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Antimicrobial resistance

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

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References

(1) EMA (2016).
http://www.ema.europa.eu/ema/index.jsp?curl=pages/special_topics/general/general_content_000439.jsp

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

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

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

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

In-vitro studies

(7) Jooste P (2009). 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).


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

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

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

Clinical studies

(12) 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(7/8):256-68.


(13) 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):172-84.

(14) 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. Article ID 243801, 127 pp.

(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. Article ID 243801, 127 pp.

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Reviews

(20) Baars E W et al. (2016). 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.

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

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Prescription studies

(22) Jeschke E, Lüke C, Ostermann T, Tabali M, Huebner J, & Matthes H (2007). Prescribing practices in the treatment of upper respiratory tract infections in anthroposophic medicine. Forschende Komplementarmedizin (2006), 14(4), 207-215.

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Lifestyle studies

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


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

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


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Other supportive studies

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

(42) Little P, Moore M, Kelly J, Williamson I, Leydon G, McDermott L, ... & Stuart B (2014). Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ, 348, g1606.

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(49) Van der Bie et al. (2008). The Healing Process - Organ of Repair. Louis Bolk Institute, Driebergen.

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