Commentary: Focus is the key to preventing antibiotic resistance


Issue Date: June 3, 2015
By Noelle Cremers
Noelle Cremers
Human use of antibiotics is linked to 16 of the 18 largest drug-resistance threats, according to the Center for Disease Control.

When Alexander Fleming discovered penicillin in 1928, the practice of medicine changed dramatically. Infections that had been deadly could now be treated effectively with an antibiotic, and countless lives have been saved. Many other antibiotics have been developed since the initial discovery—but as their use has grown, so has resistance.

It is everyone's goal to keep people and animals healthy. Working together, human and animal health experts are finding ways to keep people healthy and antibiotics effective. To achieve this goal, it is important to focus efforts where they will be most effective and have real impacts on resistance.

The Center for Disease Control published a list of the 18 largest drug-resistant threats in the U.S. in 2013; 16 of the 18 are linked to human use of antibiotics. The remaining two, campylobacter and non-thyphoidal salmonella, are food-borne pathogens. Farmers, veterinarians and other animal health experts are working together to address these areas of resistance, and these experts are finding ways to keep people healthy and antibiotics effective. Effective antibiotics remain available to treat both illnesses, and human and animal health experts are collaborating to ensure that remains the case.

It is important that efforts be appropriately focused, to ensure investments are made where real change can occur and that there aren't unintended consequences to animal or human health by unnecessary actions.

The collective focus of both the animal and human health communities needs to be where we can make the greatest impact on public health. Working together, we are finding ways to keep people healthy and antibiotics effective. While the agriculture community is focused on where we can make the biggest difference—salmonella and campylobacter—improving human use of antibiotics is likely to see the biggest public health benefits, because that represents 16 of the 18 pathogens creating today's resistance challenges, according to the CDC.

Advocates trying to limit antibiotic use in livestock frequently cite that 80 percent of all antibiotics sold in the U.S. are for use in livestock and poultry. This figure is misleading for a number of reasons.

For one thing, there are many more animals in the U.S. than people. The U.S. Department of Agriculture agricultural census documents more than 2.2 billion livestock and poultry in the U.S., while the nation's human population is estimated at 320 million. In addition, many of these animals weigh quite a bit more than people do. What matters more than volume is development of resistance. A recent animal study in France found that early, low-dose treatment with antibiotics prevented clinical onset of pneumonia and did not lead to resistance, while a later, high-dose treatment after the onset of symptoms led to development of resistance in gut bacteria. It is most important that efforts be focused on identifying how to prevent resistance.

The U.S. Food and Drug Administration is currently working with animal pharmaceutical manufacturers to re-label antibiotics that are considered important in human medicine. The new labels, which should be fully implemented by December 2016, will prohibit the use of medically important antibiotics for growth promotion or feed efficiency. This means that medically important antibiotics will only be available to prevent and treat diseases and infections. The re-labeling will further require veterinary oversight of medically important antibiotics administered by feed or water. FDA estimates that 95 percent of medically important antibiotics administered to livestock are provided through feed and water, meaning there will be a significant increase in veterinary oversight of antibiotics used by livestock.

The president is also taking steps to reduce the incidence of antibiotic resistance. In March, the White House released the president's National Action Plan for Combating Antibiotic Resistant Bacteria. This plan presents five goals:

  • Slow the emergence of resistant bacteria and prevent the spread of resistant infections;
  • Strengthen surveillance efforts to combat resistance;
  • Develop and use rapid diagnostic tests for resistance bacteria;
  • Accelerate research and development of new treatments and vaccines;
  • Improve international collaboration on antibiotic resistance.

USDA, FDA and CDC all have roles to play in implementing the plan, and associations representing livestock and poultry producers are collaborating with these agencies to implement the actions.

In addition to the significant ongoing federal efforts, California is also taking action to address antibiotic resistance. State Sen. Jerry Hill, D-San Mateo, introduced Senate Bill 27 in December. The bill would require veterinary oversight for the use of all medically important antibiotics and place limits on the prophylactic use of antibiotics in livestock and poultry. It would also create an antibiotic tracking system and create guidelines for antibiotic stewardship and judicious use.

Recognizing that everyone has a role to play in addressing antibiotic resistance, Farm Bureau has been working with Sen. Hill and the governor's administration to ensure that animal health and welfare won't be jeopardized by costly changes that limit access to important treatments. We are working collaboratively to improve antibiotic stewardship and surveillance, while maintaining access to lifesaving treatments.

(Noelle Cremers is director of natural resources and commodities for the California Farm Bureau Federation. She may be reached at ncremers@cfbf.com.)

[The online version of this commentary was revised 6/3/15.]

Permission for use is granted, however, credit must be made to the California Farm Bureau Federation when reprinting this item.