The discovery and wide availability of antibiotics since the mid-1940s have saved millions of lives. They have also led to a wide range of medical advances – such as burn treatment, open-heart surgery and bone marrow and organ transplants – in which preventing and treating infection is essential for success.
But the world is now at risk of losing this essential medical advance. Bacteria and other microbes evolve in response to their environment and inevitably develop resistance to antibiotics. Over the past decade this problem has become a crisis. Antibiotic resistance is now occurring at an alarming rate and is outpacing the development of newer agents.
This threatens patient care, economic growth, public health, agriculture and national security. Society should address any avenue that contributes to this problem.
The Centers for Disease Control and Prevention has developed the One Health concept, recognizing that human health is tied to the health of animals and the environment. All uses of antibiotics – whether in humans or animals – can lead to antibiotic resistance. Therefore, medically important antibiotics for treatment in human infections must be judiciously used in animals.
The Legislature considered two bills to reduce the use of antibiotics on California farms last session. One was defeated in the Assembly Agriculture Committee. The other was criticized for being ineffectual and was vetoed by Gov. Jerry Brown, who called for a stronger measure.
Our legislators must address antibiotic use on California farms and can play a critical role in leading the country in improving antibiotic resistance. As a medical community, we must join to support this endeavor.
Last week was Get Smart About Antibiotics Week. Although most of the material focuses on the appropriate use of antibiotics in humans, it is important to remember that approximately 80 percent of antibiotics are sold to farms. Substantial evidence demonstrates that agricultural use of antibiotics has promoted the development of antibiotic-resistant microbes on farms and that the resistance genes can spread between microbes, which can then be transmitted from animals to people who come into contact with them.
For example, by analyzing methicillin-resistant Staphylococcus aureus (MRSA) with whole genome-sequencing across 19 countries and four continents, one study showed that a susceptible strain originating in humans spread to livestock, where it acquired methicillin resistance, and then migrated back to humans.
As clinicians, we have encountered patients with infections that cannot be effectively treated with any of our current antibiotics. These patients leave an imprint on our minds and hearts. Evidence shows that at least some drug-resistant pathogens that are widespread in clinical settings may have evolved under selective pressure from antibiotic use in agriculture. This is of considerable concern and underscores the need for comprehensive stewardship across all sectors in which antibiotics are used.
Therefore, it is clear that a strategy to reduce the emergence and incidence of antibiotic resistance must include substantial changes in the use of certain antibiotics in agricultural settings.
Kavita K. Trivedi is a principal with Trivedi Consults and an adjunct clinical professor of medicine at Stanford University. Stuart H. Cohen is a professor of medicine and chief of infectious diseases at the University of California, Davis.