BEEF Editors' Blog

Doctors, Mothers Responsible For Antibiotic Resistant Bugs

The issue of antibiotic resistant pathogens won't go away, and will only be managed if everyone--cattle producers, government, scientists and consumer advocates--work together.

Yes, that headline is provocative. But it’s also true…up to a point. And the gulf between the headline’s truth and its half-truth illustrates several realities that the beef industry must continue to deal with.

First, let’s set the record straight. No, doctors and mothers are not totally (emphasis on the word totally) responsible for antibiotic resistance. On the other hand, however, yes, mothers and doctors are responsible for antibiotic-resistant bugs. But only partly.

So are you. And no, animal agriculture is not totally (emphasis on the word totally) responsible for antibiotic-resistant pathogens, as some would have us believe. The completely accurate headline is this: Everyone Is Responsible For Antibiotic Resistance. To quote Steven Solomon, director of the Centers for Disease Control (CDC) Office of antimicrobial resistance, and co-chair of the federal interagency taskforce on antimicrobial resistance, “There is not a time when you put antibiotics into this ecosystem that it does not contribute to resistance in some way. “

And, please, don’t misunderstand. I’m not casting aspersions at mothers or doctors. They are only doing what they think they need to do. Mothers especially. I know this from first-hand experience and many years of close observation. I have three mothers to deal with—the one who birthed me, the one who birthed our children, and the child who birthed my granddaughter. 

Now, to get to the point, which is that antibiotic resistance is everyone’s problem. And it will only be managed if everyone—human health, animal health and consumer advocates—work together.

The first of the realities that my not-quite-totally-true headline illustrates is that provocative headlines have always sold newspapers.

I’ll spare you the numbers, but we scribes have mere seconds to capture your attention and convince you to click on an article. Right or wrong, and the editors at BEEF would argue more on the wrong side than the right, provocative headlines have always been a fact of life. Now, in this post-print, neuvo-modern, digital-electronic, fast-news world we live in, the pressure to write provocative headlines is even more intense.

It made you look, didn’t it? And if you’re still with me, you are among the minority of readers who clicked on this editorial.

Here’s the second reality, and the partial truth behind the headline. When a mother takes her sick child, or you take your sick self, to the doctor, she and you expect to be given something that will make it better. Period.

Mothers are going to behave like mothers, both individually and collectively. That is perhaps one of the most powerful forces on earth, and one reason for concern among human health professionals about antibiotic overuse in human medicine.

Likewise, when you have a sick animal and call the veterinarian, or more likely go to the feed store and buy a bottle of antibiotic, you expect that it will make things better. If it doesn’t, what do you do? Give it another shot, probably of the same stuff. This would be an appropriate time to recall Einstein’s observation on insanity.

And that’s where things regarding antibiotic-resistant bacteria get complicated. I’ll give you two quotes to back up that claim:

  • “If you think you understand antibiotic resistance, it hasn’t been adequately explained to you.” Guy Loneragan, veterinary epidemiologist and professor of food safety and public health, Texas Tech University.
  • “Antibiotic resistance may be the single most complex problem in all of public health.” Steven Solomon, CDC.

Thus, I’m not going to explain antibiotic resistance in this editorial. I spent three fascinating days last month at a symposium where some really smart people from both human and animal health discussed the issue. If you want to delve deeper into the subject, I encourage you to go to the National Institute of Animal Agriculture (NIAA) website.

What I am going to do is emphasize the point made any number of times during the symposium. And that is this: everyone—human doctors and human patients, veterinary doctors, (and this very much includes small-animal vets) along with their animal and human patients—all have an important role in dealing with antibiotic resistance.

We’re not going to stop microorganisms from becoming resistant to antibiotics. The bugs have too much of a head start, Solomon says, by several billion years. But there are things we can do to keep the problem from growing beyond the ability of technology as we know it today to deal with pathogens.

 

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The first is to use antibiotics judiciously and only when needed. Just because you have a sick calf doesn’t mean you need to give it a shot of antibiotic. Antibiotics are useless against viral infections. See Solomon’s quote above about what happens when you use an antibiotic where it isn’t needed. How do you tell the difference? That’s where using your veterinarian as a herd health consultant instead of an EMT who comes screeching up to the scene of the wreck is really, really, really (that’s three reallys, which means it’s really important) important.

Bottom line—how we (which means you) use antibiotics will partly determine how they can be used and obtained in the future, and how many antibiotics animal agriculture will have at its (meaning your) disposal.

The second point is this: we can’t let the discussion about antibiotic use and antibiotic resistance devolve into a shouting match. My recent editorial on horse slaughter shows very well what happens when an issue becomes so heated and polarized that civil discussion becomes impossible.

For the first time that I’m aware of, at least in a public setting, the NIAA symposium brought consumer groups, animal agriculture and human medicine into the same room, all talking about antibiotic resistance, and all doing so in a very civil and professional manner.  Representatives from the Center for Science in the Public Interest (CSPI), Pew and the Natural Resources Defense Council attended the symposium, and the CSPI representative was one of the presenters. NIAA is to be commended for that.

That dialogue absolutely must continue. Animal agriculture needs antibiotics. It is at its core an issue of animal welfare and humane animal stewardship. But we need to figure out ways to use those antibiotics judiciously and to seek alternatives to antibiotics in our animal health protocols. That means that every livestock owner must have, at some level or another, a relationship with a veterinarian.

Human medicine needs antibiotics. It is at its core an issue of delivering both the absolute best clinical health and public health systems that we can humanly do. If society must choose between antibiotic use for humans and antibiotic use for animals, guess who wins.

And we all need to tone down the rhetoric. Polarizing this issue serves only to ensure that the problem of antibiotic-resistant bacteria will get worse. Should that happen, everyone who truly cares about humans and animals alike will lose.

 

 

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Discuss this Blog Entry 16

Tamara Choat (not verified)
on Dec 10, 2013

Yes, I clicked on the provocative headline out of guilt ... about four hours after I put my 18-month-old daughter's bottle of antibiotic back in the refrigerator. Great reading.

on Dec 10, 2013

I read an article by Dr. Mercola that stated the agriculture industry uses 80% of the antibiotics produced in the US. I hope our industry would highly discourage the use of antibiotics to only sick animals and not for the altering of the size or weight of our food source.!!! 80% = 24 million pounds annually.

on Dec 11, 2013

Sandkicker--That 80% figure, just like my headline, is both true and false. It will take much too much space to address that here, but I will do so in Friday's BEEF Cow-Calf Weekly.In the meantime, if you wish to dig deeper, I encourage you to watch Dr. Richard Raymond's presentation at the NIAA antibiotics symposium. It's from this talk that I wrote the ediorial that we'll publish Friday. http://ec.libsyn.com/p/e/6/a/e6a0b2031399bc43/131112_NIAA_Raymond.mp4?d1...

Burt Rutherford

John R. Dykers, Jr (not verified)
on Dec 10, 2013

Well written, Burt. One dogmatic slip: "When a mother takes her sick child, or you take your sick self, to the doctor, she and you expect to be given something that will make it better. Period." rather than "Period", say "or be reassured one will get better". (I concocted "Dr. Dykers' Cold Medicine" to help folks who did not need an antibiotic feel better while they were healing.)
Also a common misperception " Antibiotics are useless against viral infections." Often the "sickness" in a viral infection is a bacterial superinfection or infection of opportunity allowed by the viral illness. Also the sickness of a viral infection may simply be the body's defense mechanisms that will eventually result in healing. Will enter this then separately a letter on the paradigm of antibiotic resistance.
John Dykers, Jr. MD

on Dec 11, 2013

Dr. Dykers--Thanks for the correction and the clarifications. This is a very important and incredibly complex issue. However, the mothers I'm most familiar with pretty much prescribe to the "period" philosophy. And they'll shop the docs until they find one who agrees with them.

Burt Rutherford

John R. Dykers, Jr (not verified)
on Dec 12, 2013

True! Doctor shopping is more prevalent in all areas. Pt's know how to "push our buttons!" I was fortunate to gradually develop a loyal core of patients who would accept the advice to skip antibiotic or take short big doses, and followed them closely to check on my own advice. Reference following letter already posted.
John R. Dykers, Jr. MD retired

John R. Dykers, Jr (not verified)
on Dec 10, 2013

added this letter sent Monday, written last week.
Jeffrey A. Linder, MD, MPH, of Harvard Medical School and Brigham and Women’s Hospital in Boston. Yet Linder and his colleague Michael L. Barnett, MD

Dear Drs. Linder and Barnett,
We are operating on a false paradigm regarding antibiotic treatment of acute infections: sore throat, middle ears, sinuses, bronchitis, UTI, etc. All this comes from a physician whose bias includes having concocted Dr. Dykers' Cold Medicine to give to patients who did NOT need an antibiotic. Mathematically, the evolution of a resistant organism is directly related to the time the innoculum is exposed to that antibiotic. Please extrapolate what we have learned from the evolution of multidrug resistant tuberculosis.
1. These illnesses should be seen AND treated as urgently/promptly as possible. Why? because the innoculum is lower the earlier in the process, and the opportunity to tip the balance in favor of the effectiveness of the patient's own defence mechanisms is greatest. The culprit is not the FREQUENCY of antibiotic treatment; it is the duration.
2. The decision not to treat with antibiotic is more difficult early in the process. If the sickness has been going on for several days and the patient is handling it well, it may be obvious from history and physical exam, a WBC with diff or a microscopic exam of the urine, or a rapid strep test, that the patient's own immune mechanisms will result in healing.
3. Early in the sickness, a single dose of antibiotics may be transformative. It is both glib and unknowable in this instance to assume that the antibiotic was "unnecessary". Most of the time, NOBODY knows what the organism is, viral or bacterial or both, at this stage, and erradicating secondary bacterial infection in a primarily viral illness may still be transformative.
4. The worst thing that can be done is give ampicillin 250 mgm tid for 10 days! This is a straw man for the sins of antibiotic "overtreatment" born of laziness, old doctor's tale of 10 day treatment, AND the origin of that myth in the landmark 1960's Utah study of beta strep and 10 days of penicillin preventing rheumatic fever.
5. IF the patient is "sick" AND antibiotic treatment is indicated (judgement call and we should be biased toward treatment rather than away from it in "sick" outpatients with an unknown organism) The Treatment Should Be with at least TWO antibiotics for the respiratory system, each chosen to attack the organisms most likely to be resistant to the other, AND use the BIGGEST dose tolerable, AND reevaluate in 48 to 72 hours, giving the patient encouragement to stop the antibiotics even sooner if dramatic improvement and "feeling great". Often also choose 2 for the urinary tract, depending on local culture results and resistance patterns and frequencies. Almost ALWAYS culture the urine before starting therapy, even if urine collected at home in a sterilized mayonaise jar and brought in tomorrow! If we treat UTI symptoms without a culture and 2-3 days later the patient is sicker, we are up the creek without a paddle and forced to guess in a really dangerously sick person. Transforming or allowing cystitis to progress to pyelonephritis without a culture is a sin that ought to result in a lawsuit!
6. The shorter the antibiotic treatment the less the opportunity for the emergence of resistant organisms AND the greater the chance for relapse. This requires JUDGEMENT and we should not expect a high degree of certainty but, as your publication does, continue to push to improve that judgement, see the patients response, and change our mind and our antibiotic choice in a heartbeat.

You have likely never seen a scar from the surgical treatment of mastoiditis. Consider that carefully in comparing treatment vs no treatment with antibiotics.

Yours very truly,
John R. Dykers, Jr. MD Chairman Emeritus of The Thursday Morning Intellectual Society, retired after doing our hospital CME every other Thursday for 35 years and helping initiate the statewide CME for the NC Academy of Family Practice before that.:

Anonymous (not verified)
on Dec 12, 2013

Well said. A rational approach rather than all or none!

Charlie Powell (not verified)
on Dec 11, 2013

Hey, what's that over there in the corner? It looks like an elephant named "international use and misuse of antibiotics in humans and animals and its contribution to antibiotic resistance." Why is that overlooked, especially when many of the drugs in question are manufactured and/or sold by U.S. companies? In many countries I've traveled to, I can purchase any amount of almost any antibiotic OTC with no oversight.

on Dec 11, 2013

Mr. Powell--An excellent point. However, it's one that we, meaning the United States, has little control over. We just have to deal with those multi-drug resistant pathogens that international travelers bring back with them.

News flash--FDA just released its final Guidance 213 and proposed Veterinary Feed Directive rule. It establishes a three-year timeframe for phasing out growth-promotion uses of antibiotics important in human medicine and phasing in of veterinary oversight of these products. Expect the rhetoric--and the misinformation--to ramp up considerably.

https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-2969...

https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-2969...

Burt Rutherford

Joseph Butterweck, DVM (not verified)
on Dec 11, 2013

"the dialogue must continue". That is the most important item in your message. Do we use antibiotics responsibility? There is room for much improvement from all sectors

Jacob Metch (not verified)
on Dec 11, 2013

Burt, I am a huge fan of this article. I grew up as a Hereford breeder and am now going to grad school for environmental engineering and am working for a leader in antibiotic resistance gene research. In this work she has focused on how ARGs are transported and proliferate in soil, and especially water environments. I am now getting into ARG research and as a beef advocate I run into some internal conflicts while reading about the issue.

I really like that you are stressing that EVERYONE is responsible in the antibiotic resistance issue. From the research I have read about ARGs proliferation being heavily impacted by human factors (both wastewater treatment plants and animal feeding operations) I completely agree that the time for finger pointing is over.. everyone should point to themselves, and worry about fixing their own contributions to antibiotic resistance, then worry about others. Unfortunately I'm not encouraged that this is happening, especially in the beef industry.

I had some questions for you on this article however and forgive me if they come across as critical of beef or as naive. My main concerns have been brought up in your piece, but I was wondering about the need for feed lots to treat animals with low dosages of antibiotics. Is this practice a necessity? Along those same lines, how do you think we can avoid over treating sick animals? Do you think it would be useful to look seriously at changing the practices that cause increased disease to avoid the use of antibiotics? (I'm thinking of concentrated feeding operations here)

Basically, I have noticed in my relatively short time researching this topic that it is very serious, and poses a huge threat to human health if something is not done immediately. It also deeply saddens me that the industry I grew up loving and loving the people in it, appears to be responsible for a portion of the problem and seems to be dragging their feet about addressing their issues.

Thanks,

Jake

on Dec 13, 2013

Jake--I apologize for taking so long to reply. Been chasing other rabbits and it seems they can run faster than I can.

I addressed some of your questions in a blog I wrote in this morning's BEEF Cow-Calf Weekly. Here's the link:

http://beefmagazine.com/blog/true-or-false-animal-agriculture-uses-80-al...

I don't know if this blog helps or only confuses things further. We'll see.

Your question about using antibiotics for growth promotion strikes at the heart of the debate. FDA took a big step this week by finalizing its Guidance 213 and Veterinary Feed Directive, which will ultimately ban the use of medically-important antibiotics for in-feed and in-water use and put these uses under the oversight of a veteranarian.

However, in spite of what all the antis and naysayers would have us believe,the use of antibitoics in that way is not necessarily bad, in my opinion.

I think the problem is not over-treating animals, but under-treating them. Feedlots largely have scales and can accurately dose a sick animal based on its weight. If you're just guessing, you're probabably understimating the weight.The only way to know is to weigh the animal.

Yes, I think it's incumbent on the industry to constantly look at new management practices, or simply use those we already know about, to reduce disease. Talk to any feedyard veteranarian and I think you'll soon realize they spend most of their day working on that.

But how many animals do they have to deal with that have never been vaccinated, or vaccinated incorrectly, or because of environmental conditions like high-sulfur water arrive at the feedyard already compromised? I suspect it's more than most of us are aware of.

We can do a lot by simply doing the right things, and then doing them right, from the moment the bulls are turned out.

Don't be too hard on your cattle-producing bretheren. I think cattlemen by and large use animal health products responsibly. As we learn more about how antibiotics interact with the environment, I think cattle producers will work even harder to use these products responsibly and judiciously. We have no other alternative.

Good luck with your graduate studies. Antibiotic resistance is a phenomenon that even the best minds in both human and animal medicine don't fully understand. But that doesn't mean we shouldn't stop trying. And that doesn't mean we shouldn't use antibiotics.

Burt Rutherford

Forgot to add one thought, which is to encourage you and everyone else to go to the NIAA website at www.animalagriculture.org and listen to the speakers at this year's antibiotics symposium. Also, listen to the speakers from the 2011 and 2012 symposiums as well. There is alot of thinking from several perspectives there, and it's well worth your time.

BR

Jacob Metch (not verified)
on Jan 31, 2014

Burt,
Thank you for the reading and listening material in this interesting and important area.
As for you thought that under-treating animals is the problem. It makes sense that if you are not eliminating the population entirely within the animal, you would just be selecting for resistant bacteria and therefore increasing antibiotic resistance within the host. Since this is outside of my research area I won’t comment on that too much. However, my concern is that if that mentality is used as the silver bullet to tackle the beef industries contribution to ARGs long term, this may be dangerous. If you use more antibiotics, although there may be a decrease in ARGs within the animal, it will also lead to an increase in antibiotics or their metabolites excreted by the animal into the environment. Sub-lethal concentrations of antibiotics and their metabolites have been shown to produce a selective pressure on the environmental bacteria and lead to an increase in antibiotic resistance, and specifically, DNA elements that carry more than on antibiotic resistance gene. It’s not hard to imagine scenarios where this will be troubling because a lot of surface water that is used as a water source for municipalities are influence by agricultural runoff. So although increasing the dosing of animals will decrease ARGs within the animal, we could just be trading them for more ARGs in the environment.
I have spent several years now studying applied environmental microbiology, and if there is one thing that has stood out to me in my studies it is that microorganisms are incredibly complex, smart, and should not be underestimated. The CRC’s report on antibiotic resistance shows this. For these reasons, I think a long term solution cannot include the increased use of antibiotics. We have to focus on decreasing usage.
Thanks,
Jake

John R. Dykers, Jr (not verified)
on Dec 12, 2013

Amen to all of the above!
One approach is to finish cattle on the farm where they are born and avoid comingling -- not economically feasible for many operations, but an option to be considered as the industry develops. We did it successfully with CharLean, There are big savings to be had in vertical integration, and others are adopting our model.
John Dykers

Ronald Welsh (not verified)
on Dec 18, 2013

The article and all discussion are good intercourse on the subject of antibiotic resistance, but most important is to further the discovery or development of new antibiotics and new methods of antimicrobial activity. This has not improved much in my 30+ years of working in this area in both human and animal treatment of disease.

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Everyday musings from BEEF Editors on the latest beef industry news and events.

Contributors

Joe Roybal

Joe is a native of South Dakota and a graduate of South Dakota State University with a degree in journalism. He worked as a daily newspaper reporter and photographer before doing a six-year stint...

Burt Rutherford

Burt has nearly 30 years’ experience communicating about beef industry issues. A Colorado native and graduate of Colorado State University with a degree in agricultural journalism, he now...

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