Lancet commission calls for major changes in antibiotic use

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This week, November 18 to 24, is Antibiotic Awareness Week in the United States, Hong Kong, Canada and Australia. Thailand, Europe and Mexico among others observe Antibiotic Awareness Day on November 18. Over the past few days, we have run a series of articles from the multi-disciplinary conference on antibiotic resistance hosted by the National Institute for Animal Agriculture last week in Kansas City. In keeping with the theme, the medical journal The Lancet this week published an editorial calling for a coordinated, global effort to combat antibiotic resistance.

To address the issue, The Lancet appointed an international expert commission, which operates under the theme of “Antibiotic resistance—the need for global solutions.” The goal of the Commission is to explore “why antibiotic resistance has become such a problem worldwide, and, most importantly, proposes solutions to avert the impending crisis.” The Lancet recruited experts in the various topics and asked them to write pieces focusing on how we got to this point and potential solutions to the problem. The individual contributions were peer-reviewed, revised, and assembled into a single document.

Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems, the commission notes. “Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken.”

The group says bacterial resistance has resulted from use of antibiotics "prescribed pointlessly for viral infections, added to animal feed to boost growth of livestock, and handed out like cough sweets in the community."

The report notes that non-prescription antibiotic use is common in many countries, accounting for 19 to 100 percent of antibiotic use outside northern Europe and North America. It also notes that when prescriptions are needed to obtain antibiotics, physicians might not adequately screen for appropriate use.

The authors also say antibiotic use in veterinary medicine and for growth promotion and disease prevention in agriculture, aquaculture, and horticulture is also a major contributing factor. “Although precise estimates are scarce, of the crudely estimated 100 000—200 000 tonnes of antibiotics manufactured every year, most goes to the agricultural, horticultural, and veterinary sectors. Although the transfer of antibiotic resistance plasmids from treated animals to human beings has been long suspected, findings from recent studies using whole-genome sequencing have confirmed animal-to-human transfers of resistance genes.”

 In its call to action, the commission identifies specific points for which urgent responses are needed as well as longer-term goals. These include hospital stewardship, responsible use in agriculture (including a global phase-out of use of antibiotics for growth promotion), access in countries with weak health systems, community education, and environmental management.

The authors note we have seemingly exhausted the potential of the antibiotic classes in use so far, and new drugs—either antibiotics or from other approaches—are needed. “But academia and pharmaceutical companies have not focused on this problem for so long that antibacterial drug-development programmes have withered. To stimulate drug discovery, novel incentives for industry and new approaches to funding, licensing, and patenting may be needed.”

Notably, the authors say it is “time to move on from blame and shame.” They acknowledge the use of antibiotics in food animals remains controversial, with knowledge gaps in the understanding of the resistance dynamics, conflicting results in various studies, and in particular the difficulty quantifying the potential effect on public health. “Implementation of prudent use relies on the daily work of farmers and veterinarians. Legitimate conflicting interests can surround this implementation—eg, production economy and the ethical obligation to care for diseased animals. In view of the polarised debate, veterinarians and farmers might feel that they are blamed for a problem they perceive is essentially generated by medical doctors. This situation might lead to a defensive attitude and does not cater for productive solutions. A way forward would be to acknowledge that human health, animal health, and the environment are all interlinked, and that the responsibility for dealing with the problems of resistance is shared by all stakeholders,” the authors write. “Strong local and global partnerships are needed in which policy makers, academia, and professionals from all sectors work together to improve present systems. The common goal should be to preserve the effect of antimicrobials for future generations of human beings, but also for animals.”

Read more from The Lancet Infectious Diseases.


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Tracy    
Canada  |  November, 20, 2013 at 09:31 AM

This article by the Beef Cattle Research Council points out that since Denmark banned the use of growth promoting antimicrobials in the 1990's, we can see a clear trend of increased use of prescribed veterinary antimicrobials of greater importance in human health. In addition, there has been no clear trend towards decreased antimicrobial resistance in Danish cattle or beef. http://www.beefresearch.ca/blog/what-denmark-has-shown-us-about-the-impact-of-growth-promoting-antimicrobial-use-in-cattle-on-human-health/

    
November, 20, 2013 at 02:35 PM

"Increased use of prescribed veterinary antimicrobials of greater importance in human health" is supposed to be a conclusion? Of course there will be more prescriptions. More prescriptions does not = more drugs administered. Nor does it mean increased selection pressure for antimicrobial resistance. But it does increase the incentive for responsible use of antibiotics.

    
November, 22, 2013 at 10:06 AM

Did you read the article? INCREASED USE means more drugs administered.

michael    
kansas  |  November, 22, 2013 at 11:29 AM

As always, Advocates "admit" there is little or no evidence - most that has been "recently" found is still lacking proper verifications - that ag antibiotic use significantly contributes to resistant-diseases in humans. These same Advocates also "admit", in low whispers, that the Prime & Well-Known cause of resistant bugs is the Improper & Excessive prescribing of antibiotics to humans by Doctors. And yet, their is no Screeching Outrage & Demands that antibiotics use be restricted for MDs? Lazy & Political - it's easier to attack, demonize and regulate a politically & culturally "weak" industry like farming than it is to address the actual, known culprit - Human Medicine & Practitioners. When will we see screaming front- page stories about MDs' "abuse" and "malpractice" causing antibiotic resistant super-bugs?

    
November, 22, 2013 at 12:38 PM

Yes, I read the article. I also read the study, which says the overall use of antibiotics decreased.

    
November, 22, 2013 at 12:40 PM

Both the health industry and the ag industry are included in the concerns addressed by the editorial. I am assuming Drovers chose to discuss the ag implications, because that resonates most with their readers.

    
November, 25, 2013 at 09:07 AM

But the amount of antibiotics used that are most important to human medicine increased, which is what we need to be concerned about.