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EUROTIER: Seeking Solutions to Antibiotic Resistance

13 November 2014

GERMANY - At an event at EuroTier 2014 in Hanover this week, the President of the German veterinarians' association offered his views on possible solutions to the issue of antibiotic resistance.

The use of antibiotics in productive livestock keeping, how to manage antibiotic resistance and how to organise an effective antibiotic monitoring system: these are all important matters of current concern to practising veterinary surgeons, not only in Germany but throughout Europe, said Dr. vet. med. Hans-Joachim Götz, President of the German Federal Association of Practising Veterinary Surgeons (bpt).

The reason is that the risks posed to human health by antibiotic-resistant germs require ever more urgent solutions. One measure of the seriousness of the situation is that Germany will place 'Antimicrobial Resistance' at the centre of its G7 presidency next year.

While research continues into whether and how resistant bacteria can be passed between humans and animals, the decisive criterion for the public and politicians is the quantity of antibiotics needed to select resistant bacteria. Veterinary medicine is blamed, due to its presumed excessive and non-specific use of antibiotics, although the disturbing level of resistance in human medicine is the direct consequence of the high rate at which medical practitioners have for years prescribed antibiotics to their human patients.

How then can this problem be successfully overcome? Usually, the selective pressure on antimicrobial resistance occurs at the point where the relevant antibiotics are used. The most important factors, present in equal measure in both human and veterinary medicine, are poor hygiene in hospitals and animal housing, treatment courses for human patients or animals which are either abandoned too early or where the prescribed doses of antibiotics are too low, and the use of an ineffective antibiotic because the bacterium has not been definitively identified. Consequently, reducing antibiotic use will not, of itself, solve the problem despite the constant emphasis placed on this by politicians and the media.

If the German Federal Association of Practising Veterinary Surgeons (bpt) were to have its way, continued Dr Götz, veterinary surgeons and doctors would together, as part of the EU Commission's Anti-Microbial Resistance (AMR) action plan and of the German Antibiotics Resistance Strategy (DART), commit themselves to using antibiotics only in accordance with the guidelines and under controlled conditions, and would develop effective solutions to be communicated to veterinary surgeons and doctors via the relevant channels, so as to enlist their support for the degree of care, attention and responsibility required.

Particularly as regards the MRSA problem but also in respect of the transmission of other resistant bacteria, hospital hygiene, which must urgently be given greater priority, is the key to success. Equally, the aim of 21st century animal health policy must be to avoid disease by means of preventive action such as inoculation and hygiene measures and by better farm management and improving the conditions in which animals are kept. If, despite all these efforts, disease occurs in herds and flocks, the governing principle must be that sick animals are also entitled to be treated whenever necessary. Anything else could not be reconciled with animal welfare needs and with responsible animal husbandry methods. Antibiotics, especially reserve antibiotics, should however only be employed after considering their therapeutic efficacy and taking the possible selection of antimicrobial resistance into account.

To achieve this, the 16th amendment to the German Medicines Law, which came into force in Germany in the spring, created an antibiotics minimisation concept which leads the way not just throughout Europe but world-wide.

The bpt had argued strongly for this amendment because the new statutory provisions will, for the first time, allow farms and supervisory agencies to know the frequency with which antibiotic therapies are employed in each type of farming operation. At the same time, livestock farmers will be able to use data covering the whole country to make comparative assessments of their own position and the authorities will be made aware, in the form of a risk alert, of farms where monitoring measures need to be reviewed.

That, in the opinion of the bpt, is the right approach to permanently reducing the use of antibiotics in livestock farming and thus to being able to minimise the risk of the emergence and spread of antibiotic resistance. However, this minimisation concept has not yet been put into practice. Hopefully, as of the beginning of next year, good practice should follow on from this excellent theory.

"Antibiotic use monitoring now covers 95 per cent of poultry farms and some 90 per cent of pig rearing operations in Germany."

All the more significant is the comprehensive antibiotic monitoring currently undertaken by the poultry and pig fattening industries; long before any monitoring by government agencies, this monitoring arrangement was established through the quality assurance system arranged by the private sector on the initiative of the bpt and the German Farmers Association.

Antibiotic use monitoring now covers 95 per cent of poultry farms and some 90 per cent of pig rearing operations in Germany. As a consequence, the analysis to be carried out at the end of 2014 will, for the first time, produce a comprehensive picture of the use of antibiotics in poultry and pigs. The positive aspect is that quality assurance monitoring will provide farmers and veterinary surgeons with genuine benchmarking or the ability to 'learn from the best'.

The pressure from the added-value chain on major users of antibiotics will do the rest, according to Dr Götz. This is yet another reason why the bpt is convinced that it is important to introduce a European system to monitor antibiotic use. The new version of the animal medicines law recently put forward by the European Commission should be further improved to include this aspect.

However, at both national and EU level, there must under no circumstances be a competition to outdo each other in setting ambitious antibiotic reduction goals, said Dr Götz.

He continued: "Specialist expertise must be at the heart of any decisions about the sustained reduction in antibiotic use. Animal health must be maintained or improved. This essentially requires all therapy options to be retained, including the use of an alternative medication or the use of reserve antibiotics.

"Only the results produced by an effective monitoring system will allow the use of antibiotics to be minimised without impacting animal welfare standards. This could be reinforced and made permanent by legislation requiring mandatory veterinary monitoring of productive livestock farmers," concluded Dr Götz.

Antimicrobial Resistance

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