This policy reaffirms APHA Resolution 9908,1 which concerned "the rapid increase in antibiotic resistance in the United States and worldwide," and which recognized "the complex nature of this problem, including the selective pressure of overuse and misuse of antibiotics in human medicine, [and] the use of subtherapeutic levels of antibiotics in animal feeds."
APHA Resolution 9908 urged education and certain public policies to address this problem, including "limiting the use of antibiotics in animal feeds." Since the Food and Drug Administration (FDA) has not yet proposed such regulations, and their final adoption would likely take several years once proposed -- in light of that Agency’s acknowledgement that administrative procedures for removing already-approved drugs from animal feeds typically take from six to twenty years per drug or drug class2 -- this policy expands on policy #9908 by addressing purchasing practices, specifically the opportunity to reduce overall antibiotic use by stimulating market demand for foodstuffs produced without the use of excessive antibiotics.
Scientific study and analysis subsequent to the 1999 passage of this previous policy confirm and further reinforce the contribution of the overuse of antibiotics in animal agriculture to antibiotic resistance affecting humans.3 The New England Journal of Medicine in 2001 published an editorial titled "Antimicrobial use in animal feed-- time to stop."4 In March 2003, the Institute of Medicine report, Microbial Threats to Health, stated that "Clearly, a decrease in antimicrobial use in human medicine alone will have little effect on the current situation. Substantial efforts must be made to decrease inappropriate overuse in animals and agriculture as well."5 An expert consultation of the World Health Organization concluded in December 2003, "There is clear evidence of the human health consequences due to resistant organisms resulting from non-human usage of antimicrobials. These consequences include infections that would not have otherwise occurred, increased frequency of treatment failures (in some cases death) and increased severity of infections."6 Recently, major retail food companies have adopted policies requiring certain meat suppliers to reduce use of medically important antibiotics as growth promoters and/or for nontherapeutic purposes, and providing for a purchase preference for other suppliers that comply with the policy.7 A growing number of suppliers are able to supply meat, fish, and dairy products produced without routine use of antibiotics.8
Denmark, the world’s largest exporter of pork, successfully ended nonprescription use of agricultural antibiotics in 1999. The European Union subsequently adopted similar policies for antibiotic growth promoters.9 In August 2003, the World Health Organization released a report detailing Denmark’s success, including a 54 percent decrease in antibiotic use in food animals from 1994 to 2001.10 In the last four years several large pharmaceutical companies have either eliminated or greatly curtailed their anti-infective research activities. Few additional human antibiotics are now under development.11 Any new antibiotics are likely to be significantly more expensive;12 hospitals and health care institutions thus have a substantial interest in ensuring that existing antibiotics remain effective for treating human infections as long as possible. Therefore, to help assure that existing antibiotics remain effective for treating infections as long as possible, the APHA urges:
- Increased awareness among health care institutions and public health organizations of the contribution of non-therapeutic agricultural antibiotic use to the problem of antibiotic resistance and the roles large food purchasers can play in reducing such antibiotic use.
- Bulk purchasers of foodstuffs to adopt procurement policies that encourage and, where feasible, require procurement of meat, fish, and dairy products produced without nontherapeutic use of medically important antibiotics.
- Education of the public regarding antibiotic resistance due to non-therapeutic agricultural use.
- APHA Resolution 9908: Addressing the Problem of Bacterial Resistance to Antimicrobial Agents and the Need for Surveillance. Available at: http://www.apha.org/legislative/policy/99policy.PDF(. Accessed Jan. 30, 2004).
- Letter of February 28, 2001, from Stephen F. Sundlof, DVM, PhD, Director of FDA’s Center for Veterinary Medicine re: Docket 99P-0485/CP.
- Alliance for Prudent Use of Antibiotics. The Need to Improve Antimicrobial Use in Agriculture: Ecological and Human Health Consequences. Clinical Infectious Diseases 2002;34(Suppl 3). Available at: http://www.tufts.edu/med/apua/Ecology/faair.html. (Accessed Jan. 30, 2004). ("The elimination of non-therapeutic use of antimicrobials in food animals and agriculture will lower the burden of antimicrobial resistance...with consequent benefits to human and animal health"). See also Wegener HC. Antibiotics in animal feed and their role in resistance development. Curr Opin Microbiol 2003;6:439-445.
- Gorbach S. "Antimicrobial use in animal feed--time to stop." N Engl J Med 2001;345:1202-03
- Institute of Medicine, Board on Global Health. Microbial Threats to Health: Emergence, Detection, and Response. Washington, DC: National Academy of Sciences Press. 2003. Available at: http://books.nap.edu/books/030908864X/html/R1.html#pagetop. (Accessed Jan. 30, 2004).
- Joint WHO/FAO/OIE Expert Workshop on Non-human Antimicrobial Usage and Antimicrobial Resistance, Geneva, December 1-5, 2003, Executive Summary. Available at: http://www.who.int/foodsafety/micro/
meetings/nov2003/en/. (Accessed Jan. 30, 2004).
- McDonald’s Corporate Press Release, June 19, 2003. "McDonald’s Calls for Phase-out of Growth Promoting Antibiotics in Meat Supply, Establishes Global Policy on Antibiotic Use." Available at http://www.mcdonalds.com/usa/news/current/conpr06192003.html. (Accessed Jan. 30, 2004); Bon Appétit Policy on Antibiotics Use in Food Animals, November 18, 2003. Available at: http://www.bamco. com/pressrelease/pdfs/antibioticpolicymaster1032003.pdf. (Accessed Jan. 30, 2004).
- Numerous such suppliers, for example, are listed at www.EatWellGuide.org.
- Wegener HC. Antibiotics in animal feed and their role in resistance development. Curr Opin Microbiol 2003;6:439-445.
- World Health Organization. Impact of antimicrobial growth promoter termination in Denmark. WHO/CDS/CPE/ZFK/2003.1. 2003. Available at: http://www.who.int/salmsurv/en/Expertsreportgrowth promoterdenmark.pdf.
- See, e.g., "Why is Big Pharma Getting Out of Anti-Infective Drug Discovery?" Session at 43rd annual Interscience Conference on Antimicrobial Agents and Chemotherapy Available at: http://www.icaac.org/43ICAAC/PrelimProgram.asp. (Accessed Jan. 30, 2004).
- Environmental Defense. When Wonder Drugs Don’t Work: How Antibiotic Resistance Threatens Children, Seniors, and the Medically Vulnerable. Washington, DC: Environmental Defense. 2001. Available at: http://www.environmentaldefense.org/documents/162_abrreport. pdf. (Accessed Jan. 30, 2004).
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