Take a stand against agricultural antibiotic use

Since penicillin was introduced in the 1940s, antibiotics have transformed the way we live, turning potentially perilous strep throats and scraped knees into minor annoyances. Now the effectiveness of antibiotics is being threatened by new forms of drug-resistant bacteria, "superbugs," that are immune to many, if not all, of the antibiotics we have to treat them.

More than two million Americans develop antibiotic-resistant infections each year, and at least 23,000 die, concluded a report last month by the Centers for Disease Control and Prevention.

These superbugs originate for several reasons. The over-prescription of antibiotics is one. Another significant cause is the rampant misuse of antibiotics on factory farms, as highlighted in the CDC report. To keep drug-resistant bacteria from edging out the susceptible kind that surround and inhabit all of us, we need everyone to become antimicrobial stewards by demanding that our health professionals and farming industry use antibiotics only in appropriate circumstances.

When I graduated from medical school in 2006, there were good treatments for almost every infectious disease we saw in the United States. Now, as a clinician, I often have to tell patients and their families there is no decent effective therapy to treat their infections.

One of my patients, a robust and healthy woman with no classic risk factors, became infected by one of these superbugs. Because the bacterium was resistant to all antibiotics previously effective for her condition, she had to be treated with a cocktail of drugs. She needed three months of hospitalization and three more of intensive treatment. She was lucky. Many superbug-infected patients die. Or they are forced to choose between terrible treatment options: antibiotics that will likely cause their kidneys to fail or amputation of an infected limb.

Antimicrobial stewardship is a relatively new term in the medical dictionary. It describes efforts hospitals and medical providers are taking to safeguard antibiotics. At the hospital where I work, we review every antibiotic prescription, making sure it is the most effective and least likely to contribute to resistance.

What we and other providers are doing, however, is not enough. To head off this growing health crisis, we need to stop the emergence of antibiotic-resistant bacteria by curtailing the largest inappropriate users of antibiotics. Many meat and poultry farms, which use an estimated 80 percent of the nation's antibiotics, are places where the agriculture industry can join in this effort, especially because the vast majority of the antibiotics used in meat production are not used to treat sick animals. Instead, they are given day after day at low doses to speed growth and fend off disease that easily proliferates in overcrowded, unsanitary conditions.

Bacteria evolve quickly to elude opponents. The low doses of antibiotics many farmers feed animals wipe out susceptible bacteria, allowing resistant ones to flourish. Increasingly, these drug-resistant bacteria lead to devastating drug-resistant infections, the kind clinicians now see all too often.

Since the 1970s, scientists have raised concerns about non-therapeutic uses of antibiotics in meat and poultry production, and every major medical association has sounded the alarm. Emerging data have strengthened the connection between antibiotic resistance in the environment and infections in humans. However, the federal Food and Drug Administration has dragged its feet, even though federal law requires it to police the misuse of antibiotics in meat and poultry production.

The FDA first recognized this problem almost 35 years ago but has taken little action. In the face of the evidence, some countries have banned non-therapeutic use of antibiotics, and some farms in Pennsylvania have done the same. These farms have shown not only that they can be competitive with other farms, but also that they can thrive.

But in the United States, such farms are the exception. Because of the FDA's inaction, Congress must step in with new legislation to force FDA's hand and make meat without antibiotics the rule, not the exception.

Pennsylvanians can help by calling our elected officials, including Sen. Bob Casey (D., Pa.), who sits on separate committees that oversee FDA and agriculture, and urging them to support legislation that stops the unsafe uses of antibiotics in livestock and poultry production (S. 1256) and that sets up the collection of better information about antibiotic use and antibiotic resistance (S. 895).

We can also flex our consumer muscle and buy meat and poultry raised without unnecessary antibiotics, such as those labeled "no antibiotics ever" or "no antibiotics administered" or "organic" meat.

For antimicrobial stewardship to work, industry needs to join the medical community to stop the spread of superbugs. This life-saving task should not and cannot be left to hospitals and health-care providers alone.