Claiming that animal agriculture accounts for 80% of the use of medically important antibiotics in some countries, the World Health Organization (WHO) this week called for an end to uses other than for control and treatment of disease.
The report, titled “WHO guidelines on use of medically important antimicrobials in food-producing animals,” recommends that “healthy animals should only receive antibiotics to prevent disease if it has been diagnosed in other animals in the same flock, herd, or fish population.”
In the United States, implementation of FDA’s Guidance for Industry 213, while voluntary, has removed label indications for animal-performance uses from all medically important antibiotics. Several products are, however, labeled for disease prevention, meaning they can be administered to groups of healthy animals known to be at risk for contracting specific diseases.
Notably, the authors rate the evidence supporting each recommendation as “low quality” or “very low quality.” They stress that “the beneficial human health benefits (lowered prevalence of antimicrobial resistance in bacteria isolated from humans) strongly outweigh any potentially harmful or undesirable outcomes.”
The recommendations include:
- We recommend an overall reduction in use of all classes of medically important antimicrobials in food-producing animals.
- We recommend complete restriction of use of all classes of medically important antimicrobials in food-producing animals for growth promotion.
- We recommend complete restriction of use of all classes of medically important antimicrobials in food-producing animals for prevention of infectious diseases that have not yet been clinically diagnosed.
- We suggest that antimicrobials classified as critically important for human medicine should not be used for control of the dissemination of a clinically diagnosed infectious disease identified within a group of food-producing animals.
- We suggest that antimicrobials classified as highest priority critically important for human medicine should not be used for treatment of food-producing animals with a clinically diagnosed infectious disease.
The report also includes best practice statements, which represent recommendations the Guideline Development Group (GDG) feel are important, but that are not appropriate for formal recommendations with ratings of quality of evidence.
- Any new class of antimicrobials or new antimicrobial combination developed for use in humans will be considered critically important for human medicine unless categorized otherwise by WHO.
- Medically important antimicrobials that are not currently used in food production should not be used in the future in food production including in food-producing animals or plants.
The authors note several gaps in research on antibiotic use in agriculture and the development of antibiotic resistance among pathogens. These include:
- Identification of the most effective methods for implementing antimicrobial stewardship programs in foodproducing animals, and better understanding of values and preferences of those affected by these programs.
- Cost-effectiveness studies of interventions aimed at reducing antimicrobial use in food-producing animals.
- Effects of restriction of antimicrobial use for disease control and treatment in food-producing animals on antimicrobial resistance in bacteria isolated from animals and humans.
- Development of rapid diagnostic and antimicrobial sensitivity tests.
- Effects of restriction of antimicrobial use in food-producing animals in low and middle-income countries on antimicrobial resistance in bacteria isolated from animals and humans, and on unintended consequences.
Read the full report from WHO.