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Antibiotics Resistance: Impact and Alternatives

Antibiotics Resistance: Impact and Alternatives. WORLD HEALTH DAY 2011. Endri Haxhiraj, MSc candidate e-mail: endri@iep-al.org. The Problem .

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Antibiotics Resistance: Impact and Alternatives

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  1. Antibiotics Resistance: Impact and Alternatives WORLD HEALTH DAY 2011 Endri Haxhiraj, MSc candidate e-mail: endri@iep-al.org

  2. The Problem There is a growing concern that the use of antimicrobial drugs in veterinary medicine and animal husbandry may compromise human health if resistant bacteria develop in animals and are transferred to humans via the food chain or the environment… OIE (15) The emergence and the spread of resistance to antimicrobials in bacteria pose a threat to human and animal health and present a major financial cost… EFSA (2) “The use of antimicrobials in animals is an important factor in the development of resistance in some organisms, particularly those organisms associated with food poisoning in man” The UK’s Veterinary Medicine Directorate, 2010

  3. Print media Pathogens resistant to antibiotics, one of the most serious concerns for our health Gazeta STANDARD 15 Gusht 2010

  4. Print media Gazeta Shqip17 Gusht 2010 ALARM FOR: “THE UNDEFEATED SUPER BACTERIUM”

  5. Facts …there were 18,000 deaths (USA) in 2005 alone, that were caused by antibiotic resistant Staphylococcus aureus infections, a number higher than the number of HIV/AIDS related deaths. Infectious Diseases Society of America The use of Apovarcine as a promoter of growth in  poultry selected for enterococci that are resistant to all glikopeptids (a group of antibiotics). Vankomicine is part of this group (antibiotic of last hope for some diseases). The same clone of Vankomicine-resistant enterococci has been found in animals and people (3). NRC(3)

  6. Actual situation Anyone can go to a veterinary pharmacy and get every kind of antibiotics without veterinary supervision or other measures. Around half of the quantity of antibiotics produced in the world, is added in animals feed (for farm animals) (13), with a large proportion of antibiotics being administered in sub-therapeutic doses, not to treat diseases but to promote growth (16). Antibiotics given to animals via food or water can be dispersed through excretion, thus increasing the bacterial resistance to antibiotics(3) and the number of the resistant bacteria in the environment (9). According to some studies, antibiotic resistance is regularly occurring in hospitals (12).

  7. How did it happen? Sub-therapeutic doses of antibiotics are given to farm animals in their food and water: • To adapt to stressful environment; • To promote rapid growth;  • To “control” the level of infection and diseases in farm animals; • Because they are perceived as very useful during intensive breeding or transport (3); • Because it is considered to improve the farm’s performance when the conditions are poor: i.e. when the animal is in poor health and the living conditions are unhygienic (14). Distortion of the normal bacterial flora and promotion of bacterial resistance: • Microbial pathogens suit (as in the case of resistance to antibiotics) to new environmental conditions (5); • Create a selective pressure on bacteria, causing the development of resistance to antibiotics (6); • Bacterial pathogens that survive in the internal organs of the animal, and fed with extra antibiotics, are resistant strains (7).

  8. How does it spread? Possible ways antibiotics resistant bacteria can reach humans: • Contaminated meat;  • Transfer of antibiotic resistant genes to other strains of bacteria that infect humans;  • From humans infected with these strains (e.g., employees of slaughterhouses, manufacturers and farmers) and;  • Indirectly through the environment (8) (e.g. passage of tetracycline resistance genes from hog waste lagoons into groundwater wells) (17).

  9. Antibiotic resistance strains impact When antibiotic-resistant bacteria reach humans or other animals : • Treatment with the same antibiotic is useless;  • The infection is aggravated in elderly, children and individuals with suppressed immunity; • Choosing a suitable antibiotic can be difficult for some bacteria that are resistant to more than one antibiotic (7) (10); • A less treated infection or not treated at all increases the risk for the patient to die; • Long periods of infection increase the community health risks in public places, where the infected individual interact with other people; • New antibiotics (patents) inventions are required (11). These new alternatives, less studied, can be toxic, have serious side effects or are less effective (12); • Antibiotic resistant bacteria can overcome human and animals resistance, causing diseases that are not easy to cure (3); • More expensive hospital stays (4).

  10. 3 Practical Alternatives • Alternativesto antibiotics must gain interest and be developed. These alternatives offer similar effect, and economical values (e.g. probiotics and prebiotics). • Animal welfare improvement, which means – welfare principles: reduction of overcrowding conditions, general hygiene, and infection control techniques. • Since 2006, the EU has banned the use of antibiotics in growth promotion (14).. Measures of this level must be undertaken as soon as possible in countries like Albania.

  11. Conclusions • Action plan is needed, looking at the international approach; • Educational campaigns in different levels; • Strengthening of the legislation; • Governmental and NGOs involvement; • Follow of successful examples, e.g. Swedish animal farming.

  12. References 1- Haxhiraj, E, The Secret of Emerging Diseases, Albania 2010, Biblioteka Kombetare, Book, 19-21. 2- EFSA Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) ; Technical guidance - Update of the criteria used in the assessment of bacterial resistance to antibiotics of human or veterinary importance [1];EFSA-Q-2008-004 3- National Research Council, NRC (National Research Council, National Academy of Sciences). (1980). The effects on human health of subtherapeutic use of antimicrobials in animal feeds. Committee to Study the Human Health Effects of Subtherapeutic Antibiotic Use in Animal Feeds, Division of Medical Sciences, Assembly of Life Sciences. Washington, DC: National Academy of Sciences, Office of Publications and NRC (National Research Council, National Academy of Sciences). (1999). The use of drugs in food animals: Benefits and risks. Washington, DC: National Academy Press. 4- CDC, webpage, http://www.cdc.gov/drugresistance/about.html 5- Lindsay, J.A. (1997). Chronic Sequelae of Foodborne Disease. Emerging Infectious Diseases. Atlanta: Centers for Disease Control and Prevention. On line: http://www.cdc.gov/ncidod/EID/vol3no4/lindsay.htm 6- JSC (Joint (Swann) Committee). (1960). The Use of Antibiotics in Animal Husbandry and Veterinary Medicine. Report to Parliament. London: Her Majesty’s Stationery Office. 7- Levy, S. (1998, May 7). Multidrug resistance – A sign of the times. The New England Journal of Medicine (338), 19, 1376-1378. 8- Franklin, A. (1997, November 13). Antibiotic resistance in animal production: A threat to human and animal health. Scheele Symposium, 1997. The threat of antibiotics resistance: A Nordic perspective. Stockholm: Swedish Academy of Pharmaceutical Sciences. 9- Kolpin, D., Riley, D., Meyer, M.T., Weyer, P., Thurman, M. Pharm-chemical contamination: A reconnaissance for antibiotics in Iowa streams, 1999. Workbook for the AFO Workshop. Animal Feeding Operations: Effects on hydrologic resources and the environment. August 30-September 1, Fort Collins, Colorado. U.S. Geological Survey 10- MMWR. (1997, April 11). Multidrug-resistant salmonella serotype typhimurium – United States 1996. Morbidity and Mortalities Weekly Review 46(14), 308-310. 11- Salyers, A. (1995). Antibiotic resistance transfer in the mammalian intestinal tract: Implications for human health, food safety and biotechnology. Molecular Biology Intelligence Unit. Austin, TX: R.G. Landes Company. 12- Wegener, H.C. (1999, May 20). The consequences for food safety of the use of fluoroquinolones in food animals. The New England Journal of Medicine (340),20, 1581-1582. 12 (a)- Huovinen, P. (1997, November 13). Immediate need for antibiotic policy in the community. Scheele Symposium, 1997, The threat of antibiotics resistance: A Nordic perspective. Stockholm: Swedish Academy of Pharmaceutical Sciences. 13-CIWF website, http://www.ciwf.org.uk/news/factory_farming/defra_decision_increases_risks_to_human_health.aspx 14-Hughes P and Heritage J, Assessing quality and safety of animal feeds, FAO article, Antibiotic growth-promoters in food animals, ftp://ftp.fao.org/docrep/fao/007/y5159e/y5159e05.pdf. 15-OIE website, http://www.oie.int/en/for-the-media/press-releases/detail/article/veterinary-services-in-africa-strengthen-their-solidarity-by-establishing-a-regional-representation/ 16- World Health Organization, 1996 report, 'Fighting Disease, Fostering Development', 17-University of Illinois, Applied Environmental Microbiology, 2007

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