Antibiotic resistance is a pressing public health issue in America today. Infections from so-called “superbugs” that can’t be beat with our arsenal of drugs are responsible for over 23,000 deaths a year and two million illnesses. And the cost to treat these infections? About $20 billion a year in excess health care costs, the CDC reports. So when new findings were published last week in Nature showing a new potential antibiotic had been found, it was a bit of a feeding frenzy. Our saving grace was found in, of all places, the dirt, and the media ate it up.
But the promising news was met with an unfortunate truth. “The reality of the matter is that drug development takes time,” says Keith Hamilton, MD, director of the Antimicrobial Stewardship Program at the Hospital of the University of Pennsylvania. “And any new drug will eventually become resistant. So we should now and in the future think critically when prescribing drugs. Overuse is a problem today in the health care system, but there are measures to help combat resistance while appropriately treating our patients.”
It’s a judicious approach that not only doctors at Penn Medicine support, but also veterinarians at the University of Pennsylvania’s School of Veterinary Medicine.
Vets?
The issue isn’t just in the health care setting. Antibiotics used in the agricultural setting play a role, as well. Farm animals, like chickens and cows, are treated with the drugs to help prevent infections from spreading among the herd or flock and also used to promote growth, known as a sub-therapeutic use. But overuse is likely leading to resistant bacteria that cause infections in both animals and humans. Whether it can spread resistance genes from animal bacteria to humans is still unknown.
The use of antibiotics has been going on for decades, but more recently a brighter spotlight has been cast on the farm industry, as the U.S. Food and Drug Administration (FDA) puts forth bolder guidance and recommendations.
“We, too, have to use the antibiotics diligently to help decrease antibiotic resistance,” says Sherrill Davison, VMD, MS, MBA, an associate professor of Avian Medicine and Pathology and director of the Avian Medicine and Pathology Laboratory at Penn Vet’s New Bolton Center. An expert in such poultry diseases as the avian flu and the commonly -known salmonella, Davison has spent most of her 40-year career working with farmers and the FDA to make sure the food supply is safe and to help in the effort to treat animals fairly and keep them healthy. “We need those tools [antibiotics] in the future, so we have to be mindful about how often we use them now.”
The issue gained more steam last September when the White House called for an interagency task force to help guide antibiotic use in animal agriculture. The report specifically asks for the phase out of drugs used to promote growth and administration of drugs in “medically appropriate ways” only under the supervision of a veterinarian.
“Right now, we don’t know how antibiotics are being used in some cases, and that is why the task force is being assembled,” says Davison, who says vets and the various animal industries are working closely with the FDA. “We need to have that vet oversight to see what antibiotics are being used—and how much.”
Today, there is a good amount of “antibiotic-free” food already on the shelves. Anything marked organic means the animals haven't been treated with antibiotics for infections nor growth, while some labels indicate the animals were not treated with “antibiotic growth promotants.”
That same White House report proffered best practices for antibiotic use in humans, as well: quickly identify the microbe responsible for disease, ideally with inexpensive diagnostics; administer the most effective antibiotic at the appropriate dose, route, and time; and discontinue antibiotic therapy when it is no longer needed.
“Optimizing the use of our current antibiotics in human health care and animal agriculture will extend the longevity of these life-saving medicines and maximize their benefits,” the report stated.
Attitudes towards this judicious approach almost perfectly line up, as you can see from the experts’ comments. Yet, doctors and vets are often sitting at different tables. It’s a multidisciplinary problem that’s perhaps calling for a more multidisciplinary approach. After all, there is inappropriate use happening on both sides.
“It’s an issue that people from all disciplines need to look at together: doctors, vets, federal agencies, and food producers,” says Davison.
Hamilton agrees. Having more solidarity and national experts who represent large geographic regions, discussing national strategies, is important, he says.
“I think it’s vital to have a group that ‘cross advocates’ for the same goal, which is the judicious approach to antibiotics in humans and non-humans animals. That definitely would be powerful,” says Hamilton. “There are probably similar challenges in the vet and med world: communicating with patients—or in their case, farmers or animal owners—about the proper use of antibiotics. The messaging is a big part of all this.”
Both sides of the campus are leading the way in the antibiotic space.
Penn Medicine has a successful antimicrobial stewardship program, which since its inception in 1993 has been shown to improve appropriateness of antibiotic use and cure rates, decrease failure rates, and reduce healthcare-related costs with its multifaceted approach. More recently, Hamilton started working with the Philadelphia public health department to help inform and guide the region’s hospitals about best practices in antibiotic use.
Faculty from Penn Vet often speak out about antibiotic resistance (check out this Q&A with Davison in the Philadelphia Inquirer).
“We know overuse in animals and humans both contribute to antibiotic resistance, but more collaborative research is needed to better quantify the relationships and better understand antibiotic resistance overall,” Davison says. “If we worked together, shared resources and research, best practices, and concerns, it would only help tackle this more efficiently.”