1 |

Antimicrobial resistance from

use of Antimicrobials in Food Animals

Washington, May 4, 2010

Jorgen Schlundt and Awa Aidara-Kane Department of Food Safety and Zoonoses,

Antimicrobial resistance from

use of Antimicrobials in Food Animals

Washington, May 4, 2010

Jorgen Schlundt and Awa Aidara-Kane Department of Food Safety and Zoonoses,

2 |

WHO Food Safety and Zoonoses

Promoting Science

Enabling Action

3 |

The ProblemThe Problem

Antimicrobials save many million human lives every year – works against most infections

Antimicrobials lose effectiveness when bacteria become resistant – and all use of antimicrobials potentially creates resistance

Same classes of antimicrobials are used both in humans and animals

Widespread use of antimicrobials in livestock production - not only to treat disease

Few new antibiotics are being developed to replace those becoming ineffective through resistance

Food is the most important vector for spread of resistant bacteria between animals and humans – food trade globalized, international action needed

4 |

Health consequences of AMR

Increased number of infections

Increased frequency of treatment failures

Increased severity of infections– Prolonged duration of illness– Increased frequency of bloodstream infections– Increased hospitalization– Increased mortality – people die, who could have

been easily saved

Increased costs to society

5 |

So – the question is:So – the question is:

Does animal use mean anything?

6 |

Quinolone-resistant Salmonella Typhimurium DT104 (UK)

Quinolone-resistant Salmonella Typhimurium DT104 (UK)

0

2

4

6

8

10

1214

16

18

Per

cent

of i

sola

tes

92 93 94 95 96 97

Chickens Cattle Pigs Humans

0

2

4

6

8

10

1214

16

18

Per

cent

of i

sola

tes

92 93 94 95 96 97

Chickens Cattle Pigs Humans

November 93 – Enrofloxacin licensed

for animal use

November 93 – Enrofloxacin licensed

for animal use

7 |

Fluoroquinolone resistance in human Campylobacter (USA)

0

5

10

15

20

25

30

86 90 95 97 2000 2005

Year

Percent resistant

Approved for use in humans

Approved for use in poultry

FDA withdrewapproval

0%

Sentinel surveyCDC began surveillance

8 |

Drug use for humans and animalsDrug use for humans and animals

Humans

Food animals

France, 2005 Denmark, 2007

Humans

Food animals

9 |

0

50

100

150

200

250

300

mg

/kg

meat

pro

du

ced

Total amount (mg/kg) antimicrobial for animal use

10 |

0

50

100

150

200

250

300

mg

/kg

meat

pro

du

ced

Total amount (mg/kg) antimicrobial for animal use

11 |

WHO Global Principles for the Containment of AMR in food-

animals

• Based on World Health Assembly Resolution

• June 2000

• To minimise the public health impact of the use of antimicrobial agents in food animals

• Large consultation incl. stakeholders

12 |

So – which types of animal use:So – which types of animal use:

Treatment – save sick animals

Prophylactic – prevent disease in herd settings

Growth Promotion – grow animals faster

13 |

WHO Global PrinciplesWHO Global PrinciplesAntimicrobial Growth Promoters

Use of antimicrobial growth promoters … in humans and animals should be terminated or rapidly phased-out in the absence of risk-based evaluations.

Prophylactic use of antimicrobials

Use of antimicrobials for prevention only justified where disease is present or likely, never as substitute for good animal health management.

14 |

WHO major strategic directions(animal use)

WHO major strategic directions(animal use)

Ban antimicrobial use for growth promotion

Avoid prophylactic use of antimicrobials

Limit use of critically important antimicrobials

(World Health Day 2011 on antimicrobial resistance)

15 |

WHO Global strategy for Prevention and Control of Foodborne Antimicrobial Resistance

WHO Global strategy for Prevention and Control of Foodborne Antimicrobial Resistance

Prudent use of antimicrobial agents in all sectors – No use of antimicrobial agents for growth promotion – A good regulatory system for approval and licensing – Prescription-only

Critically Important Antimicrobials for humans – restricted use in animals Fluoroquinolones, 3 + 4 generation Cephalosporins

Monitoring of antimicrobial resistance and antimicrobial usage in human and animals

– Useful information on prevalence and trends – Input for risk assessment and risk management– A basis for choosing, implementing and evaluating interventions

16 |

2003 WHO-panel on impacts of growth promoter termination in Denmark

• Independent review panel

• Productivity only marginally affected

• Resistance against specific antimicrobials declined

• Too early to measure decline in general antimicrobial resistance