WHO warns of 'post-antibiotic era' (commentary)

WHO warns of 'post-antibiotic era' (commentary)

THE World Health Organization (WHO) recently released its first ever antimicrobial resistance report, titled "Antimicrobial Resistance: Global Report on Surveillance."

To accomplish this, WHO attempted to obtain information on resistance from 129 member states for nine bacterium/antibiotic drug of choice combinations the agency selected. Unfortunately, only 114 countries provided any data, and only 22 countries had data for all nine combinations.

In addition to the nine bacteria of concern in regard to antibiotic resistance, the report also focuses on other antimicrobial resistance that is increasing in multi-drug-resistant tuberculosis (TB), malaria, influenza and HIV.

While the U.S. does not really have a problem with multi-drug-resistant TB because of an excellent monitoring system and the availability of a treatment regimen at no cost, the fact that other countries do not have a robust public health system in place to assure adequate dosing and compliance does pose a threat here as international travel continues to increase.

The WHO report is 232 pages long, with seven pages devoted to TB and another seven pages to gonorrhea. In contrast, antibiotic resistance related to food-producing animals got a total of four pages, and most were focused on a lack of data.

The report states that only Canada, the U.S. and a few European Union countries have a national antibiotic resistance monitoring system for humans, animals and food that is robust enough to allow at least a partial comparison of data.

The first paragraph in the "Antibacterial Resistance in Food-Producing Animals & the Food Chain" section does state that resistance in human and animal health is "influenced by both human and non-human usage of antibiotics."

Then, it adds that "the magnitude of such transmission from animal reservoirs to humans remains unknown" and says "more data are needed ... to identify priority areas for intervention."

The WHO report notes that the World Organization for Animal Health (OIE) has developed a list of antimicrobials that recommends restricting usage in food-producing animals of antimicrobials that are critically important for both human and animal health.

OIE includes third- and fourth-generation cephalosporins and fluoroquinolones on that list.

In the U.S., the Food & Drug Administration already has placed major limitations on these two classes for animal use. Combined, cephalosporins and fluoroquinolones comprise less than 0.3% of all antibiotics prescribed by veterinarians in the U.S. Thank you, FDA, for doing your job and protecting my health.

Still, many countries have no limitations, and WHO is calling for action to prevent a "post-antibiotic era" in which people die from common infections.

The seven most common bacteria listed and discussed in the report are: Escherichia coli (20 pages), klebsiella (11 pages), streptococcus (10 pages), gonorrhea (seven pages), staphylococcus (seven pages), salmonella (seven pages, with a notation that less than 5% of strains are resistant to fluoroquinolones, the drug of choice to treat salmonellosis in adults) and shigella (six pages).

Salmonella and shigella, of course, can be related to consumption of foods — both animal products and produce — but the other five would be a stretch to blame on animal agriculture.

My take on these numbers, and on this report as a whole, is that a serious problem is emerging globally but that the use of antibiotics in animals raised for food is a minor and poorly understood possible contributor to antimicrobial resistance in the pathogens cited in the report.

As just one example, the report notes that 75% of people in Uganda who are infected with a common respiratory pathogen have no antimicrobials left to treat the disease because of resistance.

How does animal husbandry in the U.S. contribute to this problem?

It does not; nor does it contribute to multi-drug-resistant TB, gonorrhea or most of the other pathogens discussed.

Any further changes to how antibiotics for humans and animals are used in the U.S. must look at the bigger global picture and possible worldwide impact.

If other countries do nothing to limit the use of antibiotics in animals and people, much less track resistance patterns, any changes we make are just a drop in the proverbial bucket that may have adverse consequences globally as opposed to positive ones.

Any discussion of further restrictions on antibiotic use in animals really needs to be based on biological science, not political science.

*Dr. Richard Raymond is a former U.S. Department of Agriculture undersecretary for food safety.

Volume:86 Issue:22

Hide comments

Comments

  • Allowed HTML tags: <em> <strong> <blockquote> <br> <p>

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Publish