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Antibiotics: where do we go from here?

01 September 2016, at 1:00am

Richard Gard has been looking at recent attitudes to antibiotic use on farms, following publication of a comprehensive review, and speaking to agencies at the heart of the discussions.

THE IMPACT OF BREXIT on veterinary antibiotics may not be a topic of great concern as yet, but a considerable amount of effort is going ahead to maintain availability to veterinary surgeons and farmers in the UK. 

NOAH issued a quick response to the vote to leave the EU: “NOAH will be calling for the UK to mirror EU regulations where possible – such as licensing procedures and product packaging – to avoid barriers to trade or additional costs of complying with a dual UK:EU regulatory system. We are con dent that our government will wish to reduce unnecessary red tape.”

In May, the nal version of The Review on Antimicrobial Resistance was published. The chairman, Jim O’Neill, addresses why he, an economist, was asked to participate.

“It is now clear to me, as it has been to scientific experts for a long time, that tackling AMR is absolutely essential. It needs to be seen as the economic and security threat that it is, and be at the forefront of the minds of heads of state, nance ministers, agriculture ministers, and of course health ministers, for years to come,” he wrote.

There is much to absorb from the global report. One of the highlighted comments is: “I find it incredible that doctors must still prescribe antibiotics based only on their immediate assessment of a patient’s symptoms, just like they used to when antibiotics first entered common use in the 1950s.”

The report, commissioned by the UK government and the Wellcome Trust, took 19 months to complete. It is assumed that the current government will adopt many of the recommendations and the UK veterinary and animal health sector has largely welcomed the report and has begun moving forward to ensure that the agricultural sector contributes fully to a better managed future.

It is accepted that 700,000 people die each year from resistant infections and the supply of new medicines is insufficient to keep up with the increase in drug resistance. The report highlights that the demand for medicines is very badly managed: huge quantities of antimicrobials, in particular antibiotics, are wasted globally on patients and animals who do not need them, while others who need them do not have access.

A reduction of antibiotic use in agriculture, with measurement of antibiotic use in farming systems, is recommended, together with restrictions on the use of antibiotics that are last-line drugs for humans.

From the point of view of veterinary surgeons in large animal practice, there are concerns that the review lacks a UK agricultural context. NOAH has produced a critique and explains that many human deaths are related to HIV, TB and malaria and none of these are treated with antibiotics in animals.

Reference to tonnages of antibiotic used in humans and animals is said to be meaningless and misleading. A beef animal would require eight times the human dose to treat an infection.

Allowing for numbers of people and animals in the UK, the VMD calculates that the human use of antibiotics in the UK is 2.4 times the animal use.

Population and protein

The review does not consider the increased protein needs of a growing global population. Consumption of milk, meat and eggs is expected to increase with more livestock needed to meet the demand. Of particular concern, highlighted by NOAH, is the public health impact of produce from untreated or insuf ciently treated animals or by direct contact with these animals.

Reduction targets, adopting the Danish usage levels for example, are considered inappropriate as they risk shorter treatment duration or reduced dosage. Skipping the last day treatment of a five-day course would achieve a 20% reduction but risk allowing the least sensitive bacteria to survive. Keeping records of treatments is one essential measure and the use of illegal drugs to reduce recorded use is a recognised concern.

No mention is made of the effect of herd and flock economics on the choice, effectiveness and resolution of treatments. If the diagnosis is wrong and the treatment selected ineffective, a farm animal is likely to be slaughtered. Culling is an aspect of farm animal AMR control not available to reduce the human antibiotic resistance problem.

The review promotes the need for improved surveillance and diagnostics. Funding is anticipated for development work that will not be dependent on sales. NOAH is strongly advocating that the veterinary sector is included in future opportunities.

It will be important that development groups of all shapes and sizes are readied to bring forward any technologies that would achieve targeted and efficient antibiotic use in animals. Emphasis is also placed on the use of vaccines and alternatives to antibiotics.

Much of the content of the review will be acknowledged by veterinary surgeons and initiatives are already in place to overcome the issues raised. Three months ago an electronic medicines record book was introduced for the pig sector. Data have already been collected from 12% of the national breeding herd and 18% of the national growing and finishing herd.

Many more herds have joined the eMB scheme and the information will be used by the individual herds but also anonymised and provide data for the VMD to support national and international reporting. Other species will be able to be added to the scheme.

Total antibiotic usage in the poultry meat sector fell by 44% between 2012 and 2015. In the past year total chicken use fell by 39%. Work is continuing to collect data for cattle, sheep, eggs, game birds and fish.

Difficulties for farmers

Within dairying there are considerable dif culties for farmers if their milk fails the tests for antibiotics. Dairy UK intends that veterinary practices will be advised when a client herd has an antibiotic failure.

It is a bene t to the milk buyers not to have to deal with contaminated supplies, a bene t to the farmer not to have the hassle and expense of failure and a potential bene t to veterinary practices to become directly involved with the application of antibiotics to dairy cows and the disposal of milk from treated animals.

Zoetis and Hipra have confirmed that the uptakes of teat sealant and mastitis vaccine are increasing, which fits with the thrust for antibiotic replacement, and examples from other producer sectors need to be highlighted.

Veterinary practices can expect to become increasingly involved in herdsman training. Short videos hosted by the BCVA, MilkSure and Dairy UK are available on YouTube: “Reducing risk of AMR on dairy farms” and “AMR explainer video”. Use of such materials by veterinary practices is likely to become the norm.

The major point of emphasis, highlighted by all agencies, is the need to reduce the incidence of disease and thereby reduce the need for therapy. The national initiatives for Johne’s Disease and BVD are detailing examples of a general improvement in herd health, such as herd improvements in lameness, fertility, calf survival and reduced culling following management to control the target diseases.

One observation is that the farmers are beginning to fully appreciate the associated bene ts of total health management.

The government is expected to insist on greater activity to reduce the problem of antimicrobial resistance. The industry is engaging with the issues, but much greater activity to provide support and guidance to all farming clients is expected from veterinary surgeons. Grateful thanks to Donal Ryan (NOAH), John Fitzgerald (RUMA), Tim Hampton (ARLA) and Owen Atkinson (Dairy Consultancy). 

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