NPA warns against further 'unsubstantiated' antibiotic reductions in response to WHO guidelines

The NPA has warned that any further 'unsubstantiated' restrictions in antibiotic use beyond those agreed under new antiobiotic targets announced recently could actually make the problem worse. 

This followed the publication of new guidelines on the use of medically important antimicrobials in food-producing animals from the World Health Organisation (WHO), which include a recommendation that farmers and the food industry stop using antibiotics routinely.

WHO 'strongly recommends' an overall reduction in the use of all classes of medically important antibiotics in food-producing animals, including 'complete restriction of these antibiotics for growth promotion and disease prevention without diagnosis'.

"Where possible, sick animals should be tested to determine the most effective and prudent antibiotic to treat their specific infection," WHO said. "Antibiotics used in animals should be selected from those WHO has listed as being 'least important' to human health, and not from those classified as 'highest priority critically important'. These antibiotics are often the last line, or one of limited treatments, available to treat serious bacterial infections in humans."

WHO said its guidelines were informed by a systematic review published in The Lancet Planetary Health, which found that interventions that restrict antibiotic use in food-producing animals reduced antibiotic-resistant bacteria in these animals by up to 39%. 

"Scientific evidence demonstrates that overuse of antibiotics in animals can contribute to the emergence of antibiotic resistance," said Dr Kazuaki Miyagishima, Director of the Department of Food Safety and Zoonoses at WHO. "The volume of antibiotics used in animals is continuing to increase worldwide, driven by a growing demand for foods of animal origin, often produced through intensive animal husbandry.”

UK targets 

The UK livestock industry is already making great strides in reducing antibiotic use. Figures collected via the eMB-Pigs database showed the pig industry cut use by 35% in 2016, with further reductions expected this year, while new targets require a 62% overall reduction between 2015 and 2020. 

Use of CIAs was reduced by 73% last year and now account for just 0.1% of total antibiotic use.

NPA senior policy advisor Georgina Crayford said: "The use of critically important antibiotics (CIAs) for human health is already restricted as part of the Pig Veterinary Society prescribing principles.

"However, NPA is concerned that further unsubstantiated restriction of antibiotics available to the agricultural sector could lead to reliance on too few antibiotic classes and may increase the rate at which resistance could occur."

RUMA response 

Gwyn Jones, chairman of the Responsible Use of Medicines in Agriculture (RUMA) alliance, said the new WHO guidelines were 'largely consistent with UK farming’s direction of travel' but were 'unnecessary' for the UK, given recent progress. 
 
"A clear strategy in the UK has produced rapid reductions of 27% in sales of antibiotics for food-producing animals within two years and significant falls in sales of highest priority antibiotics, meaning a major government target has been exceeded two years early. A new and demanding set of targets for each of the key livestock sectors will ensure momentum continues.
 
"But the WHO Guidelines also expose some important differences between the global and the European – and specifically the UK – position.

"For example: antibiotics are controlled by prescription in the UK and use for growth promotion was banned over 10 years ago; UK government and RUMA follow the European Medicines Agency – not WHO – guidelines on CIA definitions because they identify the degree of risk to human health should antimicrobial resistance develop after use in animals; and the UK, with its high regard for animal welfare, observes a ‘One Health’ approach focused on the best outcomes for people, animals, and the environment.
 
"We know some practices in veterinary medicine, as in human medicine, cannot continue. But we also recognise that time, investment and support are needed to make long-term sustainable changes without harming animal welfare. This means the WHO guidelines, especially based on what the WHO admits is low or very low quality evidence, are neither compatible with the UK farming industry’s priorities, nor necessary given recent progress."

BVA response 

British Veterinary Association senior vice president Gudrun Ravetz said: “We welcome the WHO continuing to tackle this serious global health issue. Their guidelines echo the guidance BVA has long been issuing on the responsible use of antimicrobials.
 
“We agree that the prophylactic use of antimicrobials in healthy animals to prevent disease is never a substitute for good animal husbandry and management.
 
“Through cross-sector working, the UK is leading the way in significantly reducing antimicrobial usage, having already achieved the UK Government usage targets set for 2020.
 
“Critically Important Antimicrobials use is at a very low level in the UK, and, as recent Government data shows, is continuing to decrease. It is encouraging that WHO recognises that these vital medicines are sometimes needed, under veterinary judgment and prescription, as a last resort, to prevent the further spread of disease and to protect animal and human health.”