Reviews into antibiotics and anti-microbial resistance proliferate

21 Dec

tracy and pigTracy Worcester has drawn our attention to the subject of antibiotic resistance, which is growing – developing not in humans, but in bacteria that can then infect humans. Surgical and cancer chemotherapy patients rely on antibiotics to protect them from potentially life-threatening illnesses and declining efficacy could turn routine procedures into life-threatening ones.

Calls for funding aka ‘adequate market incentives’

antibiotics report coverAmerica’s Center for Disease Dynamics, Economics & Policy (CDDEP) produces independent, multidisciplinary research to advance the health and wellbeing of human populations in the United States and around the world.

Its October publication (right) estimates that between 38·7% and 50·9% of pathogens causing surgical site infections and 26·8% of pathogens causing infections after chemotherapy are resistant to standard prophylactic antibiotics in the USA.

RAND Europe and KPMG have both assessed the future impact of antimicrobial resistance [AMR] and a recent Chatham House report on new business models for antibiotics highlighted the problem of inadequate market incentives.

The use of antibiotics in agriculture

Haroon Siddique writes in the Guardian about another study, commissioned by David Cameron. The Review on Antimicrobial Resistance has been produced by a team of economists and administrators with one scientific adviser, supported by the Wellcome Trust fund.

It finds that the unpredictable nature of the development of resistance to such drugs, and the limits put on the sale of antibiotics to ensure they are used appropriately, are two factors which many pharmaceutical companies mention to explain why they have cut back or stopped altogether their investment in R&D on new antimicrobials.

antibiotics 2approvals to 2010

It warns that the use of antibiotics in agriculture is fuelling drug resistance and must be cut back or even banned where they are important for humans – see CDDEP risk assessment below, deemed over-cautious by some.

antibiotics 2graph by 2050

The review found that global use of antimicrobials in food production at least matched that by humans, extending even to the widespread application in some areas of “last resort” antibiotics for humans – which cannot be replaced when ineffective – to animals.

Acknowledging that the proper use of antibiotics is essential for treating infections in animals, as in humans, and offers considerable benefits for food production, the authors stress that “excessive and inappropriate” deployment, including to stop development of infections within a flock or herd, or simply to increase the pace at which animals gain weight, is a problem.

The team proposes that there should be a limit for each country to reduce antibiotic use in food production to an agreed level per kilogram of livestock and fish.

This should be determined by experts, but they suggest that a good starting point would be reducing levels to that of Denmark – an average of less than 50mg of antibiotics per year per kilogram of livestock in the country. Denmark has combined low use with being one of the world’s largest exporters of pork.

Tracy Worcester has a different proposal: use the power of the purse

Instead of buying meat from animal factories that cram so many pigs into vast sheds which need routine doses of antibiotics to keep the animals alive, we can buy meat from real farms. Pigs on outdoor farms, or indoors with adequate space and bedding, are healthy and hardly ever need antibiotics.

One of her fellow-campaigners, actor Dominic West, opposed a recent factory farming application. He hopes that when we buy British we know we are not supporting this type of cruel and dangerous farming: ‘The costs are much too high, from the superficial horrors of stench and stressed, unhealthy animals to antibiotic resistance that brings us closer to the end of antibiotics as a cure for human diseases. He says, ‘The world must move on, and we can all help by only buying pork from high welfare UK farms.’

Tracy points out that we have the choice to buy meat with the high welfare labels RSPCA Assured, Outdoor Bred, Free Range or Organic – eat less meat as Anna advocates – or go meat-free. See the World Health Organisation on the health issues here.

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