Yes,1/3 of Antibiotic Prescriptions for Humans Are Unnecessary. But, Much More of the Antibiotics Used for Livestock Need Action.

The Washington Post reported this week about a CDC and Pew study that quantifies the misuse of antibiotics in human medicine. The study indicates that nearly 1/3 of antibiotics prescriptions are not needed. This is important because, as the article notes, there has been a “frightening rise of drug-resistant superbugs in recent years,” and misuse of antibiotics is driving the threat. Without working antibiotics, modern medicine’s foundations begin to tremble and shake.

Infections that we now treat as an inconvenience could become massive problems, even life-threatening, in the not-very-distant future. Think of all the people that used to die from tuberculosis, pneumonia, and infected cuts before the advent of antibiotics and all the medical procedures and surgeries that rely on the ready availability of working antibiotics.

This is exactly why it’s important not to limit our focus to human medicine alone. Because 70% of the medically important antibiotics (i.e. those important for human medicine) sold in this country are actually sold for use in livestock and poultry, not in humans. The volume of antibiotics sold for use in livestock continues to rise—it has gone up 23% over the last 5 years. Much of the antibiotics given to livestock are for animals that are not sick, either to speed up weight gain or to compensate for stressful and crowded conditions and poor diets common in much of our industrial meat and poultry production systems. About 96% of the antibiotics sold for animal use are added to feed and water, the preferred way to deliver antibiotics to large flocks or herds of animals at the same time. Unfortunately, this pervasive practice is also a key contributor to the proliferation of antibiotic resistant bacteria, which spread from the farm in air, water, soil, meat, and through unwitting workers. They can make us sick and/or pass on resistance to other bacteria which can make us sick.

Yet, we have yet to see anywhere near the same amount of effort to curb the misuse of antibiotics in livestock as in human medicine. But, we collectively have the opportunity to change things for the better.

If we can reduce antibiotic use in hospitals, we can reduce it on farms

Not all is doom and gloom. We are seeing some progress. The White House has released a National Action Plan for Combatting Antibiotic-Resistant Bacteria.  On the human side of the equation, the Administration has set a goal of reducing inappropriate antibiotic use in outpatient settings by half and in inpatient settings by 20%. It has set numeric goals to reduce the incidence of various resistant infections, and to improve data collection in human medicine settings. These are worthy goals.

But where the bulk of US antibiotic sales occur—on the animal side—the Administration’s resolve has been feeble. It has set no national targets for reducing antibiotic use in livestock.  Instead, the Administration relies on the Food and Drug Administration (FDA) proposal. As NRDC has pointed out before, the FDA’s solution is to stop the use of antibiotics on animals that are not sick under one guise (speeding up growth), but allow it under another guise (to prevent diseases that may follow from poor conditions and diets). Since the use is virtually identical under either label, FDA’s plan essentially urges that “six of one” be discontinued, while endorsing “half a dozen of the other.”

And this is where we have some opportunities.

• As with human use of antibiotics, the Administration should set a target for the reduction of antibiotic use in livestock.
• Alternatively, it should stop all routine use of antibiotics on animals that are not sick, whether it is to speed up animal growth or to compensate for stressful conditions or poor diets. Last December, the American Academy of Pediatrics released a technical report that concluded that antibiotics should be used in livestock “only to treat and control infectious diseases and not to promote growth or to prevent disease routinely.” Similarly, the World Health Organization, recommended during last November's World Antibiotic Awareness Week that we need to "[e]nsure that antibiotics given to animals . . . are only used to control or treat infectious diseases" (emphasis theirs).
• Either way, collecting data on how antibiotics are used on farms (which is currently missing) is an important step in improving the state of things.

We know all this is possible, because these goals are being set for the human use of antibiotics. We also know this is possible because of the progress we are seeing beyond the FDA. California passed a law last year that prohibits the regular use of antibiotics on animals that are not sick, whether for speeding up growth or to compensate for conditions and diets. The California law also requires the state to collect data on livestock antibiotic use. Other states will hopefully follow suit. In the meantime, a parade of food companies and producers, from McDonald’s to Subway and Perdue, have made commitments in the last year to stop the routine use of antibiotics in raising chicken. Countries like Denmark and Netherlands have long shown the way. Now, it is time for the US to take the baton because market action is not enough on its own—those who continue the problematic practices will continue to create risks for the rest of us unless the government paints clear lines within which everyone must play. We should be rising to the challenge, not shrinking from it.