Monday, August 29, 2016

Improving Knowledge of Antibiotic Resistance - What You Should Know

This month's Food Protection Trends has an article by a group of experts on the topic of antibiotic resistance and the impact on human and animal health.  The goal was to provide knowledge to professionals in an way to counter the many misstatements being made in the news media by uninformed 'professionals.'

First, there are four main themes that should highlight communications:

  1. Antibiotics are critical and precious and need protection. Antibiotics contribute greatly to our increased lifespan and quality of life.
  2. Antibiotics are an important tool for the treatment and prevention of disease in both humans and animals.  Healthy animals lead to a healthful food supply. There will likely always be some appropriate antibiotic use in the food supply. As in human health, animal antibiotics will be used at certain times in agriculture.
  3. Antibiotic use leads to antibiotic resistance. All uses, whether in the context of human medicine, veterinary medicine, or agriculture, exert selection pressure.
  4. With antibiotics, less is better. Antibiotics must be used cautiously. Each usage increases the long-term risk home by future generations. The balance of risk vs. benefit must be an ongoing dialogue among all stakeholders.
One of the major misconceptions is that animals are given antibiotics indiscriminately.   This is not the case in the US (but it may not be worldwide).
Some speculation has perpetuated the notion that 80 percent of antibiotics sold in the United States are used in the agriculture industry for growth promotion and infection prophylaxis. However, this is simply not true (11). Regardless of the amount, food-producing animals that receive antibiotics must undergo a specified withdrawal time for the drug to be eliminated from the animal prior to it entering the food supply.
Another important thing to point out is that animals need antibiotics from time to time, and not using antibiotics is not the best strategy.
Judicious use of antibiotics early in an animal's life can reduce the need for heavy antibiotic use later on.
And with that, the demand for antibiotic free meat is not based on sound science.  Unfortunately this consumer demand has pushed some producers into providing this meat.
However, most people agree that it is appropriate to use antibiotics to treat a sick cow or chicken, and when companies produce antibiotic-free meat, it means they use no antibiotics. There is even more controversy in using antibiotics for disease prevention, both in food animals and humans. However, if one administers a small dose of antibiotics to chicks in the first week of life, one can avoid larger doses of antibiotics to treat infected chickens later on. The roundtable concluded that a complete elimination of antibiotic use in animals intended for food is likely too extreme to serve the ultimate purpose of reducing the risk of antibiotic resistance. Some antibiotic use to treat and prevent disease in agricultural animals is appropriate. 
FDA has issued guidance on this antibiotic use with animals that limits the types of antibiotics that can be used and when those antibiotics can be used.
The report led to U.S.  FDA Guidance #209, which established two voluntary  principles (10):
• Use of medically important antimicrobial drugs in food producing animals should be limited to uses considered necessary for animal health.
• Use of medically important antimicrobial drugs in  food-producing animals should include veterinary oversight/ consultation.

This guidance led to FDA Guidance #213, establishing procedures for voluntarily phasing out growth promotion indications for medically important antibiotics in alignment with Guidance #209, and proposing changes to the Veterinary Feed Directive (VFD) regulation ( 12). As a result, the use of antibiotics in animal feed for growth promotion has been eliminated.
With food, proper cooking and preparation reduces the risk of foodborne illness.

A bigger issue may be the practices of the medical field and by consumers where there can be misuse and over-prescription.

Food Protection Trends
Enhancing Practitioner Knowledge about Antibiotic Resistance: Connecting Human 
and Animal Health
Michael Doyle, David Acheson, Jason Newland, Tarry Dwelle, William Flynn, 
H. Morgan Scott, Randall Singer, Marianna Smith Edge and Tony Flood
The development of antibiotic-resistant bacteria is associated with increases in mortality, morbidity., length of hospitalization, and health-care costs ( 6). While the medical community and the general public are becoming increasingly aware of this association, widespread strategies are needed to prevent the spread of antimicrobial-resistant organisms. This article discusses the proceedings from a roundtable convened in Washington, D.C. to develop a collaborative dialogue among human and animal health communities on antibiotic resistance. A summary of the proceedings .includes key recommendations for stakeholders to institute strategies for preventing the spread of antimicrobial-resistant organisms.

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