By Lori Young, MS, RN,C, and Barbara Sattler, DrPH, RN

Since the anthrax incidents that occurred in the wake of the events of Sept. 11, we have become increasingly aware of how important antibiotics are to us. As health professionals, we understand that overuse and/or misuse of antibiotics leads to selection and proliferation of resistant forms of bacteria, which contribute to the rise in antibiotic- resistant bacteria. The emergence of antibiotic-resistant bacteria is fast becoming a major life threatening public health issue.

Adverse health effects associated with the increased incidence of antibiotic-resistant human infections caused by antibiotic-resistant bacteria increase the risk for therapeutic failures during the treatment course for these infections, resulting in lengthy illness, lengthy hospitalizations and possibly death.

Today, 70 percent of all hospital-acquired infections are caused by antibiotic-resistant bacteria. Some of these infections, such as Vancomycin-Resistant Enterococcus (VRE) and Methicillin-Resistant Staphylococcus Aureus (MRSA), are no longer confined to hospitals, but are found in community populations.

In the United States, the use of antibiotics in animal agriculture has increased by approximately 50 percent since 1985. Today, corporate factory farms that crowd thousands of hogs, chickens and cows into industrial barns and lots have replaced small, family-owned livestock farms. In these factory farms, contract farmers are hired by these corporations to administer antibiotic-supplemented feed and/or water to healthy animals as growth enhancers. Annually, these animals consume an estimated 70 percent (25 million pounds) of all antibiotics manufactured. Moreover, many of the same antibiotics used in animal agriculture are used for human treatment. For example, penicillin, tetracycline, and erythromycin have been widely used in animal agriculture, as well as avoparcin, which is chemically related to vancomycin.

In 1997, the World Health Organization called for a ban on using antibiotics to promote growth in animal agriculture, and in 1998, the European Union banned adding human-use antibiotics to animal feed. The United States has no such policy.

In 1999, an interagency task force comprising the Federal Drug Administration, Centers for Disease Control and Prevention, the National Institutes of Health and 10 other federal agencies and departments was created to develop a plan and coordinate federal actions to address the threat of antimicrobial resistance. The plan is to encompass four major components that will focus on surveillance, prevention and control, research and product development. So far, no policies have been developed surrounding the use of antibiotics in animal agriculture.

Why is it important that the United States have a health policy to address antibiotic use in agriculture? According to David Wallinga, MD, MPA, Antibiotic Resistance Project director, Institute for Agriculture and Trade Policy, "Across the U.S., new infections are emerging that respond poorly, or not at all, to previously effective antibiotics. The reason is antibiotic overuse. Even when used appropriately, antibiotics will spur some resistance among bacteria. However, inappropriate antibiotic use greatly accelerates and worsens resistance. While overuse in human medicine has been the focus of much work, inappropriate antibiotic use in agriculture has been virtually ignored in this country. Recent estimates are that 70 percent of ALL antibiotics in the U.S. are given to healthy poultry, pigs, and beef cattle. These medicines aren't being used to treat sick animals; rather, they are put at low levels in animal feed to promote faster growth and to compensate for the often crowded, unsanitary and stressful conditions that typify industrial animal agriculture. Several of these antibiotic growth promoters are identical, or nearly so, to important human medicines, like penicillins, tetracycline, erythromycin and sulfa drugs. The American Medical Association opposes the non-therapeutic use of antibiotics in animals; the World Health Organization urges phase-out of medically-important drugs for use as growth promoters."

At such a critical time when antibiotic-resistant bacteria and infectious disease is on the rise, it is important that we raise awareness of this complex public health safety issue. As patient advocates and health professionals, we should voice our concern regarding overuse and misuse of antibiotics used in animal agriculture to our state and federal legislators and call for a health policy on this issue.

Unless antibiotic resistance problems are detected as they emerge, and actions are taken to contain them, the world could be faced with previously treatable diseases that have again become untreatable, as in the days before antibiotics were developed.

Lori Young, a recent master's graduate from the Community/Public Health Nursing at the University of Maryland, and Barbara Sattler, director of the Environmental Health Education Center at the University of Maryland, Baltimore School of Nursing, are members of the Maryland Nurses Association.

References

Molbak, K. et al. (1999). An outbreak of multidrug-resistant, quinolone-resistant Salmonella enterica serotype typhinurium DT 104. New England Journal of Medicine. 341(19): 1420-1425.

Smith, K.E. et al. (May 20, 1999). Quinolone-resistant campylobacter jejuni infections in Minnesota, 1992-1998. New England Journal of Medicine. 340:1525-1532.

Union of Concerned Scientists. (2001). Hogging It: Estimates of Antimicrobial Abuse in Livestock. Cambridge, Massachusetts. Mellon, M., Benbrook, C. and Benbrook, K.L. (Eds.)

U.S. Centers for Disease Control and Prevention. (2001). A Public Health Action Plan to Combat Antimicrobial Resistance. Retrieved Sept.19, 2001 from http://www.cdc.gov/drugresistance/.

U.S. Food and Drug Administration (2001). Antibiotic Resistance . Retrieved Sept. 19, 2001, from http://www.fda.gov/oc/opacom/ hottopics/anti_resist.html.

Wegener, H.C. (1999). The consequences for food safety of the use of fluoroquinolones in food animals (editorial). New England Journal of Medicine. 340: 1581-1582.

World Health Health Organization. (2000). Overcoming Antimicrobial Resistance. Retrieved July 28, 2001 from http://who. int/infectious-disease-report/2000/ ch3.htm.