{"id":29828,"date":"2024-09-20T16:29:38","date_gmt":"2024-09-20T15:29:38","guid":{"rendered":"https:\/\/ppr-antibioresistance.inserm.fr\/?p=29828"},"modified":"2025-02-26T14:53:32","modified_gmt":"2025-02-26T13:53:32","slug":"renforcer-lacces-aux-antibiotiques-negliges-en-europe","status":"publish","type":"post","link":"https:\/\/ppr-antibioresistance.inserm.fr\/fr\/edito\/renforcer-lacces-aux-antibiotiques-negliges-en-europe\/","title":{"rendered":"Renforcer l’acc\u00e8s aux antibiotiques n\u00e9glig\u00e9s en Europe"},"content":{"rendered":"\n

L\u2019acc\u00e8s aux antimicrobiens est n\u00e9cessaire pour qu\u2019un syst\u00e8me de sant\u00e9 moderne fonctionne correctement, permettant de traiter les infections et de faire des interventions chirurgicales avanc\u00e9es, telles que des transplantations d\u2019organes ou des chimioth\u00e9rapies, en limitant les risques d\u2019infections post-chirurgicales.<\/p>\n\n\n\n

Chaque ann\u00e9e, pr\u00e8s de 1,3 millions de personnes d\u00e9c\u00e8dent d\u2019infections bact\u00e9riennes r\u00e9sistantes.1 Cela n\u2019implique pas que les bact\u00e9ries en question soient r\u00e9sistantes \u00e0 tous les antibiotiques, mais plut\u00f4t que les patientes ou patients n\u2019ont pas re\u00e7u le bon antibiotique au bon moment. Cependant, il y a aussi une hausse des infections bact\u00e9riennes multi-r\u00e9sistantes.2<\/p>\n\n\n\n

Dans les pays \u00e0 revenus \u00e9lev\u00e9s, l\u2019antibior\u00e9sistance est principalement due \u00e0 un exc\u00e8s de consommation. Plus un antibiotique est utilis\u00e9, plus il y a de chances qu\u2019une bact\u00e9rie r\u00e9sistante se d\u00e9veloppe et se transmette.3 D\u2019o\u00f9 le concept du bon usage des antibiotiques \u2013 il faut utiliser le bon antibiotique au bon moment, et privil\u00e9gier l\u2019utilisation d\u2019antibiotiques \u00e0 spectre \u00e9troit. Chaque antibiotique a un spectre d\u2019activit\u00e9 antimicrobienne \u00e9valu\u00e9, qui permet de r\u00e9pertorier sur quelles bact\u00e9ries il sera efficace. L\u2019utilisation d\u2019antibiotiques \u00e0 large spectre tue non seulement la bact\u00e9rie nocive mais aussi des bact\u00e9ries anodines, ce qui augmente la probabilit\u00e9 de d\u00e9velopper des r\u00e9sistances.<\/p>\n\n\n\n

Malheureusement, dans au moins neuf pays europ\u00e9ens en 2022, il y a eu une augmentation des prescriptions d\u2019antibiotiques \u00e0 large spectre par les cliniciens.4 Ceci a un impact non seulement sur le d\u00e9veloppement de r\u00e9sistances, mais \u00e9galement sur la disponibilit\u00e9 d\u2019antibiotiques \u00e0 spectre \u00e9troit : moins de prescriptions veut dire moins de ventes, et donc un march\u00e9 moins attractif pour les entreprises qui mettent sur le march\u00e9 ces antibiotiques. Quand le march\u00e9 cesse d\u2019\u00eatre viable, les entreprises retirent leur antibiotique du march\u00e9, et il n\u2019est plus disponible quand il est prescrit par les cliniciens. De cette mani\u00e8re, beaucoup d\u2019antibiotiques \u00e0 spectre \u00e9troit ont \u00e9t\u00e9 \u00ab oubli\u00e9s \u00bb faute de disponibilit\u00e9, et ont \u00e9t\u00e9 enlev\u00e9s des recommandations nationales de prescription d\u2019antibiotiques.5<\/p>\n\n\n\n

Dans le cadre de la deuxi\u00e8me action coordonn\u00e9e europ\u00e9enne sur l\u2019antibior\u00e9sistance et les infections li\u00e9es aux soins (European Union Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections, EU-JAMRAI-2, www.eu-jamrai.eu<\/a>), une partie des travaux portent sur l\u2019am\u00e9lioration de la disponibilit\u00e9 de certains antibiotiques plus anciens et \u00e0 spectre \u00e9troit pour utilisation humaine ou v\u00e9t\u00e9rinaire. Quatorze pays ont s\u00e9lectionn\u00e9 des antibiotiques cl\u00e9s m\u00e9dicalement importants et avec des chaines de production \u00e0 risque (souvent en rupture de stock, retires du march\u00e9 ou non mis sur le march\u00e9 pour le territoire). Le but est d\u2019identifier des actions possibles pour am\u00e9liorer la disponibilit\u00e9 de ces antibiotiques. Le consortium travaillera avec les acteurs r\u00e9gionaux, nationaux, et Europ\u00e9ens sur des interventions visant l\u2019offre et la demande, afin d\u2019am\u00e9liorer la disponibilit\u00e9 de certains antibiotiques et d\u2019augmenter le catalogue d\u2019antibiotiques disponibles \u00e0 la prescription.<\/p>\n\n\n\n

Un exemple est le cas de la ph\u00e9noxym\u00e9thylp\u00e9nicilline (p\u00e9nicilline V), un antibiotique \u00e0 spectre \u00e9troit datant des ann\u00e9es 1950 dont la consommation est en baisse \u00e0 travers l\u2019Europe.6 Alors que dans les pays scandinaves la ph\u00e9noxym\u00e9thylp\u00e9nicilline reste un traitement de premi\u00e8re ligne pour beaucoup d\u2019infections, cet antibiotique n\u2019est pas possible dans certains pays Europ\u00e9ens o\u00f9 des r\u00e9sistances sont apparues. Mais ces r\u00e9sistances ne concernent pas toutes les bact\u00e9ries : par exemple les infections aux Streptococcus A peuvent \u00eatre trait\u00e9es efficacement \u00e0 la ph\u00e9noxym\u00e9thylp\u00e9nicilline dans beaucoup de pays.7 Or, cet antibiotique peut \u00eatre prescrit que s\u2019il est disponible dans les pharmacies locales.<\/p>\n\n\n\n

L\u2019acc\u00e8s \u00e0 la ph\u00e9noxym\u00e9thylp\u00e9nicilline est d\u2019autant plus compliqu\u00e9 que les diff\u00e9rents pays scandinaves utilisent des dosages diff\u00e9rents d\u2019antibiotiques pour des raisons historiques d\u2019autorisations de mise sur le march\u00e9 datant d\u2019il y a plus de 50 ans, ce qui entraine une fragmentation du march\u00e9. Pour am\u00e9liorer l\u2019acc\u00e8s \u00e0 cet antibiotique, le projet EU-JAMRAI-2 va \u00e9tudier comment les dosages peuvent \u00eatre harmonis\u00e9s en Europe (et au-del\u00e0), consolidant ainsi le march\u00e9 existant. En parall\u00e8le, les professionnels de soins doivent \u00eatre inform\u00e9s de la disponibilit\u00e9 et de l\u2019utilit\u00e9 de cet antibiotique, et il faudrait qu\u2019ils soient incit\u00e9s \u00e0 les prescrire plut\u00f4t que des antibiotiques \u00e0 spectre plus large. Ceci d\u00e9montrera aux producteurs d\u2019antibiotiques qu\u2019un march\u00e9 viable existe au-del\u00e0 des pays scandinaves.<\/p>\n\n\n\n

Un autre antibiotique \u00ab oubli\u00e9 \u00bb est le pivmecillinam (\u00e9galement une p\u00e9nicilline \u00e0 spectre \u00e9troit), mis sur le march\u00e9 dans les ann\u00e9es 1970 pour traiter les infections urinaires. Alors que cet antibiotique est peu utilis\u00e9 en Europe,6 il a r\u00e9cemment \u00e9t\u00e9 approuv\u00e9 aux \u00e9tats unis en tant que \u201cnouvel\u201d antibiotique, dot\u00e9 d\u2019une d\u00e9signation sp\u00e9ciale visant \u00e0 stimuler l\u2019innovation pour la recherche d\u2019antibiotiques, en garantissant une exclusivit\u00e9 de march\u00e9, prot\u00e9geant le produit d\u2019une production comp\u00e9titive de g\u00e9n\u00e9riques.8 L\u2019attention donn\u00e9e \u00e0 cet antibiotique aux USA pourrait provoquer des effets positifs en Europe, en montrant aux cliniciens europ\u00e9ens l\u2019utilit\u00e9 de cet antibiotique, qui peut \u00eatre produit et distribu\u00e9 en Europe sous forme de m\u00e9dicament g\u00e9n\u00e9rique \u00e0 des prix comp\u00e9titifs.<\/p>\n\n\n\n

Un manque d\u2019acc\u00e8s \u00e0 des antibiotiques importants augmente la probabilit\u00e9 de d\u00e9velopper des r\u00e9sistances antimicrobiennes. Si le bon antibiotique n\u2019est pas disponible au bon moment, les cliniciens prescrivent d\u2019autres antibiotiques moins efficaces \u00e0 spectre large. Si cette indisponibilit\u00e9 persiste, les cliniciens changent leurs habitudes de prescription, ce qui entraine la suppression d\u2019un m\u00e9dicament du march\u00e9. Les antibiotiques \u00e0 spectre \u00e9troit sont un march\u00e9 vuln\u00e9rable, ce march\u00e9 \u00e9tant de plus en plus petit et les retours sur l\u2019investissement faibles. Le consortium EU-JAMRAI-2 va tenter de d\u00e9montrer que cela peut changer. Les pays membres peuvent assurer un acc\u00e8s fiable aux antibiotiques \u00e0 spectre \u00e9troit en s\u2019appuyant sur des coop\u00e9rations et interventions r\u00e9gionales et europ\u00e9ennes.<\/p>\n\n\n\n

\n\n\n\n

R\u00e9f\u00e9rences<\/h2>\n\n\n\n

1. Murray CJ, Ikuta KS, Sharara F, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet 2022; 399(10325): 629-55.
2. European Centre for Disease Prevention and Control. Risk Assessment: Emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in EU\/EEA countries – first update. Stockholm: ECDC, 2024.
3. Holmes AH, Moore LS, Sundsfjord A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. The Lancet 2016; 387(10014): 176-87.
4. European Centre for Disease Prevention and Control. Antimicrobial consumption in the EU\/EEA (ESAC-Net). Stockholm: ECDC, 2023.
5. Pulcini C, Mohrs S, Beovic B, et al. Forgotten antibiotics: a follow-up inventory study in Europe, the USA, Canada and Australia. International journal of antimicrobial agents 2017; 49(1): 98-101.
6. Bruyndonckx R, Adriaenssens N, Hens N, et al. Consumption of penicillins in the community, European Union\/European Economic Area, 1997\u20132017. Journal of Antimicrobial Chemotherapy 2021; 76(Supplement_2): ii14-ii21.
7. Van Driel ML, De Sutter AI, Thorning S, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database of Systematic Reviews 2021; (3).
8. US Food & Drug Administration. FDA Approves New Treatment for Uncomplicated Urinary Tract Infections. 2024. https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-approves-new-treatment-uncomplicated-urinary-tract-infections (accessed May 6 2024).<\/p>\n\n\n\n

<\/div>\n\n\n\n
\n\n\n\n
<\/div>\n\n\n\n

Autrice<\/h3>\n\n\n\n
\"\"<\/figure>
\n

Dr. Antoine ANDREMONT, MD, PhD<\/strong><\/p>\n\n\n\n

Senior Scientist<\/em><\/p>\n\n\n\n

Norwegian Institute of Public Health, Oslo, Norway<\/strong><\/p>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"

L\u2019acc\u00e8s aux antimicrobiens est n\u00e9cessaire pour qu\u2019un syst\u00e8me de sant\u00e9 moderne fonctionne correctement, permettant de traiter les infections et de faire des interventions chirurgicales avanc\u00e9es, telles que des transplantations d\u2019organes ou des chimioth\u00e9rapies, en limitant les risques d\u2019infections post-chirurgicales. Chaque ann\u00e9e, pr\u00e8s de 1,3 millions de personnes d\u00e9c\u00e8dent d\u2019infections bact\u00e9riennes r\u00e9sistantes.1 Cela n\u2019implique pas que […]<\/p>\n","protected":false},"author":271,"featured_media":29829,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"categories":[3341],"tags":[6607],"acf":[],"yoast_head":"\nRenforcer l'acc\u00e8s aux antibiotiques n\u00e9glig\u00e9s en Europe - Interface nationale ANTIBIOR\u00c9SISTANCE<\/title>\n<meta name=\"description\" content=\"Informations, \u00e9v\u00e8nements et actualit\u00e9s autour de l'Antibior\u00e9sistance en France et \u00e0 l'international.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ppr-antibioresistance.inserm.fr\/fr\/edito\/renforcer-lacces-aux-antibiotiques-negliges-en-europe\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Renforcer l'acc\u00e8s aux antibiotiques n\u00e9glig\u00e9s en Europe - 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