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International Coordination
Anthroposophic Medicine
School of Spiritual Science
Medical Section at the Goetheanum

Antimicrobial resistance

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Antimicrobial resistance and the burden

One of the current major global health problems is the increasing microbial resistance to antibiotics, antiviral medicines, antifungals, among others. The burden of antimicrobial resistance (AMR) is large. An estimated 25.000 people infected with multidrug-resistant bacteria die each year in the EU (EMA, 2016). Infections caused by these multi-resistant bacteria in the EU lead to additional healthcare costs of at least EUR 1.5 billion per year, and loss of productivity (EMA, 2016). In the USA yearly at least 2 million people are infected with resistant bacteria (EMA, 2016). It is expected that the burden of the problem will increase exponentially, if no appropriate measures are taken. By 2050 worldwide more than 10 million people will die each year. The economic cost will also be significant, with the world economy being hit by up to $100 trillion (O’Neill, 2016).

Policies to control AMR

Worldwide strategies to control AMR and its consequences (mortality, costs) are being developed, focussing on: improving awareness and understanding of antimicrobial resistance by means of communication, education and training; strengthening knowledge through surveillance and research; reducing the incidence of infection; optimizing the approproate use of antimicrobial agents; and developing the economic case for sustainable investment that takes account of the needs of all countries, and increases investment in new medicines, diagnostic tools, vaccines and other interventions (EC, 2016; WHO, 2016). Currently these strategies appear to be insufficient, as for example demonstrated in the unchanged European consumption rates of antibiotics during the years 2011 - 2014 (Smith, 2016). One of the current focus of policies is to reduce antibiotics prescription and antibiotics consumption by means of stimulating appropriate use of antibiotics and by finding alternatives for antibiotics (NICE, 2015; O’Neill, 2016). 

AM prevention and treatment strategies

In daily clinical practice AM promotes a health promotion oriented lifestyle and treats patients with the aim to support and strenghten the self-healing or self-regulating ability of the human organism to cope with diseases (e.g., restricted use of antibiotics and antipyretics in infections, use of alternative treatments with natural medicinal products and non-medicinal treatments (e.g., external embrocation and compresses)). As a result of this approach, it is hypothesized that the organism in general will become less vulnerable for infections (prevention) and more resourceful/ resilient in overcoming occurring infections. According to the experience of expert AM professionals this approach is effective and safe, and results in lower antibiotic prescription and consumption. 

Is the AM contribution evidence-based?

Currently AM preventive and treatment strategies are partly based on AM concepts and long-term (more than 90 years) clinical experience developed in clinical practice treating patients. There is a small but increasing amount of evidence from in-vitro studies, observational studies and randomized controlled trials demonstrating lower antibiotic prescription rates by AM doctors, positive client experiences with prevention and treatment, and safety and efficacy of treatment (Jeschke, 2007; Baars, 2016 Hamre, 2005; Koster et al., 2014). Currently an international research consortium of conventional and CAM (Complementary & Alternative Medicine) researchers is executing AMR research projects and is developing strategies to increase the body of evidence on the contribution of (C)AM.

Read more … Articles and Projects

January 2018

Prof. Dr. med. Erik Baars
Louis Bolk Instituut, Driebergen, University of Applied Sciences Leiden,
Leiden, Netherlands

Univ.-Prof. Dr. med. David Martin
University of Witten-Herdecke Faculty of Health Department of Human Medicine
Institute of Integrative Medicine (IfIM)
Gerhard Kienle Chair of Medical Theory, Integrative and Anthroposophic Medicine
Gemeinschaftskrankenhaus Herdecke, Germany

References

  1. European Medicines Agency EMA 2016;
    https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/antimicrobial-resistance

  2. Koster E B, Ong R R, Heybroek R, Delnoij D M, Baars E W he consumer quality index anthroposophic healthcare : a construction and validation study. BMC health services research 2014; 14(1), pp. 1

  3. NICE guideline Antimicrobial stewardship : systems and processes for effective antimicrobial medicine use. 2015;

  4. O'Neill J Tackling drug-resistant infections globally : final report and recommendations. London: Wellcome Trust & HM Government 2016;

  5. Smith E Evaluation of the EC Action Plan Against the Rising Threats From Antimicrobial Resistance : Final Report. Luxembourg: Publications Office of the European Union 2016; pp. 150

  6. World Health Organization Global action plan on antimicrobial resistance. Geneva: WHO 2015;

  7. Jooste P An in-vitro study of the comparative effect of individual components of two anthroposophical complexes to chloramphenicol on the growth of Staphylococcus aureus (Doctoral dissertation). 2009;

  8. Maune S Anti-microbial potential of medical plant extracts (Sinupret®) regarding sinusitis. European Journal of Integrative Medicine 2008; 1, pp. 12-13

  9. Roser E et al. Screening of Anthroposophic medications on antibiotic activity in vitro. Der Merkurstab 2014; 6, pp. 448-455

  10. Roser E Investigating the antimicrobial potential of selected Anthroposophic medications which were promising in the screening (Doctorate thesis) 2015;

  11. Roser E, Gründemann C, Engels I, & Huber R Antibacterial in vitro effects of preparations from Anthroposophical Medicine. BMC Complementary and Alternative Medicine 2016; 16(1), pp. 372

  12. Schiefelbein B I An in-vitro study of the comparative effect of two anthroposophical eyedrop preparations on the growth of Staphylococcus Aureus (Doctoral dissertation) 2008;

  13. Hamre H J, Fischer M, Heger M, Riley D, Haidvogl M, Baars E, Bristol E, Evans M, Schwarz R, Kiene H. Anthroposophic vs. conventional therapy of acute respiratory and ear infections : a prospective outcomes study. Wien Klin Wochenschr 2005; 117(7), pp. 256-68

  14. Hamre H J, Fischer M, Heger M, Riley D, Haidvogl M, Baars E, Bristol E, Evans M, Schwarz R, Kiene H. Anthroposophische vs. konventionelle Therapie bei akuten Ohr- und Atemwegsinfekten : eine prospektive Outcomes-Studie. Der Merkurstab 2005; 58(3), pp. 172-84

  15. Hamre H J, Glockmann A, Schwarz R, Riley D S, Baars E W, Kiene H, Kienle G S. Antibiotic use in children with acute respiratory or ear infections : prospective observational comparison of anthroposophic and conventional treatment under routine primary care conditions. Evid Based Complement Alternat Med 2014; pp. 127
    Article ID 243801

  16. Hamre H J, Glockmann A, Schwarz R, Riley D S, Baars E W, Kiene H, Kienle G S. Antibiotic use in children with acute respiratory or ear infections : prospective observational comparison of anthroposophic and conventional treatment under routine primary care conditions. Evid Based Complement Alternat Med 2014; pp. 127
    Article ID 243801

  17. Jeschke E, Ostermann T, Lüke C, Tabali M, Kröz M, Bockelbrink A, … & Matthes H Remedies Containing Asteraceae Extracts. Drug safety 2009; 32(8), pp. 691-706

  18. Jeschke E, Lüke C, Ostermann T, Tabali M, Huebner J, Matthes H. Verordnungsverhalten anthroposophisch orientierter Ärzte bei akuten Infektionen der oberen Atemwege. Forschende Komplementärmedizin/Research in Complementary Medicine 2007; 14(4), pp. 207–215

  19. Stoss M, Michels C, Peter E, Beutke R, & Gorter R W Prospective cohort trial of Euphrasia single-dose eye drops in conjunctivitis. The Journal of Alternative and Complementary Medicine 2000; 6(6), pp. 499-508

  20. Süsskind M, Thürmann P A, Lüke C, Jeschke E, Tabali M, Matthes H, & Ostermann T Adverse drug reactions in a complementary medicine hospital : a prospective, intensified surveillance study. Evidence-Based Complementary and Alternative Medicine 2012;

  21. Alfvén T, Braun-Fahrländer C, Brunekreef B, Mutius E, Riedler J, Scheynius A, … & Michels K B Allergic diseases and atopic sensitization in children related to farming and anthroposophic lifestyle–the PARSIFAL study. Allergy 2006; 61(4), pp. 414-421

  22. Albonico H U, Bräker H U, & Hüsler J Febrile infectious childhood diseases in the history of cancer patients and matched control Medical hypotheses 1998; 51(4), pp. 315-320

  23. Jeschke E, Ostermann T, Tabali M, Bockelbrink A, Witt C, Willich S N, & Matthes H The treatment of children with anthroposophic medicine in daily primary care : Results of a network study. European Journal of Integrative Medicine 2009; 1(4), pp. 203

  24. Jeschke E, Ostermann T, Tabali M, Kröz M, Bockelbrink A, Witt C M, … & Matthes H Anthroposophic medicine in pediatric primary care : a prospective, multicenter observational study on prescribing patterns. Alternative therapies in health and medicine 2011; 17(2), pp. 18

  25. Jeschke E, Lüke C, Ostermann T, Tabali M, Huebner J, & Matthes H Prescribing practices in the treatment of upper respiratory tract infections in anthroposophic medicine. Forschende Komplementarmedizin 2007; 14(4), pp. 207-215

  26. Kok E T, Jong M C, Gravendeel B, Van Leeuwen W B, & Baars E W Resistance to Antibiotics and Antifungal Medicinal Products : Can Complementary and Alternative Medicine Help Solve the Problem in Common Infection Diseases? The Introduction of a Dutch Research Consortium. Evidence-Based Complementary and Alternative Medicine 2015;

  27. Eurocam The role of Complementary and Alternative Medicine (CAM) in reducing the problem of antimicrobial resistance. 2015;

  28. Baars E W et al. Scoping review to explore the contribution of anthroposophic medicine to the reduction of antimicrobial resistance : Background, expertise, evidence and projects. Oestrich-Winkel/ Driebergen: Sustainable Business Institute/Louis Bolk Institute 2016;

  29. Alm J S, Swartz J, Björkstén B, Engstrand L, Engström J, Kühn I, … & Reinders C An anthroposophic lifestyle and intestinal microflora in infancy Pediatric Allergy and Immunology 2002; 13(6), pp. 402-411

  30. Alm J S, Swartz J, Lilja G, Scheynius A, & Pershagen G Atopy in children of families with an anthroposophic lifestyle. The Lancet 1999; 353(9163), pp. 1485-1488

  31. Byström E, Lindstrand A, Likhite N, Butler R, & Emmelin M. Parental attitudes and decision-making regarding MMR vaccination in an anthroposophic community in Sweden : A qualitative study. Vaccine 2014; 32(50), pp. 6752-6757

  32. Duffell E. Attitudes of parents towards measles and immunisation after a measles outbreak in an anthroposophical community Journal of epidemiology and community health 2001; 55(9), pp. 685-686

  33. Earn DJ, Andrews PW, Bolker BM Population-level effects of suppressing fever. Proceedings of the Royal Society of London B: Biological Sciences 2014; 281(1778), pp. 20132570

  34. Ernst E. Anthroposophy: a risk factor for noncompliance with measles immunization. The Pediatric infectious disease journal 2011; 30(3), pp. 187-189

  35. Hanratty B, Holt T, Duffell E, Patterson W, Ramsay M, White J M, … & Litton P UK measles outbreak in non-immune anthroposophic communities : the implications for the elimination of measles from Europe. Epidemiology and infection 2000; 125(2), pp. 377-383

  36. Hesla H M, Gutzeit C, Stenius F, Scheynius A, Dahl H, Linde A, & Alm J Herpesvirus infections and allergic sensitization in children of families with anthroposophic and non-anthroposophic lifestyle : he ALADDIN birth cohort. Pediatric Allergy and Immunology 2013; 24(1), pp. 61-65

  37. Klotter J Anthroposophic lifestyle & allergies in children. Townsend Letter: The Examiner of Alternative Medicine 2006; (274), pp. 24-26

  38. Moenkhoff M, Baenziger O, Fischer J, & Fanconi S. Parental attitude towards alternative medicine in the paediatric intensive care unit. European journal of pediatrics 1999; 158(1), pp. 12-17

  39. Muscat M. Who gets measles in Europe? Journal of Infectious Diseases 2011; 204(1), pp. 353-365

  40. Rosenlund H, Bergström A, Alm J S, Swartz J, Scheynius A, van Hage M, … & Riedler J Allergic disease and atopic sensitization in children in relation to measles vaccination and measles infection 2009; 123(3), pp. 771-778

  41. Siedler A, Mankertz A, Feil F, Ahlemeyer G, Hornig A, Kirchner M, … & Reiter S Closer to the goal : efforts in measles elimination in Germany 2010. Journal of Infectious diseases 2011; 204(1), pp. 373-380

  42. Zuzak T J, Zuzak-Siegrist I, Rist L, Staubli G, & Simoes-Wust A P Attitudes towards vaccination : users of complementary and alternative medicine versus non-users. Swiss medical weekly 2008; 138(47), pp. 713

  43. Kienle GS. Fever in Cancer Treatment : Coley's Therapy and Epidemiologic Observations. Global Advances in Health and Medicine 2012; 1(1), pp. 90-8

  44. Little P, Moore M, Kelly J, Williamson I, Leydon G, McDermott L, … & Stuart B Delayed antibiotic prescribing strategies for respiratory tract infections in primary care : pragmatic, factorial, randomised controlled trial. BMJ 2014; 348, pp. 1606

  45. Martin D D. Fever : Views in Anthroposophic Medicine and Their Scientific Validity. Evidence-Based Complementary and Alternative Medicine 2016;

  46. Panossian A, Wikman G Efficacy of Andrographis paniculata in upper respiratory tract infectious diseases and the mechanism of action. Evidence and rational based research on Chinese drugs 2013; pp. 137-179

  47. Wagner L et al. Herbal Medicine for Cough : a Systematic Review and Meta-Analysis. Forsch Komplementmed 2015; 22, pp. 359-368

  48. Wang C H, Fang C C, Chen N C, Liu S S H, Yu P H, Wu T Y, … Chen S C Cranberry-containing products for prevention of urinary tract infections in susceptible populations : a systematic review and meta-analysis of randomized controlled trials. Archives of internal medicine 2012; 172(13), pp. 988-996

  49. Ritchie J, Wilkinson J, Gantley M, Feder G, Carter Y, & Formby J A model of integrated primary care : anthroposophic medicine. London, UK: Queen Mary, University of London 2001;

  50. Schempp CM, Wölfle U, Rispens JA, Schaette R. Coriander (Coriandrum sativum L.) : a Mediterranean umbellifer with medicinal and antimicrobial properties. Merkurstab 2011; 64, pp. 339-345

  51. Van der Bie et al. The Healing Process : Organ of Repair. Driebergen: Louis Bolk Institute 2008;

  52. Wapf V, & Busato A. Patients' motives for choosing a physician : comparison between conventional and complementary medicine in Swiss primary care. BMC Complementary and Alternative Medicine 2007; 7(1), pp. 1