Antimicrobial oversight in veterinary news

Antibiotic resistance is growing, and we’ve all heard that doctors should prescribe fewer antibiotics. But the bulk of antibiotic use in the United States is in food animals. Producers feed antibiotics not only to sick animals, but to promote growth. This is a potential issue for human health, but the solution isn’t immediately clear. Which antibiotics specifically should be limited? Where exactly should we draw the line between use to prevent disease and use to promote growth?

A news article in the June 1 issue of the Journal of the American Veterinary Medical Association (JAVMA), “Proposal calls for changes in antimicrobial use,” (not open access) describes guidance documents published by the Food and Drug Administration about the use of antibiotics in food animals. The FDA’s plan for managing antibiotic use in livestock involves:
  • voluntary compliance by producers and pharmaceutical companies
  • cessation of use of antibiotics for growth
  • “judicious” use of antibiotics for prevention and treatment of disease
  • involvement of veterinarians in the decisions to use or not use antibtiotics in particular cases
Voluntary compliance, of course, means that new regulation is not currently intended. Producers and pharmaceutical companies could choose to ignore these guidelines. The guidelines recommend that antibiotics no longer be fed for any reason except “for uses necessary for animal health.” The JAVMA article gives specific examples of some borderline cases. For example, antibiotics might be appropriate prophylactically in the case of stressed cattle which are therefore more susceptible to particular diseases. Additionally, the guidelines suggest that pharmaceutical companies should refrain from selling certain antibiotics directly to producers, requiring that a veterinarian provide a prescription first.

What’s good here is veterinary involvement, though I’m biased in that area. Veterinarians are the group who best understand the implications of the use of particular antibiotics, both from the perspective of benefits to human health when antibiotic use is reduced, as well as benefits to animal health and producer finances when it is increased. Veterinarians will be able to make decisions more flexibly about how and when to use antimicrobials in the absence of regulations. As our understanding of appropriate use changes, changes in practice will not be delayed by the syrup-slow process of changing regulations.

What’s disappointing, but not surprising, is the failure of the JAVMA article to discuss a reduction in the need for antibiotic use in food animals to reduce disease. Conventional food animal husbandry, in my opinion, can be highly stressful for animals, with crowded housing and long-distance transportation. Antibiotics are useful to keep these highly stressed animals from succumbing to disease, but shouldn’t we also be talking about reducing their stress to reduce their susceptibility in the first place?

What’s worrisome about the proposed guidelines, of course, is obvious: will producers and pharmaceutical companies voluntarily comply? The FDA proposes a three year window to see if they do. After that, it seems likely that they will pursue a regulatory solution. I very much hope that the voluntary solution works. As I said above, I believe it’s a more agile solution, able to adapt more flexibly to changes in our understanding of antibiotic use in food animals. However, I hope the FDA is not overly optimistic about human nature by making the guidelines entirely voluntary.

June 1, 2012, Vol. 240, No. 11, Pages 1266-1277
doi: 10.2460/javma.240.11.1266