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/