Table. DANMAP’s contributions to decreasing antimicrobial agent resistance in Denmark, 11 years*.
| Sector | Problem | Intervention (reference) | Type of intervention | Intervention had effect |
|---|---|---|---|---|
| Food animal | High occurrence of vancomycin-resistant Enterococcus faecium isolates in food and production animals | Banned avoparcin: Denmark May 1995 and EU Dec 1997. Provided data for national and EU ban. Monitored effect of ban in animals, food, and healthy humans. | Regulatory | Yes |
| High occurrence of streptogramin-resistant E. faecium isolates in food and production animals | Banned virginiamycin: Denmark Jan 1998 and EU Jul 1999. Provided data for national and EU ban. Monitored effect of ban in animals, food, and healthy humans. | Regulatory | Yes | |
| High use of fluoroquinolones in animal production | Restricted use of fluoroquinolones in animal husbandry, by Danish law in 2002. | Regulatory | Yes | |
| High use of antimicrobial agents in swine production | Implemented new guidelines for veterinary practitioner prescription of antibacterial agents for swine production in 2005. | Guideline | Not yet known | |
| Food | Higher levels of resistance in Salmonella and Campylobacter isolates from imported food than from Danish food | Implemented evaluation of safety of food products, by November 2006. | Regulatory | Not yet known |
| Human | Increasing macrolide resistance in Streptococcus pneumoniae | Published report to prescribers in EPI-NEWS (13). | Awareness campaign | Yes |
| Increasing use of newer, broad-spectrum antibiotics, especially in hospitals | Published report to prescribers in EPI-NEWS (14). | Awareness campaign | No, use of newer, broad-spectrum antibiotics still increasing | |
| Higher levels of resistance in travel-associated Salmonella and Campylobacter infections | Published report to prescribers in EPI-NEWS (14). | Awareness campaign | Not yet known | |
| Increasing no. of methicillin-resistant Staphylococcus aureus (MRSA) cases | Published report to prescribers in EPI-NEWS (15). Informed national reference center, which reported to physicians and other prescribers (15). Made notification mandatory Nov 2006 (16). | Mandatory notification | Not yet known | |
| Increasing use of antimicrobial agents, outside and inside hospitals | Published report to prescribers in EPI-NEWS (14). | Awareness campaign | No, antibiotic use still increasing | |
| Increasing ciprofloxacin resistance related to increasing ciprofloxacin use | Published report to prescribers in EPI-NEWS (14). | Awareness campaign | No, ciprofloxacin use and resistance still increasing, but low compared with that of other countries |
*DANMAP, Danish Integrated Antimicrobial Resistance Monitoring and Research Program; EU, European Union.