Antibiotics are a powerful and important tool in human and animal medicine, and proper use will keep them effective. That was a key message from Terry Dwelle, MD, state health officer of North Dakota, at the National Institute of Animal Agriculture’s antibiotic conference this week in Kansas City.
Dwelle says introduction of antibiotics in the 1940s, coupled with vaccination and improved sanitation, resulted in fewer deaths from infectious diseases. Antibiotics are used to treat and prevent infections in humans and animals, and for production efficiency in food animals.
Dwelle acknowledges that using antibiotics in livestock production can add to the risk of emergence of resistant pathogens. He also, however, voluntarily practices medicine in Sub-Saharan Africa, and has seen the effects of malnutrition first hand. Malnutrition magnifies the effects of infectious diseases, particularly in children, and plays a role in the deaths of half of the 10.9 million deaths of children to infectious disease each year. Production of animal protein is important in battling global malnutrition, and Dwelle says society must balance the risk of using antibiotics in animal agriculture with the need for food.
The emergence and spread of antibiotic resistance is, however, a serious problem, with multiple and complex causative factors. Dwelle says from 30 to 60 percent of antibiotic prescriptions in human medicine are inappropriate, including improper dosing and use of broad-spectrum antibiotics as first-line treatments. Studies also have shown a high rate of antibiotics prescribed for colds and other viral sicknesses, largely due to patients pressuring their physicians to prescribe something when they feel sick. Studies have shown 32 percent of patients believe taking an antibiotic during a cold prevents more serious illness and 48 percent expect to take antibiotics for a cold.
Animal applications, he says, also play a role. There are several documented examples of humans contracting antibiotic-resistant pathogens through contact with animals or animal products. Where a direct link is found, Dwelle says, discontinuing specific animal applications for specific antibiotics can reverse the trend toward resistant pathogens.
Dwelle offers the following suggestions for minimizing the risk of antibiotic-resistant pathogens in livestock production:
- Use antibiotics only when indicated.
- Use the least broad-spectrum products first.
- Use them for the least time possible.
- Use adequate therapeutic doses.
- Use antibiotics not important to human medicine whenever possible.
- When using “crossover drugs,” manage their use for the least impact on human health.
- Appropriately monitor cultures and sensitivities to detect signs of resistance.
Dwelle suggests several tactics for addressing antibiotic resistance across human and veterinary medicine. These include:
- Public information campaigns.
- Intensive information campaigns for physicians.
- Proactive hospital antibiotic usage programs.
- Collaborative task forces involving physicians, veterinarians and public-health experts.
Dwelle finishe by saying he is personally interested in participating in such a collaborative effort to address the issue.