sales of veterinary medicines with antibiotic activity, and the best-selling class for these animals was penicillins, followed by tetracyclines and sulfonamides. Under the AMEG categorisation of antibiotics for prudent and responsible use in animals, about 65% of total EU sales for food-producing animals were of category D, which should be used as first-line treatment whenever possible, 29% of category C, which should be considered only when no category D antibiotic could be clinically effective, and 6% of category B, which is critically important in human medicine and whose use in animals should be restricted to mitigate the risk to public health.
In 2023, use data were collected for four main food-producing species: cattle, pigs, chickens and turkeys. Veterinarians were the sole data providers in 16 reporting countries, and the other 13 used other providers as well as veterinarians, including pharmacies, feed mills, farmers or breeders and retailers. Data on use were being collected across the EU for the first time, and many countries were still setting up or improving their systems for collecting them. So the use data for 2023 were not complete and accurate enough to start reporting quantitative information. Countries with experience in collecting use data offered guidance and support to the others, and Member States are committed to consolidating their collection systems to increase accuracy and coverage.
Consumption and resistance in animals and people
The Joint Interagency Antimicrobial Consumption and Resistance Analysis (JIACRA) is a joint report of the European Food Safety Authority, the European Medicines Agency and the European Centre for Disease Prevention and Control. Its July 2017 edition presented new data on antibiotic consumption and resistance that reflected improved surveillance across Europe. Its conclusions were in line with those of the first report, published in 2015, but better-quality data allowed a more sophisticated analysis. The 2017 report found that there were still important differences across the EU in the use of antibiotics in animals and in humans: overall use was higher in food-producing animals than in humans, but varied by country and by antibiotic. Polymyxins, colistin among them, were used widely in the veterinary sector and increasingly in hospitals to treat multidrug-resistant infections, while third- and fourth-generation cephalosporins and quinolones, also considered critically important for human health, were used more often in humans than in animals. Resistance to quinolones, which are used to treat salmonellosis and campylobacteriosis in humans, was associated with the use of antibiotics in animals, and the use of third- and fourth-generation cephalosporins to treat infections caused by Escherichia coli and other bacteria in humans was associated with resistance to those antibiotics in E. coli found in humans. Experts of the three agencies recommended further research to understand better how antibiotic use and resistance affect one another.
The joint report of the three agencies published in June 2021 took a One Health approach to antibiotic consumption and resistance in Europe for 2016–2018, and found that antibiotic use had decreased and was now lower in food-producing animals than in humans. Use of polymyxins, colistin among them, nearly halved in food-producing animals between 2016 and 2018, a positive development because polymyxins are also used in hospitals to treat patients infected with multidrug-resistant bacteria. The picture varied significantly by country and by antibiotic class: for example, aminopenicillins, third- and fourth-generation cephalosporins and quinolones were used more in humans than in food-producing animals, and polymyxins and tetracyclines more in food-producing animals than in humans. In humans, use of carbapenems, third- and fourth-generation cephalosporins and quinolones was associated with resistance to these antibiotics in E. coli infections, and similar associations were found in food-producing animals. Consumption of antimicrobials in animals was linked with resistance in bacteria from food-producing animals, which was in turn associated with resistance in bacteria from humans. In Campylobacter species, which are found in food-producing animals and cause foodborne infections in humans, resistance in animals was associated with resistance in the same bacteria in humans. The report's results call for continued efforts to tackle antimicrobial resistance at national, EU and global level across the healthcare sectors.