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How to manage your farm with respect to limiting antimicrobial resistance?

How to manage your farm with respect to limiting antimicrobial resistance?

In this blog:
  • Difference between antimicrobial resistance and antibiotic resistance
  • Current situation of AMR
  • What is causing antibiotic resistance?
  • Should we stop using antibiotics? 
  • What can you do?
  • What does Kepro do to prevent AMR?

Antimicrobial resistance is a very important topic in the field of veterinary (and human) medicine nowadays. In this blog we will explain more about the situation on antimicrobial resistance  and measures against it. We will also explain how you can use antibiotics correctly to inhibit further development of antibiotic resistance.    

Difference between antimicrobial resistance and antibiotic resistance
Antimicrobials are agents that kill or stop the growth of microorganisms. Medicines that are antimicrobials are: antibacterials (antibiotics), antifungals, antiparasitics ans antivirals. 

So, there is a difference between antimicrobial resistance (AMR) and antibiotic resistance. Antimicrobial resistance includes resistance to all antimicrobials (as named above), while antibiotic resistance includes the resistance of bacteria against antibiotics. Antibiotic resistance is the most threathening and the most relevant in veterinary medicine.   

Current situation of antimicrobial resistance
Farmers and vets report that some current therapies are no longer effective, and in human medicine, people die or need very expensive therapies due to antimicrobial resistance. There are different well known groups of resistant bacteria which are causing harm to humans and animals, like:
  • MRSA (Methicillin Resistant S. Aureus)
  • VRE (Vancomycin Resistant Enterococci)
  • CRE (Carbapenem Resistant E. Coli)
  • ESBL (Extended Spectrum Beta-Lactamases)
Scientists calculated, that if we don’t change anything in human and veterinary medicine, human deaths each year due to AMR will be up to 10 million by 2050. On the map in image 1 you can see how many this will be in your part of the world.eb3de5a4-3dc6-42e5-bbe7-028cb395b41b.jpgImage 1 - Deaths atrributable to antimicrobial resistance every year by 2050 (source: review on antimicrobial resistance 2014)

The map shows a big difference between Europe and Africa and Asia. This is caused by the fact that in Europe, strict measures are in place to prevent resistance. The measures are:
  • A ban on the preventive use of antibiotics in groups of animals,
  • A ban on the preventive use of antimicrobials via medicated feed,
  • A reinforced ban on the use of antimicrobials for promoting growth and increasing yield (in addition to the 2006 prohibition of using antibiotics as growth promoters in feed),
  • The possibility to reserve certain antimicrobials for humans only,
  • The obligation for Member States to collect data on the sale and use of antimicrobials.
Other reasons for increased problems with AMR in some countries are:
  • Low enforcement on measures and regulations,
  • Substandard (bad quality) drugs,
  • Counterfeit drugs of bad quality. 
The advice is to only use drugs that are produced in a factory under GMP quality standards and that have been produced in countries where quality control is strict. Kepro fits these requirements.At the moment the WHO (World Health Organisation) is making a plan to fight AMR all over the world. Each member country should make a national action plan to:
  • Improve awareness and understanding of AMR through effective communication, education and training,
  • Strengthen the knowledge and evidence base through surveillance and research,
  • Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures,
  • Optimize the use of antimicrobial medicines in human and animal health,
  • Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Background information:
The opinion in the market 
In 2012, a Consumer Reports survey found that 86 percent of consumers polled said that meat and poultry raised without antibiotics should be available in their local supermarket; more than 60 percent said they would be willing to pay at least $0.05 cents per pound more for it, and nearly 40 percent said they would pay an extra $1 or more per pound (Meat on drugs, 2012). As the public has become more educated and aware of the antibiotic resistance crisis, they are increasingly voting with their wallets. Sales estimates of meat raised without any antibiotics increased 25 percent from 2009 to 2011 (Perrone, 2012). The increase occurred despite an overall decline in U.S. per capita meat consumption. USDA-certified organic meats—just one part of the market for meat raised without routine use of antibiotics—were the fastest-growing segment of the $31 billion organic foods industry in 2011 (Organic Trade Association, 2012). In 2013, sales of organic meat, poultry, and fish were up 11 percent over the prior year, to $675 million (Organic Trade Association, 2014).   
  What is causing antibiotic resistance?
Bacteria are always searching for ways to survive. The more often we are trying to kill them with antibiotics, the better they get adapted to the chemicals. At some point the bacteria are developing coping mechanisms to fight the antibiotics. They can do this in four different ways (see image 2):
  • Inactivation of the drug by enzymes,
  • Activation of drug efflux pumps (fast pumping of the drugs out of the bacteria),
  • Alteration of the drug target,
  • Inhibition of the drug intake by changing the cell wall of the bacteria.
db1ccff7-fc70-44e6-b2bf-c548e729eb7e.jpgImage 2 - Mechanisms of a bacterial cell to become resistant to an antibiotic  (source: ANTIMICROBIAL RESISTANCE (AMR) – Dr Rajiv Desai [Internet]. 2016)

When a few bacteria are resistant amongst all other bacteria, a problem is not there yet (see image 3). When antibiotics are administered, the antibiotics will kill all bacteria, also good bacteria which protect the animal from infection. The resistant bacteria will stay behind because they do not respond to the antibiotic anymore. These resistant bacteria are able to replicate and transfer their drug resistance to other bacteria, which causes problems.38a00a6c-66f5-492a-9b12-0b6edbf7e037.pngImage 3 - Development of resistance (source: Centers for Disease Control and Prevention.)
Becoming resistant is easier for a bacteria when:
  • Antibiotics are frequently used,
  • Antibiotics are underdosed regarding to the weight of the animal,
  • Mixtures of non-synergetic antibiotics are used,
  • The therapy length is not respected,
  • The diagnosis is not correctly made,
  • Antibiotics are used to which bacteria are already resistant. 
Should we stop using antibiotics? 

 No, we need them to fight infections. But we need to be careful when using them.  For example, if a broiler farmer gets diarrhoea in his broilers every time in the fourth week of the cycle. He can give the broilers antibiotics every time, but in the end he will have resistant bacteria to that antibiotic on his farm. 

 It is better if the farmer makes a diagnosis on what’s the cause of the diarrhoea. Is it a bacteria and will antibiotics help? Or may changing the management be enough?...

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