Antibiotics are for treating infections. Period.

By Susan A. Schneider, Director of LL.M. Program in Agricultural & Food Law at Arkansas School of law and contributor to the Agricultural Law blog.

On September 16, the Centers for Disease Control issued its report, Antibiotic Resistance Threats in the United States, 2013. The report characterizes the problem as follows:

"Each year in the United States, at least 2 million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. Many more die from other conditions that were complicated by an antibiotic-resistant infection.

Antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. healthcare system. In most cases, antibiotic-resistant infections require prolonged and/or costlier treatments, extend hospital stays, necessitate additional doctor visits and healthcare use, and result in greater disability and death compared with infections that are easily treatable with antibiotics. The total economic cost of antibiotic resistance to the U.S. economy has been difficult to calculate. Estimates vary but have ranged as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars)."

Bacteria evolve quickly, and the development of some resistance over time can be anticipated. However, the more antibiotics that are used and the conditions under which they are used can dramatically speed this process. The CDC Report identifies the use (and overuse) of antibiotics as “the single most important factor in the development of resistant bacteria.”

The Report identifies the use of antibiotics in livestock production as one significant contributor to the development of resistance. This conclusion has been reached in numerous scientific studies confirming this connection.  See, for example, No Time to Lose: 147 Studies Supporting Public Health Action To Reduce Antibiotic Overuse In Food Animals (IATP, Nov. 8, 2012).

Antibiotics are used in livestock production in three ways. First, they are used to treat disease and infection, much as they are used for humans or for pets. In addition, however, they are used extensively at sub-therapeutic levels (i.e., below the level that you would use to treat infection) in order to prevent infection and increase growth rates. Many of these antibiotics are sold over-the-counter without veterinary prescription and added to feed and water at low levels. FDA’s most recent report on antibiotic use revealed that in 2011, 29.9 million pounds of antibiotics were used in livestock production, compared to only 7.7 million pounds used for human treatment. This data is graphically shown by the Pew Campaign on Human Health and Industrial Farming:

The CDC Report identifies several different ways that the use of antibiotics in livestock production can affect antibiotic resistance and human health. Animals are fed antibiotics at low levels and consequently develop resistant bacteria in their guts. This drug-resistant bacteria can be found on the meat and transmitted to humans through handling the raw meat or consuming it without proper cooking. Similarly, the drug-resistant bacteria may be found in the feces of the animal and transferred to cropland through fertilizer use or water runoff. Any contamination of crops can pass the drug-resistant bacteria on to humans who consume the contaminated food or come in contact with the contaminated water.

The report cites the FDA Draft Guidance for Industry on the use of antibiotics in animal agriculture as a positive step. This Guidance identifies certain categories of antibiotics as particularly important for treatment of human disease, calls for veterinary oversight of the use of these medically important antibiotics, and seeks the voluntary adoption of the “judicious use” of antibiotics in livestock feed.

Critics, however, argue that the pharmaceutical and livestock industries have too much financial stake in the use of antibiotics for any voluntary guidance to work. Moreover, they argue that the FDA’s definition of “judicious use” will do little to reduce the use of antibiotics.

The FDA indicates that medically important antibiotics should not be used for “increased rate of weight gain” or “improved feed efficiency.” However, these antibiotics could be used for “the treatment, control, and prevention of specific diseases.”  This allows the continued use of medically important antibiotics, given at low levels in feed, for the prevention of disease rather than saving these drugs for the treatment of disease when it occurs. Note that weight gain and feed efficiency, while not considered to be an appropriate reason for use, will occur as a result of this use. FDA policy was taken to task by Dr. Robert Lawrence of Johns Hopkins Bloomberg School of Public Health in the article in the Atlantic, The FDA Did Not Do Enough to Reduce Antibiotic Use in Animals.

As the CDC Report indicates, “[antimicrobial resistance is one of our most serious health threats.” And, any use of antibiotics encourages the development of resistance bacteria. Antibiotics must be used sparingly in order to preserve their effectiveness. The report concludes, “These drugs should only be used to treat infections.”

Just as we do not give antibiotics for disease prevention in humans, the use of antibiotics for disease prevention in animals must be questioned. This use, particularly when antibiotics important for humans are involved, should not be considered to be “judicious use.” Efforts should be made to re-evaluate our production methods to reduce crowding and stress, thereby reducing the risk of disease without the use of sub-therapeutic antibiotics.

Professor Susan A. Schneider teaches agricultural and food law courses at the University of Arkansas School of Law and serves as the Director of the unique advanced legal degree program, the LL.M. Program in Agricultural & Food Law. Schneider was raised on a family farm in Minnesota and has devoted her legal career to work in agricultural and food law. Her private practice experience includes agricultural law work with firms in Arkansas, Minnesota, North Dakota, and Washington, D.C. as well as service as a staff attorney at Farmer's Legal Action Group Inc. (FLAG). She now serves on the FLAG Board of Directors. She is a past president of the American Agricultural Law Association (AALA) and was the recipient of the 2011 AALA Distinguished Service award. She is a frequent speaker at agricultural and food law conferences. Professor Schneider is a significant contributor to the Agricultural Law blog. Her twitter account @aglawllm is followed by many interested in agricultural and food law issues.

Cow photo by USDAgov.

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