LO­CAL OPIN­IONS

The Washington Post Sunday - - METRO - BY EMILY L. HEIL The writer, an as­sis­tant pro­fes­sor of phar­macy prac­tice and science at the Univer­sity of Mary­land School of Phar­macy in Bal­ti­more, is co­or­di­na­tor of the An­timi­cro­bial Stew­ard­ship Pro­gram at the Univer­sity of Mary­land Med­i­cal Cen­ter.

Mary­land can slow the spread of su­per­bugs by pre­vent­ing the mis­use of an­tibi­otics on farms.

As­tory of yet an­other per­son suc­cumb­ing to an in­fec­tion caused by a su­per­bug, this time in Nevada, came across my news feed re­cently. Un­for­tu­nately, I don’t need to read about the woman’s re­cent death to know that we have an an­tibi­otic-re­sis­tance cri­sis. As an in­fec­tious-dis­eases phar­ma­cist and co­or­di­na­tor of the An­timi­cro­bial Stew­ard­ship Pro­gram at the Univer­sity of Mary­land Med­i­cal Cen­ter, I live and breathe the science on an­tibi­otic re­sis­tance and am acutely aware of the con­se­quences of in­ac­tion.

I have some alarm­ing news: If we want an­tibi­otics to work for fu­ture gen­er­a­tions, we need to act fast to curb their overuse in an­i­mals.

It is well-known that an­tibi­otic-re­sis­tant bac­te­ria have cre­ated an in­creas­ing chal­lenge to health-care providers and have caused ill­nesses and deaths in our so­ci­ety. States should curb the overuse of an­tibi­otics to pre­vent the spread of re­sis­tant bac­te­ria.

The Cen­ters for Disease Con­trol and Pre­ven­tion es­ti­mates at least 23,000 deaths and 2 mil­lion ill­nesses oc­cur each year in the United States as a re­sult of re­sis­tant bac­te­ria. An­tibi­otic re­sis­tance in­creas­ingly threat­ens to send so­ci­ety back to a pre-an­tibi­otic era that would sig­nif­i­cantly cur­tail many of the ad­vances made in medicine. Surgery, ven­ti­la­tor care, in­ten­sive-care units and many ag­gres­sive can­cer chemo­ther­apy reg­i­mens re­quire an­tibi­otics to work.

While orig­i­nally con­sid­ered mir­a­cle drugs, many an­tibi­otics have lost their abil­ity to pro­tect against harm­ful bac­te­ria. Many of these bac­te­ria have evolved and mu­tated, al­low­ing them to re­sist, in the worst cases, all of our avail­able an­tibi­otic ther­a­pies be­cause of the sheer vol­ume of use in con­cen­trated en­vi­ron­ments such as on farms. In­ci­dence rates have risen over­all, and the prob­lem has spread world­wide as a re­sult of in­ad­e­quate in­fec­tion-con­trol prac­tices and in­ter­na­tional travel.

There are tremen­dous do­mes­tic ef­forts to cur­tail un­nec­es­sary an­tibi­otic use in hu­mans to en­hance in­fec­tion­con­trol prac­tices and an­tibi­otic stew­ard­ship. These pro­grams have helped drive a de­crease in an­tibi­otic pre­scrip­tions per capita for hu­mans in re­cent years. But these pro­grams do noth­ing to con­trol an­i­mal ap­pli­ca­tions, which en­com­pass nearly 70 per­cent of the med­i­cally im­por­tant an­tibi­otics sold in the United States.

The So­ci­ety of In­fec­tious Dis­eases Phar­ma­cists re­cently pub­lished a po­si­tion state­ment in an is­sue of Phar­ma­cother­apy out­lin­ing the dan­gers caused by an­tibi­otics used in agri­cul­ture. The authors, in­clud­ing me, de­scribe how an­tibi­otic re­sis­tance can trans­fer from the farm to hu­mans in ways other than con­sump­tion of un­der­cooked meats. Re­sis­tance also can spread through di­rect con­tact with an­i­mal han­dlers, through wastew­a­ter runoff from farms har­bor­ing re­sis­tant bac­te­ria and even through di­rect in­oc­u­la­tion of flies that har­bor re­sis­tant bac­te­ria from the farm to sources out­side of the farm. These modes of doc­u­mented re­sis­tant-bac­te­ria trans­fers high­light the com­plex na­ture of the prob­lem.

Two Food and Drug Ad­min­is­tra­tion reg­u­la­tions that ad­dress the use of an­tibi­otics on farms went into full ef­fect on Jan. 1. One rule re­moved growth-pro­mo­tion uses from an­tibi­otic prod­uct la­bels. Food an­i­mal pro­duc­ers can­not legally use those an­tibi­otics for growth-pro­mo­tion pur­poses.

At the same time, the FDA also re­quires ve­teri­nary over­sight of drugs avail­able for use in an­i­mal feed through a Ve­teri­nary Feed Di­rec­tive (VFD). Now, no med­i­cally im­por­tant an­tibi­otics given in feed are avail­able over the counter; they in­stead re­quire a VFD to be ad­min­is­tered. The VFD also re­quires a valid vet­eri­nar­ian-client re­la­tion­ship and man­dates that the vet­eri­nar­ian as­sume re­spon­si­bil­ity for mak­ing clin­i­cal judg­ments about the an­i­mal’s health and pro­vide any nec­es­sary fol­low-up care.

While these reg­u­la­tions are small but pos­i­tive steps, they will not alone solve the prob­lem. The FDA reg­u­la­tions will not pre­vent the use of an­tibi­otics at iden­ti­cal or near-iden­ti­cal doses for the pur­pose of disease pre­ven­tion rather than growth pro­mo­tion.

Through the use of good an­i­mal hus­bandry tech­niques, vac­cines, pro­bi­otics and other al­ter­na­tives, the an­i­mal agri­cul­ture in­dus­try can and should move away from low-dose an­tibi­otic use for rou­tine disease pre­ven­tion and use an­tibi­otics only to treat sick an­i­mals.

Cal­i­for­nia passed a law that bans an­tibi­otics used reg­u­larly for disease pre­ven­tion when an­i­mals are not sick. This law com­ple­ments the new FDA reg­u­la­tions.

The Mary­land Gen­eral As­sem­bly will con­sider a sim­i­lar mea­sure in its 2017 ses­sion, the Keep An­tibi­otics Ef­fec­tive Act, and I en­cour­age the pub­lic and my col­leagues in the pub­lic-health com­mu­nity to sup­port the bill.

An­tibi­otic re­sis­tance poses a pro­found threat to our med­i­cal sys­tems and pub­lic health, but we do have so­lu­tions. Will Mary­land use them?

MELISSA BROWER/CEN­TERS FOR DISEASE CON­TROL AND PRE­VEN­TION VIA AS­SO­CI­ATED PRESS

A com­puter-gen­er­ated im­age of an­tibi­otic-re­sis­tant bac­te­ria.

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