Antimicrobial drugs have been widely used in human and veterinary medicine for more than 50 years, with tremendous benefits to both human and animal health .However increasing perception of risks of antimicrobial resistance impeding the therapeutic outcomes for human patients has put the topic of use of antibiotics in animal production on the anvil. Misuse and overuse of antibiotics is thought to be the cause of selection for resistance and its persistence in the environment. Hence, efforts have been made to promote the judicious use of these drugs in humans as well as in animals . Using the drugs judiciously means that unnecessary or inappropriate use should be discouraged and avoided.
WHO and OIE Recommendations:
In animal production, antibiotics are used for achieving four clinical goals viz. treating sick animals, controlling the spread of an infection in at risk flock, preventing the exposure of herd or a flock to a potential infection and for improving the performance of animals. Regulators in different countries /economic communities have attempted to clamp or restrict these antibiotic uses differently. Initiatives by World Health Organisation to create awareness on judicious use of antibiotics and restricting the use of antibiotics in food producing animals to therapeutic purposes and under prescription is noteworthy one (Margaret Chan, Director General, WHO, 2012).In 2015, WHO assembly adopted a global 5-point action plan as follows:
To improve awareness and understanding of antimicrobial resistance through effective communication, education and training
To strengthen the knowledge and evidence base through surveillance and research
To reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures
To optimize the use of antimicrobial medicines in human and animal health;
To develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions
Antimicrobial Resistance Monitoring:
Antibiotic Resistance Monitoring had been a key component of all noises around this context. There were several ARM reports like (i) DANMAP 2014 (ii) MARAN 2015 (iii) NARMS 2011 and (iv) CIPARS 2009. Each of these programs is great scientific work. However they are not harmonized. Hence, comparing these reports and making a useful decision are very difficult. In the midst of these, the antibiotic classes that evoke most interest are fluoroquinolones and cephalosporins.
The rational approach to understand and undertake effective measures would begin with Risk Analysis. Risk analysis includes risk assessment, risk management and risk communication. The founding blocks of risk assessment are “release, exposure and consequence”.
Release: Resistance determinants (RzD) must be released from foodborne bacteria that acquire resistance in an animal during treatment.
Exposure: A person must ingest food from such a source that contains bacteria with RzD.
Consequence: The person who ingested these bacteria must become sick and cannot be appropriately treated.
The paper discusses each of these risk assessment in detail with a specific example of antibiotics with the pathways leading to the risk of foodborne illness in humans.
In contrast to WHO intentions and actions, currently, few laws in India govern antibiotic use in foodanimals, and most pertain only to animal products for export.General Statutory Rule (GSR) 28(E) mandates a withdrawalperiod for use of antibiotics in food producing animals from thetime of administration until the production of foodstuffs. GSR588 (E) specifies that all drugs in the H1 category, includingmany antibiotics, require a prescription, and requires separatepharmacy documentation of those prescriptions that are subjectto review .
Role of veterinarians in risk communication:
On an entirely a different note, it is interesting to see some of the professional bodies like American Veterinary Medical Association, have been working with partners in U. S and outside to develop strategies to better protect public and livestock health, keep our food supply safe and train the professional fraternity on the new and shaping regulations .
This is the time when our profession shall come together and propose the regulators what is best from a scientific and public health point of view.
In order to conserve antibiotic effectiveness in humans andanimals, we recommend the following:
1) As a profession, lead the efforts to enhance the animal health, wellness and performance to provide safe food to food chain. Actively lead the advocacy and support professional oversight of antibiotic use in food animals.
2) Take the professional leadership in shaping the awareness among farmers, customers and consumers about the value of responsible use of antibiotics, educating them on how does a responsible use of antibiotics preserve the efficacy of antibiotics for human therapy. Shape the educational initiatives in your communities and organizations
3) Actively engage within your communities to spread the answersto the questions on how animals are raised, build their confidence in the responsible use of antibiotics for animal health, well-being and food safety. Our fellow citizens have the right to know from where their food is coming and how is it produced.
4) Actively collaborate with institutions and regulators in monitoring, surveillance and tracking realistic antibiotic resistance data, thereby build a scientific database to dwell upon and make decisions.
All our efforts would be vital for the collective vision of ONE HEALTH that is optimal health for people, animals and environment.
by Subramanya Bhat S* and Shabbir Simjee**, Elanco Animal health