A coalition of 37 organizations, including the Food Animal Concerns Trust, has urged U.S. Secretary of Agriculture Tom Vilsack to adopt measures aimed at reducing the significant use of medically important antibiotics in food-animal production. The coalition’s case is that the coalition’s appeal brings national attention to a central public health debate. In fact, nearly two-thirds of all medically important antibiotics sold in the United States are used in agriculture. This creative effort aims to address the swell threat of antibiotic resistance. The frequent use of these antibiotics in livestock has aggravated the problem.
Our letter to Secretary Vilsack is a straightforward, clear ask. It demands that we ban the use of medically important antibiotics to prevent disease in food animals, permitting their use only when an illness is diagnosed. We know that this request, coming at the last minute, is a lot to ask. Yet recent statistics indicate that U.S. sales of antibiotics for use in animals increased by more than 10% from 2017-2021, compared to a downward trend in antibiotic use in food-animal production in Europe since 2010.
Growing Concern Over Antibiotic Resistance
Health organizations have warned for decades over the harmful effects of the overuse of antibiotics on food animals. They further caution that these practices are rapidly accelerating the emergence of antibiotic-resistant pathogens. “The spread of superbugs, and the threat it represents, cannot be slowed without curbing the overuse of antibiotics,” stated the coalition, emphasizing the need for immediate action to mitigate this public health crisis.
Reduce processing and use of antimicrobials solely to therapeutic need. Strengthen surveillance of agricultural antibiotic use, prioritize research into effective alternative disease prevention methods, and strengthen reporting requirements around antibiotic sales and usage.
“As Secretary, you have the opportunity using existing authorities to make our food system much safer by implementing these steps to stop the overuse of antibiotics by the meat industry that is leading to the spread of deadly antibiotic-resistant pathogens.” – Food Animal Concerns Trust and 36 other organizations
These four proposed measures will lay the groundwork towards a healthier, safer and more accountable food growing and production system. They address the growing danger of antibiotic resistance that is a clear and glaring threat to human health.
Inconsistent Adherence to Tamiflu Guidelines
A public health crisis recently came to light through a national survey. It demonstrated that less than half of pediatricians are prescribing oseltamivir (Tamiflu) to children hospitalized with influenza in accordance with national guidelines. According to guidelines from the American Academy of Pediatrics (AAP), all U.S. children hospitalized for influenza should receive oseltamivir during their hospital stays. Yet in a recent survey, clinicians were still only recommending the antiviral drug, 49.5% of the time.
The research surrounding this survey suggests a concerning discrepancy in inpatient oseltamivir treatment across pediatric patients. Almost all respondents expressed a desire for more robust evidence to justify treatment protocols. In fact, 87.4% would rate the importance of conducting an oseltamivir randomized trial in hospitalized children as moderate to extremely important.
“Most respondents (87.4%) believed a randomized trial of oseltamivir in hospitalized children was moderately to extremely important.” – authors
These differences in prescribing practices nationwide make one wonder how closely providers are following widely accepted guidelines. This alarming statistic underscores the importance of additional education and research to improve clinical management of influenza in pediatric patients.
Evaluating Remdesivir Use for COVID-19 Patients
A second storm has boiled up around the use of the antiviral remdesivir and what it means for their impact on hospitalized COVID-19 patients. The Aurora healthcare system in Minnesota did a study of its own on remdesivir. The results showed that restricting remdesivir increased the likelihood of death for patients with competent immune systems. The test study estimated the impact of 4,774 patients, comparing their 14-day risk of death before and after introducing restrictions on the use of remdesivir on patient outcomes.
Researches did not observe an increased risk of death. They did observe a surprising increase in ICU admissions and use of mechanical ventilation among patients treated with remdesivir following the intervention. This occurrence is probably due to a more high-risk patient population receiving remdesivir in that period.
“Remdesivir use was associated with an unexpected increased risk of ICU admission and MV within the post-intervention group only, which is likely explained by the higher-risk patient population that received remdesivir.” – study authors
HealthPartners researchers noted a lack of evidence supporting routine remdesivir use in the era of endemic SARS-CoV-2. This is especially important in light of the fact that the population is largely seropositive. This casts significant uncertainty on our continued dependence on this one antiviral drug. We need to keep judging how well it’s working and be open to changing our treatment protocols.
