Antibiotic use: Just how much is too much?

I recently read an article in Redbook¹ about the risk of antibiotic use in humans and animals; Not that I normally read Redbook. I never realized Redbook was such a political magazine. The article was aptly titled “Antibiotics are not candy.” It makes many good points about how human misuse may be contributing to the problem with antibiotic resistance in humans.  It also raises the valid concern about antibiotic usage in farm animals which may also be affecting antibiotic efficacy in humans. However, I need to point out a few potential untruths in the article.

1.  As terrible as Brody’s MRSA infection was, it was not from an animal type of MRSA. The type routinely cultured from pigs and poultry (ST398) rarely affects humans. The CDC has stated MRSA should not be considered as a foodborne illness.
2.  Other human disease examples noted in this article are not related to livestock, such as gonorrhea and carbapenem-resistant Enterobacteriaceae. (CRE). The association between chicken and urinary tract infections is scientifically very unproven.
3.  Another common resistant human infection, Vancomycin-resistant Enterococci (VRE), cannot not be blamed on vancomycin use in livestock.  Europe has the same rate of VRE as the US and we have never used, in animals, the vacomycin relative called avoparcin.
4.  The ideas shown in the compelling figure on page 151 have been evaluated in the multiple scientific peer reviewed papers and many confidential FDA required risk assessments. All that work has shown a negligible chance that the events would occur with frequency to harm the public health.

In regard to the article’s five (highly political) steps to fight super bugs, I would say:

1.  Use antibiotics correctly: Amen. The American Veterinary Medical Association and other practitioner groups have long promoted the prudent and judicious use of antibiotics.
2.  Buy meat labeled “raised without antibiotics” or “organic.”: If animals are raised without antibiotics, I wonder, “What happened to the ones got sick? Were they denied treatment so that farmer could get the premium price paid for antibiotic free?”
3.  Ask your favorite restaurants if they use meat raised without antibiotics: What does a veterinarian do for sick animals on a farm supplying Chipotle? Does this practice lead to animal welfare abuses?
4. Spread the message: Amen. We can all do better. I travel the world telling farmers and veterinarians to “put their antibiotic use house in order!”
5. Tell Congress to pass a law: NO.  As the article mentioned FDA has made a significant change in the way antibiotics will be used; spelling the end of growth promoting uses.  A law is too broad of a policy tool for this problem. It is like going after a mosquito with a bazooka.

I agree that resistant bacteria are an ongoing problem. But they have been for at least 4 million years.  Many types of resistant bugs were recently found in a cave in New Mexico, untouched by civilization.² (Also, resistant bacteria have been found in antibiotic-free meat, but that’s another topic for another blog.)³
 

¹Antibiotics are not candy. http://www.redbookmag.com/health-wellness/advice/how-antibiotics-cause-superbugs?click=main_sr

²Antibiotic Resistance Is Prevalent in an Isolated Cave Microbiome.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324550/pdf/pone.0034953.pdf

³ Drug Resistant Bugs found in Antibiotic-Free meat. http://www.wired.com/wiredscience/2012/01/organic-meat-superbugs/

Super Moms and Super Food

My hat goes off to the Pew organization for utilizing a special holiday, Mother’s Day, to push its unscientific agenda.¹  I must comment on super Moms as I am married to one!  My wife homeschools 8 children, runs two businesses, cares for 3 aged parents and puts up with me. Also, we raise two or three “natural” pigs a year.

What I can assure you is that Mom will use antibiotics when any of her babies need it!  People forget that farming is like running a maternity center and/or a nursery. Animals get sick just like kids. Therefore we need to be prudent in our antibiotic use. This is my message to veterinarians and mothers.

Preventive use of antibiotics can be prudent. After the second child in our house is diagnosed with “strep throat” the doctor will leave an open prescription for whoever in the house may need it, thus saving another doctor visit; reducing our health care costs.  The same is done on the farm. If the veterinarian can anticipate the disease outbreak, they may prescribe medicine for the entire group.  This prescription can reduce the total amount of product used on the farm and reduce the number of dead and suffering animals.

Of course, most Moms are also concerned about the safety of food for their “flock”.  I hope they understand that healthy animals are an important means to deliver safer meat.  In fact a report came out last week highlighting the inextricable link between animal health and meat safety.²

Some might argue if animals and my multiple kids, for that matter, were not raised in such high concentration, they would not need antibiotics. That is just not true.  I bet if you asked only Moms who had never used antibiotics to attend the “protest” it would have been a thin crowd.

¹http://www.saveantibiotics.org/moms/MothersDay.html
²Council of Agrictultural Science and Technology. 2012. The Direct Relationship between Animal Health and Food Safety Outcomes.
http://www.cast-science.org/download.cfm?PublicationID=155971&File=f0308f5988973b9a9f49461ae5d127335e74

Healthy Animals Make Confident Consumers

On May 7 I presented a commentary in Washington, D.C.  for the Council for Agricultural Science and Technology. The commentary, entitled "The Direct Relationship between Animal Health and Food Safety Outcomes," outlines how changes in production practices (for example, antimicrobial use) greatly impacts animal health, which in turn, has a significant impact on public health.


The paper is available for a free download at the link below.


http://www.cast-science.org/download.cfm?PublicationID=155971&File=f0308f5988973b9a9f49461ae5d127335e74