Antibiotic Resistance


If the phrase “too much of a good thing” applies to anything, it surely applies to antibiotics. Their discovery was one of the most important medical advances of the last century, but overuse has eroded their effectiveness. There’s widespread agreement on the need to speed up development of new antibiotics and to discourage doctors from prescribing the drugs when they’re not needed. Another side of the issue is more contentious: roughly 80 percent of antibiotics in the U.S. are fed to farm animals. Regulators say using them to fatten livestock faster helps spread drug resistance. Meanwhile, about 50,000 people a year die in hospitals from drug-resistant infections in the U.S. and Europe, with millions more falling sick, and antibiotic-resistant gonorrhea has spread to 10 countries.

The Situation

In March, U.S. President Barack Obama’s administration released a national plan to combat antibiotic-resistant bacteria. It calls for the government to invest in new antibiotic research and require hospitals to increase infection controls. The announcement came amid criticism that the government’s response has been insufficient. In 2012, Congress passed legislation creating incentives for drugmakers to come up with new antibiotics, including faster review and extended protection from generic competition; other bills would go farther, for instance permitting approval of life-saving antibiotics based on trials that are smaller than normally required. Health officials report some success in campaigns to limit inappropriate use by humans — per-capita antibiotic use in the U.S. dropped about 15 percent between 2001 and 2010, and it’s beginning to fall in China, where consumption is 10 times as high. The Food and Drug Administration has proposed requiring companies to prove the effectiveness and safety of antibacterial hand washes, arguing that they don’t improve health and may be contributing to resistance. On the animal front, the FDA in June 2014 announced that all relevant drug companies had agreed to its voluntarily plan to relabel antibiotics, making their use contingent on a veterinarian’s prescription. Democrats have proposed an outright ban on giving the drugs to healthy animals. The state of California adopted such a ban in October 2015. The European Union imposed one in 2006. After its worst annual sales slump in five years, McDonald’s in March said it would stop serving chicken raised with antibiotics “important to human medicine” in its U.S. restaurants. The next month, Tyson Foods, the biggest seller of chicken in the U.S., announced it would eliminate the use of such drugs in healthy birds by September 2017.

Sources: National Healthcare Safety Network, U.S. Centers for Disease Control and Prevention
Sources: National Healthcare Safety Network, U.S. Centers for Disease Control and Prevention

The Background

Bacteria are constantly mutating, and some change in ways that let them survive a particular treatment. Repeated exposure leads to more of the resistant bacteria. The antibiotic era in animal agriculture began in 1946, when researchers noted that chickens fed low doses of the drugs grew faster. Antibiotics have become a crucial part of factory farming – animals in cramped conditions would be vulnerable to infections without daily doses of the drugs. In 1972, an FDA task force warned that antibiotic-resistant microbes in animals could be passed to humans. For decades, the livestock and pharmaceutical industries successfully fended off regulation, arguing that little correlation could be drawn between antibiotics used in agriculture and resistant infections in humans. Health officials have become increasingly skeptical of that claim amid mounting contradictory evidence. The increasing prevalence of counterfeit antibiotics certainly feeds resistance. Meanwhile, the number of large drug companies developing new antibiotics dropped to four in 2014 from 20 in the late 1990s.

Sources: Center for Drug Evaluation and Research, CenterWatch
Sources: Center for Drug Evaluation and Research, CenterWatch

The Argument

The FDA says its voluntary relabeling strategy will reduce antibiotic use in livestock faster than a ban that would take years to push through. Industry groups such as the American Meat Institute applauded the voluntary approach. Some consumer advocates criticized the plan as a hollow gesture. Because farmers can still use antibiotics to prevent disease, meaningful change is unlikely, a 2013 study concluded. EU officials say they have seen some decline in the use of antibiotics since the 2006 ban, though the effect has been muted by higher rates of illness when herds aren’t taking them to promote growth. Denmark put a ban in place earlier and has seen a bigger drop — partly because farmers learned that they needed to raise their animals in healthier conditions once they weren’t getting a daily dose.

The Reference Shelf

  • Reports on the crisis of and tackling antimicrobial resistance, commissioned by the U.K. Prime Minister.
  • Reports on antibiotic resistance from the World Health Organization and the CDC.
  • A U.K.-Swedish report on the threat antibiotic resistance poses to global health security.
  • The Pew Charitable Trust’s report “Reviving the Pipeline of Life-Savings Antibiotics.”
  • Statement by the Infectious Diseases Society of America on the 2012 GAIN Act, which added incentives for antibiotic development.
  • A Bloomberg QuickTake on food safety.

(This QuickTake includes a corrected reference to the relative importance of the discovery of antibiotics.)

First Published March 13, 2014