Antimicrobial Resistance: The Role of Food Animal Production

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Picture1Antimicrobial resistance (AMR) can arise from inappropriate use of antimicrobial medications (AMMs).  In the United States, more than 80% of all AMMs are used in food animal production, including classes of medications that are on the WHO list of critically important AMMs. Prior to 2017, many AMMs for food animal production could be purchased and used without a prescription and for purposes such as “growth promotion,” rather than for treating a documented infection.

In 2012 and 2013, the FDA released Guidance for Industry, which sought to define judicious use of AMMs in food production, as well as to recommend that the animal pharmaceutical industry voluntarily change their labeling of critically important AMMs used in food production. In short, the FDA recommended that certain AMMs should no longer be used without veterinary oversight or solely for “growth promotion.” Using these medications against their labelled purposes would then constitute a violation of the Federal Food, Drug, and Cosmetic Act.

Picture2Despite pushback from industry groups such as the National Pork Producers Council and the National Turkey Federation, which argue that there is no firm science supporting the concept that AMMs in animal production result in AMR in humans, the FDA has shown some early successes of their new guidelines. According to reports published this year, the pharmaceutical industry voluntarily either changed all new drug applications to require veterinary oversight or withdrew    the applications from consideration by January 2017.                     Credit: wellnesswarrior.org

However, there is more work to be done. Further guidance from the FDA should tighten controls on the use of AMMs in food production for disease prevention purposes. Currently, use of AMMs for disease prevention can include prophylactic administration of subtherapeutic doses for prolonged periods, dosed imprecisely in feed or water, to entire herds or flocks. Additionally, organizations focused on veterinary medicine and animal care, such as the USDA, should be made part of the Transatlantic Task Force on Antimicrobial Resistance (TATFAR). Finally, improved animal husbandry in food production facilities (decreased crowding, improved sanitation) would lead to less infectious disease.

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Credit: Ruralmadison.org

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7 Responses to “Antimicrobial Resistance: The Role of Food Animal Production”

  1. sarahrosenbergjhmi Says:

    Interesting take on AMR coming from inappropriate uses of AMM. Are there any studies that have shown the association between AMR and AMM? It seems that there is a lot of correlation, but temporal research needs to be established to justify causality. I’m curious on how you would model that study, or if people have already done it.
    How severe would the penalties be if someone were to violate the the Federal Food, Drug, and Cosmetic Act and how does the FDA plan on evaluating whether people are abiding by these regulations. And will there be any additional training to veterinarians to look out for specific indicators that would lead to antibiotics being used for “growth promotion?” There are a lot of questions to be asked on this topic, like what proportion of antibiotics purchased are for disease vs growth promotions? If more were for disease, then we should focus on stronger regulations to improve animal husbandry. If there are more cases for growth promotion, then creating barriers for AMM is a good start. Have there been any plans to label AMM treated meats? Or perhaps more thorough inspections of these facilities? What about getting the veterinarian community more involved with abiding by these regulations?
    Overall, great topic. There is definitely a lot that needs to be done.

  2. trailblazingspouse Says:

    Yes, there are numerous studies showing the association between the use of AMMs and AMR ((1) Cantas, et al. A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota; Front Microbial 2013; (2) Manges, et al. Food borne origins of E.coli causing extra intestinal illnesses; Clin Infect Dis 2012).

    Furthermore, they have been able show that these resistance genes are able to be transmitted through the food chain into humans by by PCR testing geographically and temporally matched E.coli isolates from humans and chickens and showing identical resistance patterns (Johnson, et al. Antimicrobial drug resistant E.coli from humans and poultry products; Emerging Infectious Diseases 2007). In addition to passing AMR bacteria through the food chain, AMR genes are also passed to humans through contamination of the environment or groundwater with animal feces, as well as through contact with animal or veterinary workers on farms.

    A serious problem with these GFIs is that the FDA has very little surveillance capability. As I stated, the GFI is completely voluntary, though it does seem as though the pharmaceutical companies are willing to comply at this time. The FDA does not have the regulatory ability to actually oversee farm conditions.

    Your question regarding what proportion of antibiotics purchased are for disease vs. growth promotion is a good one. Unfortunately, the numbers presented by the various stakeholders varied. According to industry sources, only 13% are used for growth promotion purposes. However, I just want to make sure that it is clear that these GFIs are not just to stop the use of AMMs for growth promotion. They are also designed to prevent over-the-counter use of antimicrobials in food production.

    I agree that veterinarians have not taken much of a lead on this topic. The veterinary groups, such as the AVMA, all have position statements that are very positive on the judicious use of antimicrobials, but they did not jump in as aggressive proponents of the issue at an early date. The veterinarian community, however, is careful to abide by any and all laws as failure would lead to loss of their licenses to practice.

    As far as your questions regarding meat labeling and meat processing facilities, as I not sure. Animal production and meat processing, believe it or not, are two different fields with completely different regulatory agencies. I agree they are great questions, but they would require their own blog post! Briefly, though, I can say that I suspect that a driving force for pharmaceutical companies and food production facilities to agree to limit their use of AMMs is because consumers are becoming wary of antibiotics in their food.

  3. desormeaux1 Says:

    The topic of AMM use in food animal production is very relevant today as it has been shown to lead to antibiotic resistance. I agree with you that the FDA should push to enforce regulations on the inappropriate use of antibiotics because AMR is becoming a major public health threat with significant economic consequences: in North America $21-35 billion/year are spent on AMR (1).
    It’s important as you mentioned that the US collaborates with international partners to gather evidence that would allow to counter the push back from groups like the National Pork producer council. A great example is that of Denmark, the largest exporter of pork in the world that was able to increase swine production by 47% while reducing antimicrobial use in swine by 51% (2).

    1. Howell L ed. Global Risks Report 2013. from World Economic Forum. Retrieved on 2/21/2017 http://www3.weforum.org/docs/WEF_GlobalRisks_Report_2013.pdf2.Carol Cogliani, Herman Goossens, and Christina Greko. Restricting Antimicrobial Use in Food Animals: Lessons from Europe. Microbe / Volume 6, Number 6, 2011

  4. marysmithsbf Says:

    Thank you for this post, the contribution of the food/animal industry to the worldwide public health problem of antimicrobial resistance is a compelling topic. The problem of antimicrobial resistance is complex, with multiple factors including the crux of your post- the use of antibiotics in food-producing animals for prophylaxis and growth promotion without adequate regulation. I agree with your assessment that with such a large portion of antibiotic use, two-thirds, residing in the animal/food industry, there should be tighter regulation and oversight on what/when antibiotics can be prescribed.

    However, an additionally troubling problem is the dearth of surveillance or monitoring systems tracking antibiotic usage in the animal food industry. In 2014, Former President Obama issued an executive order creating a Federal Interagency Task Force on Combating Antibiotic Resistance, outlining a ‘National Action Plan’ in which one of the goals was to improve the surveillance efforts in part in the animal food industry (1). Currently the National Antibiotic Resistance Monitoring System (NARMS) is a collaborative program between the FDA, CDC, and USDA to monitor susceptibility in food animals, meats, and humans (2). The issue is that, although well intentioned, the plan is not extensive enough. Presently, the NARMS, which monitors susceptibility in meats and food animals, only receive samples from 14 health departments on only four of the CDC’s top 10 resistant microbial threats (2). To really track and curb the antibiotic resistance crisis in the food animal industry, it would most likely require expanding NARMS to not only offer surveillance on certain strain susceptibilities in food animals, but also track antibiotic usage by mandating that food-producing animal farms report their usage (2).

    1. Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria. (2016). Initial assessments of the national action plan for combating antibiotic-resistant bacteria. (). Washington, Dc: The White House.
    2. U.S. Food and Drug Administration. (2015). An overview of NARMS. Retrieved from http://www.fda.gov/AnimalVeterinary/SafetyHealth/AntimicrobialResistance/NationalAntimicrobialResistanceMonitoringSystem/ucm453363.htm

  5. ginnesjhu Says:

    Thank you for your post, I appreciate your post about antimicrobial resistance and how the bulk of it is contributed by the animal sector. As it turns out, I am conducting my dissertation research on antimicrobial resistance and as a veterinarian, I have a lot of experience working the food industry both federally and internationally.

    First, I need to comment on the 80% animal usage of AMM argument. This argument is used and the study it came from was a bit flawed. It came from a press conference by Congresswoman Louise Slaughter and she backtracked what she said, warning that the studies that that supported this figure was actually from two different data and two different models and therefore should not be compared (https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm261160.htm). Similarly, there are logarithmically more animals than people in the United States that are used to feed people, which equates to further antibiotic usage for these animals. Similarly, many of these animals (pigs and cows (dairy and beef)) are much larger than people. This said, the food industry requires the use of more antibiotics than people for these reasons. The types of antibiotic use is also something that we must look at. About 40-60% of the uses of antibiotics are from the class “ionophores” which is NOT used in human medicine at all.

    In terms of feeding the herd in the water and food to prevent widespread disease: this is necessary. Because of the sheer number of pigs, lack of labor, and the requirement to treat the population as opposed to the individual pig, we need to dose the water. This has shown to be effective at preventing widespread disease in the heard versus not using this method. The alternative is large losses of production. (https://projects.ncsu.edu/project/swine_extension/healthyhogs/book2000/almond.htm)

    Finally, I think the Veterinary Feed Directive (VFD) produced by the FDA, which was enacted this year, has addressed a lot of the concerns in the public. Many times before VFD, producers were able to order antibiotics for their feed right from the feed mill. Now they have to go through veterinarians, who are required to have a veterinarian-client-patient-relationship with the owner and the animals. Veterinarians are not evil, i promise you. We understand antimicrobial resistance and we don’t like it as much as the next person (maybe even less actually, because of occupational hazards). I have talked to many veterinarians in industry who do not sign off on inappropriate use for growth promotion or sub-therapeutic uses. Putting these drugs in veterinary oversight is VASTLY important – it is akin to putting AMM use in the hands of physicians for people.

    This all said – of course the food industry contributes to AMR globally, however we are unsure how much it actually adds as opposed to all of the other ways that AMR occurs (such as non-compliance and overuse of antibiotics in the human sector, factory outputs, etc, etc).

    Thank you again for your post. It’s a really interesting area!! (though I am a LITTLE bit biased because this subject is what where my PhD is centered)

  6. Zhengchun Jiang Says:

    It is astonishing that most antimicrobial medications go into husbandry industry serving growth promotion purpose. I strongly appeal to tighter control of the prescription of antimicrobial medications in husbandry industry since antimicrobial resistance is pressing considerable burden on the treatment of diseases. To support the policy from an academic perspective, more biomedical or public health researches are needed to provide rigorous and solid evidence on the association between antimicrobial resistance on human beings and the use of antimicrobial medicine use in livestock. To be honest, I am doubting the implementation of the policy, which try to control the AMMs use from the demand side. Possibilities are there AMM manufacturers or sellers will offer veneries commission to encourage more prescriptions, at the meantime, livestock industry workers will try all kinds of methods to get overdose AMMs out of the pursuit of productivity. It is very hard to control the behaviors at the individual level. But how about control the AMMs from supply side at the organizational level? Restrict the provision volume to individual veterinaries and try to guide those AMM manufacturers towards the development of some higher value-added products? It would be easier if we can control the distribution of AMMs from their sources.

  7. ALL GOVERNMENT AGENCIES NEED TO COME TOGETHER AND UNDERSTAND THE DRIVERS OF THIS PROBLEM-ANTIMICROBIAL RESISTANCE | Site Title Says:

    […] via Antimicrobial Resistance: The Role of Food Animal Production — SBFPHC Policy Advocacy […]

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