I had a conversation with a vet friend last year who declared that antibiotic resistance was a problem of hospitals, not agricultural production. My jaw dropped. Somewhere around 80% of domestic antibiotics are used in animals. A small amount is for pets, horses, or non-routine clinical treatment, but the vast majority of antibiotics are used in livestock. Often (but not always), they are used prophyllactially as a maintenance feed supplement. Overcrowding and inappropriate feed, routine in CAFOs aka concentrated animal feeding operations, promote conditions which favor sub-clinical illnesses that slow growth or have the potential to lead full-blown infections. The routine use of antibiotics: 1) promotes growth; 2) keeps the animals healthy enough to get them to market.
Why is this a problem?
Basically, every time you expose a microbe (a bug like Salmonella, for example) to an antimicrobial, a few of them will adapt and survive. The next time that drug is used to kill them, the offspring of those bugs won’t die. Imagine this ten, twenty, thirty generations out, and a significant portion of the critters causing your infection will not die when treated with that antimicrobial. That, in short, is antibiotic (or antimicrobial) resistance. It means that the drugs don’t work because the microbes have learned to survive them. Treating animals with human drugs when the underlying problems are systematic, rather than a specific clinical case, literally breeds resistance.
Exposing zoonotic organisms– bacteria and viruses that transfer from humans to animals and vice versa– to drugs used in human treatment unless absolutely necessary has contributed significantly to the frequency of antibiotic resistance. The bacteria (and viruses, parasites, etc) travel easily and often between humans and livestock. There are three basic routes of exposure:
1) Actual food. Nearly all supermarket chicken carries Salmonella, and testing reveals high rate of resistance among those.
2) Farmers, farmworkers, and their families. People who handle the animals directly or who are in contact with farm items (even something like doing laundry, or riding in the same car, can transfer certain pathogens).
3) The environment: water, soil, and air. Chicken houses are notorious for blowing large amounts of dust out of their vents. That dusts carries on the wind, enters the water, and the soil. Other production methods, like run-off and leakage from manure pits, also contaminate water and soil. Even wild animals like birds can pick up pathogens by simply landing in a field, or on a manure pile. They spread those bacteria around the ecosystem.
Our inability to treat infections spreads feeds directly from the routine use of antibiotics on the farm to the home and hospital. Researchers, public health, and medical organizations have all uniformly acknowledged that fact for almost a decade. The FDA initially did so in 1977. We must examine the whole system, instead of segregating it into “clinical”, “routine”, “livestock”, “companion animals/pets”, and “humans”. We are all vulnerable, and without an effective approach, we will lose the effectiveness of our antibiotics entirely.
Given the extensive spread and travel of resistant microorganisms, we can not eliminate the development of resistance or transfer to humans without significantly changing our livestock production methods. It is possible. Denmark majorly reduced their use of antibiotics in pigs, and the level of resistance to one antibiotic in bacterial samples went from well over 90% to 25% in five years. If memory serves me right, costs were not majorly increased. McDonald’s has even started working with producers to reduce antimicrobial use. Why on earth has McDonald’s–a profit driven company– made more progress on the issue than Congress and the FDA, sanctioned to protect human health?
What should we do?
So, one come back from my vet friend was that the hospitals and doctors needed to get on the wagon. I would argue that they have. Hospitals have begun taking infections, particularly those caused by microbes with resistance to one or more drugs, very seriously, and most have strict protocols on how to handle infected patients. In addition, the CDC is very active in engaging clinicians on avoiding over-prescription. There are even limited financial penalties. But– where’s the livestock sector? Absent. The ethanol industry is even trying to gain permission to use one drug as a “food supplement.” CSPI and NRDC actually just sued the FDA about their lack of action.
Without major pressure from consumer, Congress and the FDA will do nothing. We will continue to lose our ability to treat diseases. Write your representatives, and senators, to tell them that you are concerned about antibiotic resistance. Suggest they cosign PAMTA. Tell them about the friend who required IV antibiotics to treat an infected thumb, the ear infection in your screaming two-year-old that took three rounds of antibiotics, or the runner who fell in Central Park and required IV antibiotics after a scraped knee was infected by MRSA. Not only are these painful experiences for patients, but they are expensive and preventable. We’re talking millions of dollars, and saving lives.
Otherwise, spread the word. Link to the information; persuade your friends and families to contact their representatives. Choose meat raised without antibiotics (or none at all). Look for items labeled “certified organic,” “no antibiotics administered,” or “raised without antibiotics.” FYI, antibiotics are generally kept out of the milk stream (producers and distributors can be very substantially fined) by removing animals when they are treated for clinical illnesses.