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Global overview on antibiotic use policy in veterinary medicine

Dr Shabbir Simjee

Global Regulatory & Technical Advisor Microbiology & Antimicrobials

Elanco Animal Health Basingstoke, England

Resistance & Food Safety

There are public concerns that people may acquire foodborne illnesses that cannot be appropriately treated with antibiotics as a result of antibiotic-resistant bacteria that are derived from food animals that have been treated with antibiotics

 

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Veterinarian’s Oath

(Approved by HOD, 1954; Revision approved by HOD, 1969; Revision approved by the Executive Board 1999, 2010, 2011)

Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.

I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics.

I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.

https://www.avma.org/KB/Policies/Pages/veterinarians-oath.aspx

Contents

Europe – Where Have They Been?        

USA – Where Are They Going?        

Food Brands – Where Do They Want To Go?        

Implementing Responsible Use – Where Should We Go?        

Elanco – Where are we going?

Europe : Where have we been?

Responsible Use vs. Precautionary Principle

The Danish Experiment

1995   National ban on avoparcin1998   National ban on virginiamycin1999   Voluntary agreement to discontinue antibiotic growth promoter (AGP’s) for finishing swine      2000   Voluntary ban of AGP in piglets

AGP misconception: feed efficiency and reduced rates of infection

Has the Danish Experiment Been Beneficial?

1. Decrease antibiotic use?

2. Public Health Benefit?  Reduced illness Reduced resistance in human isolates 

3.  Animal Health

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Has the Danish Experiment Benefited Public Health? – Not yet
  • Reduced human food borne illness?
    • Salmonella  à Decreasing, but still high prevalence
    • Campylobacter à Decreasing, but still high
  • Reduced resistance in human pathogens?
    • NO, increased in Salmonella
    • NO, remains low in Campylobacter VRE, steady over time in hospital patients

prevalence

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Did the Danish Experiment work?

Summary of the Danish Experiment

  • Decrease antibiotic use? – Depends…
    • Unintended consequence - increase treatment
  • Public Health Benefit? – None shown yet

–     Danish therapeutic antibiotic use is on the rise

antibiotic use, including human use antibiotics

–     No decrease in Salmonella illness

–     Increased resistance in Salmonella Typhimurium Antibiotics are still a necessary tool used in raising pigs!

USA : Where Are They Going?
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Food Brands : Where Do They Want To Go?
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As such, SUBWAY said it is asking its suppliers to do the following (Oct. 23, 2015 ):

  • Adopt, implement and comply with the U.S. Food and Drug Administration’s (“FDA’s”) guidance for industry 209 and 213, which requires that medically important antibiotics not be used for growth promotion. Visit the FDA site to learn more
  • Assure that all antibiotics use is overseen, pre-approved and authorized by a
  • Keep accurate and complete records to track use of all antibiotics
  • Adhere at all times to all legal requirements governing antibiotic withdrawal times. This assures that antibiotics have been eliminated from the animals’ systems at the time of slaughter
  • Actively encourage, support and participate in research efforts focused on improving animal health while reducing antibiotics use

 licensed veterinarian before they are administered to any animal

 

Implementing Responsible Use :  Where Should We Go?

Global AMR Action Plans

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Options for action 8 March 2012 "In terms of new replacement antibiotics, the pipeline is virtually dry. But much can be done. This includes prescribing antibiotics appropriately               and only  when needed, following treatment correctly, restricting the use of antibiotics in    food production to therapeutic purposes and tackling the problem of substandard and counterfeit medicines."

The May 2015 World Health Assembly adopted a global action plan on antimicrobial resistance, which outlines five objectives:

  • To improve awareness and understanding of antimicrobial
  • To    strengthen   the   knowledge   and     evidence             base through surveillance and research
  • To reduce the incidence of infection through effective sanitation,
  • To optimize the use of antimicrobial medicines in human and
  • 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.

resistance through effective communication, education and training

hygiene and infection prevention measures

animal health;

 

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The 3-step RA Process

An antibiotic must select for foodborne bacteria that acquire antibiotic-resistance in food animals during treatment 

"Release"

A person must ingest meat from a treated animal that is contaminated with those same antibiotic-resistant foodborne bacteria

"Exposure"

The person that ingests these bacteria must become sick with a bacterial infection that cannot be appropriately treated with antibiotics as a result of those animal-derived antibiotic- resistant bacteria

"Consequence"

Ionophore Risk

The use of ionophores in food animals does not create a risk to human health because none of the risk criteria are met.

     X  An antibiotic must select for foodborne bacteria that acquire antibiotic-resistance…

      X  A person must ingest meat from a treated animal that is contaminated…

      X  The person that ingests these bacteria must become sick with a bacterial infection…

Orthosomycin Risk

The use of orthosomycins in food animals does not create a risk to human health because the third risk criteria is not met.

    /  An antibiotic must select for foodborne bacteria that acquire antibiotic-resistance…

    /  A person must ingest meat from a treated animal that is contaminated…

    X  The person that ingests these bacteria must become sick with a bacterial infection…

No Risk vs. Low Risk: Macrolides

The use of macrolides in food animals could potentially compromise human health risk; all of the risk criteria are met.

    /  An antibiotic must select for foodborne bacteria that acquire antibiotic-resistance…

    /  A person must ingest meat from a treated animal that is contaminated… 

    /  The person that ingests these bacteria must become sick with a bacterial infection…

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Colistin - Reactions from the EU 
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“Responsible use does not simply equate to using fewer antimicrobials. Use the right drug in the right amount by the right route for the right period of time”

Jackie Atkinson, Director of Authorisations Veterinary Medicines Directorate United KingdomJanuary 21, 2012

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Posted in: Antibiotics