Minister must take action over rising use of farm drugs implicated in new 'superbug' crisis

21 December 2006

The Soil Association demands the Government takes urgent action to prevent an emerging farm ‘superbug’ problem turning into a major public health crisis. The new superbug has been confirmed on 11 cattle farms in the UK, and more cattle and pig farms are under investigation [1]. Yet despite a high death rate from human infections, farm use of the antibiotics implicated in 'boosting' the superbug, has been allowed to increase dramatically. The use of antibiotics in human medicine is also believed to be an important contributory factor [2].

The serious new infection, a strain of E.coli which is exceptionally multi-resistant to antibiotics, emerged in 2003 and has since spread rapidly. Full national statistics on deaths are not available, but an outbreak in Shropshire led to 28 deaths out of 105 patients and an outbreak in Southampton led to 29 deaths [3,4].The elderly are most at risk, and the Chief Medical Officer has reported that people who contract urinary tract infections caused by this type of E. coli have a 30% risk of dying [5].

Richard Young, Soil Association Policy Adviser said, ‘There is growing evidence that the excessive use of antibiotics on intensive livestock farms is a central factor in the spread of this new type of E.coli. Seven years ago, the Government agreed that the use of farm antibiotics needed to be reduced, but it has done very little to bring this about and some of its policies have even encouraged use to increase. Overall there has been no significant change in the overall farm use of antibiotics since 1999, even though livestock numbers have declined, but the most serious indictment of the Government’s inaction is that it has allowed a recent substantial rise in the farm use of the very drugs which are believed to be contributing to the new superbug problem.’

In a letter to Ben Bradshaw, the Government minister responsible for veterinary medicines, the Soil Association sets out a range of initiatives the Government should take to address the issue at the farm level [6]. Priorities include banning the advertising of the suspect drugs to farmers, something the minister has previously refused to do (despite lobbying from the Soil Association), as well as the provision of advice to vets and all livestock farmers, including organic farmers, on how to reduce reliance on them.

Government scientists are still unsure exactly how this type of E.coli (known as CTX-M ESBL E.coli) developed, and why it is spreading so quickly [7]. However, many accept that the infection is sometimes carried on food and that the farm use of a group of antibiotics known as cephalosporins is likely to be part of the growing problem. These are licensed for dairy cows, beef cattle and pigs, and occasionally used under special exemptions in poultry production.

Dr. Georgina Duckworth, an author of a report published last year by the Health Protection Agency (HPA) about the emergence of ESBL E.coli said: ‘The findings in our report show evidence of people carrying these bacteria in their gut. If this is found to be commonplace in the general population this may point towards the food chain being a potential source.’ [8]

The HPA has also warned that there is evidence that ESBL resistance genes are slowly emerging in salmonella as well, and acknowledges that this ‘may be related to the veterinary use of cephalosporins’[9].

Professor John Threlfall from the HPA and Dr. Miranda Batchelor from the Government’s Veterinary Laboratories Agency, have argued that, ‘Wherever possible the use of newer generation cephalosporins should be limited in veterinary medicine.’[10]

Yet government figures just published show that the reverse is happening. In 2005, the veterinary use of cephalosporin antibiotics increased for the third year in a row. At almost 4 tonnes of active ingredient, total veterinary use was 23% higher than in 2004 and 58% higher than in 2002 [11].

Concern focuses on the most modern versions of these drugs, known as 3rd and 4th generation cephalosporins. The World Health Organisation (WHO) has classified these as ‘critically important for human medicine’[12].Furthermore, veterinary use of another class of antibiotics known as the fluoroquinolones, which the WHO has also classified as critically important for human medicine and which may be implicated in the ESBL problem as well, was 39% higher in 2005 than in 2004.

Ends

For further information contact:

- Richard Young 01386 859099 mobile 079 19194235 or ryoung@soilassociation.org

- Cóilín Nunan01890 870687 coilin.nunan@phonecoop.coop

- Soil Association press office on 0117 9142448 or 07932040452 or 07747021117.

Notes for Editors

[1]     Department for Environment Food and Rural Affairs, Zoonoses: Extended-Spectrum Beta-Lactamase (ESBL) - Defra Position, http://www.defra.gov.uk/animalh/diseases/zoonoses/esbl.htm

[2]      In a review paper just published scientists state, ‘It may be that low-level gut colonization occurs in the community, via the food chain, perhaps with plasmid transfer to resident E.coli, and that the proportion of resistant E.coli with CTX-M enzymes tends to be enriched during healthcare contacts, owing to frequent antimicrobial exposure.’ See Soil Association letter for reference.

[3]      Livermore D.M. and Hawkey P.M., 2005. CTX-M: changing the face of ESBLs in the UK, Journal of Antimicrobial Chemotherapy, 56: 451-454

[4]      Donaldson L., 2005. Annual Report of The Chief Medical Officer 2004 on the state of public health, Department of Health

[5]      Donaldson L., 2006. Annual Report 2005, The Chief Medical Officer on the state of public health, Department of Health

[6]      The Soil Association’s letter to the Minister Ben Bradshaw (copy available on request) recommends that the Government:

·provide advice to all livestock farmers, including organic farmers, on how to reduce the use of cephalosporins and fluoroquinolones

·establish the extent of the ‘off-label’ use of 3rd and 4th generation cephalosporins in poultry production and consider whether additional restrictions are required

·establish the amounts of antibiotics given to food animals by compound, antibiotic class and target species

·double the withdrawal periods for cephalosporins for meat animals to allow resistant bacteria to decline before slaughter

·introduce withdrawal periods on products which have low or zero withdrawal periods

·ban the advertising of 3rd and 4th generation cephalosporins and of fluoroquinolones to farmers

·introduce surveillance for ESBLs and other cephalosporin resistance in salmonella and E.coli from poultry, pigs and cattle in both live animals at abattoirs and retail outlets

[7]      ESBL stands for Extended-Spectrum Beta-Lactamase and are enzymes produced by the bacteria that make them resistant to most penicillin-type antibiotics. CTX-M refers to the fact that the bacteria are particularly resistant to cefotaxime, a 3rd generation cephalosporin. It is the CTX-M variety of ESBL E.coli which has recently emerged and begun to spread.

[8]      Health Protection Agency, Press Release: HPA publishes report on infections caused by ESBL-producing E. coli, 12 September 2005, http://www.hpa.org.uk/hpa/news/articles/press_releases/2005/050912_esbl.htm

[9]      Health Protection Agency, 2005. Investigations into multi-drug resistant ESBL-producing Escherichia coli strains causing Infections in England, http://www.hpa.org.uk/hpa/publications/esbl_report_05/53_other.htm

[10]    Batchelor M., Threlfall E.J., Liebana E., 2005. Cephalosporin resistance among animal-associated Enterobacteria: a current perspective, Expert Review of Anti-Infective Therapy, 3:403-17

[11]    Veterinary Medicines Directorate, 2006. Sales of antimicrobial products authorised for use as veterinary medicines, antiprotozoals, antifungals, growth promoters and coccidiostats in the UK in 2005

[12]    World Health Organisation, 2005. Critically important antibacterial agents for human medicine for risk management strategies of non-human use

 

Use of antibiotics in organic farming

Antibiotics are permitted in organic farming. However, the use of all antibiotics on organic farms certified by the Soil Association is limited to clearly defined situations. But the Soil Association is not complacent about the issues raised by the development and spread of ESBL E.coli. While we have already placed special restrictions on the use of fluoroquinolone antibiotics, we have not yet formally considered whether similar restrictions are needed on the use of 3rd and 4th generation cephalosporins.In addition, complementary therapies and trace elements must be used instead of antibiotics where these are effective. After the use of antibiotics, all organic farmers must observe significantly longer withdrawal periods than required by medicines legislation before meat, milk or eggs may be sold for human consumption. This is to further reduce the chance of antibiotic residues in food, and to allow any resistant bacteria to decline. For some important antibiotics withdrawal periods required under Soil Association standards are longer than those specified under national minimum organic standards set by the Government. The number of antibiotic treatments permitted for individual animals is also limited, and any animals which receive more treatments than allowed, lose their organic status.

Reference: Soil Association Organic Standards 10.9 and following.






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