Emily L. Heil, an assistant professor of pharmacy practice and science at the University of Maryland School of Pharmacy in Baltimore, is coordinator of the Antimicrobial Stewardship Program at the University of Maryland Medical Center.
A story of yet another person succumbing to an infection caused by a superbug, this time in Nevada, came across my news feed recently. Unfortunately, I don’t need to read about the woman’s recent death to know that we have an antibiotic-resistance crisis. As an infectious-diseases pharmacist and coordinator of the Antimicrobial Stewardship Program at the University of Maryland Medical Center, I live and breathe the science on antibiotic resistance and am acutely aware of the consequences of inaction.
I have some alarming news: If we want antibiotics to work for future generations, we need to act fast to curb their overuse in animals.
It is well-known that antibiotic-resistant bacteria have created an increasing challenge to health-care providers and have caused illnesses and deaths in our society. States should curb the overuse of antibiotics to prevent the spread of resistant bacteria.
The Centers for Disease Control and Prevention estimates at least 23,000 deaths and 2 million illnesses occur each year in the United States as a result of resistant bacteria. Antibiotic resistance increasingly threatens to send society back to a pre-antibiotic era that would significantly curtail many of the advances made in medicine. Surgery, ventilator care, intensive-care units and many aggressive cancer chemotherapy regimens require antibiotics to work.
While originally considered miracle drugs, many antibiotics have lost their ability to protect against harmful bacteria. Many of these bacteria have evolved and mutated, allowing them to resist, in the worst cases, all of our available antibiotic therapies because of the sheer volume of use in concentrated environments such as on farms. Incidence rates have risen overall, and the problem has spread worldwide as a result of inadequate infection-control practices and international travel.
There are tremendous domestic efforts to curtail unnecessary antibiotic use in humans to enhance infection-control practices and antibiotic stewardship. These programs have helped drive a decrease in antibiotic prescriptions per capita for humans in recent years. But these programs do nothing to control animal applications, which encompass nearly 70 percent of the medically important antibiotics sold in the United States.
The Society of Infectious Diseases Pharmacists recently published a position statement in an issue of Pharmacotherapy outlining the dangers caused by antibiotics used in agriculture. The authors, including me, describe how antibiotic resistance can transfer from the farm to humans in ways other than consumption of undercooked meats. Resistance also can spread through direct contact with animal handlers, through wastewater runoff from farms harboring resistant bacteria and even through direct inoculation of flies that harbor resistant bacteria from the farm to sources outside of the farm. These modes of documented resistant-bacteria transfers highlight the complex nature of the problem.
Two Food and Drug Administration regulations that address the use of antibiotics on farms went into full effect on Jan. 1. One rule removed growth-promotion uses from antibiotic product labels. Food animal producers cannot legally use those antibiotics for growth-promotion purposes.
At the same time, the FDA also requires veterinary oversight of drugs available for use in animal feed through a Veterinary Feed Directive (VFD). Now, no medically important antibiotics given in feed are available over the counter; they instead require a VFD to be administered. The VFD also requires a valid veterinarian-client relationship and mandates that the veterinarian assume responsibility for making clinical judgments about the animal’s health and provide any necessary follow-up care.
While these regulations are small but positive steps, they will not alone solve the problem. The FDA regulations will not prevent the use of antibiotics at identical or near-identical doses for the purpose of disease prevention rather than growth promotion.
Through the use of good animal husbandry techniques, vaccines, probiotics and other alternatives, the animal agriculture industry can and should move away from low-dose antibiotic use for routine disease prevention and use antibiotics only to treat sick animals.
California passed a law that bans antibiotics used regularly for disease prevention when animals are not sick. This law complements the new FDA regulations.
The Maryland General Assembly will consider a similar measure in its 2017 session, the Keep Antibiotics Effective Act, and I encourage the public and my colleagues in the public-health community to support the bill.
Antibiotic resistance poses a profound threat to our medical systems and public health, but we do have solutions. Will Maryland use them?