An­tibi­otic leg­is­la­tion falls short in Maryland

The Washington Post Sunday - - LOCAL OPINIONS - BY JOR­DAN COOPER AND ELLEN SILBERGELD

Maryland’s Keep An­tibi­otics Ef­fec­tive Act of 2017 is one step in the right di­rec­tion — but only one step, thanks to a loop­hole in the leg­is­la­tion large enough for a bat­tle­ship to pass through.

The bill, which went into ef­fect last month, at­tempts to limit the pro­phy­lac­tic use of an­tibi­otics in live­stock and poul­try to ar­rest the spread of an­tibi­otic-re­sis­tant strains of bac­te­ria so as to pro­long the ef­fi­cacy of our an­tibi­otic drugs. The leg­is­la­tion is to be com­mended for pro­hibit­ing the use of an­tibi­otics in live­stock and poul­try to pro­mote weight gain or to im­prove feed ef­fi­ciency. Un­for­tu­nately, the bill does not re­quire con­fir­ma­tion of dis­ease in a herd or flock be­fore an­i­mals can be treated with an­tibi­otics.

The World Health Or­ga­ni­za­tion op­poses this sort of loop­hole be­cause, given the crowded con­di­tions of fac­tory farms, it would not be dif­fi­cult for a vet­eri­nar­ian to con­clude that ev­ery an­i­mal stands a rea­son­able risk of con­tract­ing a dis­ease. This sit­u­a­tion is anal­o­gous to how a pe­di­a­tri­cian might con­clude that ev­ery child who at­tends day care should take an­tibi­otics on a daily ba­sis through­out child­hood sim­ply be­cause they have an increased risk of con­tract­ing strep throat.

The most com­pelling ar­gu­ment for clos­ing this leg­isla­tive loop­hole is that with­out these changes, we will con­tinue to erode the ef­fi­cacy of our lim­ited ar­mory of an­tibi­otics for use in medicine. It is im­por­tant to ad­min­is­ter the proper class and dose of an­tibi­otics to an­i­mals, lim­it­ing their use to ap­pro­pri­ate sit­u­a­tions to pro­long the ef­fec­tive­ness of an­tibi­otics for use by hu­mans and an­i­mals. While all uses of an­tibi­otics con­trib­ute to the di­min­ish­ment of their ef­fec­tive­ness, the vol­ume of an­tibi­otic use in food-an­i­mal pro­duc­tion is greatly ac­cel­er­at­ing, in­creas­ing an­tibi­otic re­sis­tance in bac­te­ria that cause hu­man dis­ease.

Hu­mans who con­sume meat from an­i­mals that re­ceived pro­phy­lac­tic an­tibi­otics are ex­posed to strains of bac­te­ria that have evolved to sur­vive the ef­fects of the an­tibi­otics. In ef­fect, our de­mand for cheap and abun­dant meat has led to our care­less use of pro­phy­lac­tic an­tibi­otics in an­i­mals. That has re­duced the ef­fi­cacy of an­tibi­otics for hu­man use. The re­sults are shock­ing.

Wide­spread an­tibi­otic re­sis­tance has be­come a cri­sis on a global scale in ur­gent need of re­dress. The Cen­ters for Dis­ease Con­trol and Preven­tion in­di­cates that Mary­lan­ders en­dure a rate of health-care-as­so­ci­ated in­fec­tions that is higher than the na­tional base­line. We in­cur large costs as­so­ci­ated with an­tibi­oti­cre­sis­tant strains of bac­te­ria that in­fect hos­pi­tal­ized pa­tients. This re­sults in ex­tended hos­pi­tal stays, increased med­i­cal com­pli­ca­tions, increased costs and increased loss of life. Some of the most well-known cul­prits, some­times re­ferred to as “su­per bugs,” are me­thi­cillin-re­sis­tant Sta­phy­lo­coc­cus au­reus (MRSA) and Clostrid­ium dif­fi­cile (C. diff). These bac­te­ria have de­vel­oped re­sis­tance to many dif­fer­ent an­tibi­otics.

This cri­sis is ex­ac­er­bated by the lack of new an­tibi­otic mol­e­cules. De­vel­op­ing and test­ing new an­tibi­otics is a time-con­sum­ing process. While we wait for these new dis­cov­er­ies, we must pro­tect the an­tibi­otics that we have by pro­hibit­ing the ad­min­is­tra­tion of sub-ef­fec­tive and in­ap­pro­pri­ate pro­phy­lac­tic doses of an­tibi­otics in in­dus­trial food-an­i­mal pro­duc­tion.

We sup­port the ac­tions of the Maryland leg­is­la­ture in de­vel­op­ing the Keep An­tibi­otics Ef­fec­tive Act of 2017. There is much that is good in this leg­is­la­tion but, in fail­ing to pre­vent the abuse of pro­phy­lac­tic an­tibi­otic uses in live­stock, fish and poul­try, we will fall short of ac­com­plish­ing its in­tent of pro­tect­ing the health of Mary­lan­ders. Jor­dan Cooper is a health-care pol­icy ex­pert. Ellen Silbergeld, a MacArthur Foun­da­tion fel­low, is the au­thor of “Chick­eniz­ing Farms and Food” and a spe­cial con­sul­tant to the World Health Or­ga­ni­za­tion Food Safety Pro­gram.

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