Volume 1

Resistance to antibiotics and other antimicrobial agents / Select Committee on Science and Technology.

  • Great Britain. Parliament. House of Lords. Science and Technology Committee.
Date:
1998
Catalogue details

Licence: Open Government Licence

Credit: Resistance to antibiotics and other antimicrobial agents / Select Committee on Science and Technology. Source: Wellcome Collection.

    99/112 (page 97)
    be. Then, early this year, a ’phone call from Colindale alerted FDA to the emergence of ciprofloxacin resistance in S. typhimurium DT]04 inthe UK. Since then, FDA has issued tio more approvals for fluoroquinolones for animals; meanwhile, sure enough, 10 per cent resistance to fluoroquinolones has been found in Campylobacter, though none as yet in Salmonella. FDA are using DNA fingerprinting to see whether resistance in Campylobacter can be traced to poultry and sarafloxacin; they suspect so strongly, but have not yet proved it. 76. FDA believe that lives are not at risk; but Dr Sundlof frankly admitted that they are not sure, and they are very concerned. At the same time, they have no intention to deprive agriculture altogether of the benefits of antibiotics; they have to balance the interests of agriculture against those of public health, and, as Dr Sundlof explained, this is not easy. Interestingly, he did not consider that this was an issue which could safely be put to the people. The FDA has seconded someone to the UK CVL and PHLS to learn from our experience of fluoroquinolone use. In discussion at FDA, someone took us aback by asking simply, why the UK continues to approve fluoroquinolones for animal use, when the USA has stopped doing so on advice from British scientists. 77. Dr Tauxe expressed to us CDC’s serious concern over continued veterinary use of fluoroquinolones. He told us how Congress recently blew a large hole in the Swann regime by legislating to permit any antibiotic approved for use in one species, including man, to be used in any other. This enactment was promoted by the veterinary profession; it was resisted by CDC, who succeeded only in winning exceptions for the fluoroquinolones and the glycopeptides. 78. US agriculture uses around 16m Ib of antimicrobials for animals every year, of which CDC believes 40-80 per cent to be unnecessary. In Dr Tauxe’s view, antibiotics are being used as a “crutch” for otherwise impossibly intensive farming practices. He likened the modern farm to a nineteenth-century city before the revolution in sanitation and public health. He pointed to the example of Denmark, where by improved farming practice the level of Salmonella had been dramatically reduced without increasing costs. 79. Like the EU, the FDA has prohibited the growth promoter avoparcin. Dr Sundlof was unable to reveal the reason, but said that it was not fear of fostering resistance to other glycopeptides including vancomycin, though this fear would now deter the FDA from approving animal use of any glycopeptide. The USA has plenty of vancomycin-resistant bacteria as it is (see above, VISA and VRE). Dr Sundlof blames this on overuse of vancomycin in human medicine; but Dr Siegfried of PhRMA, who is personally “appalled” at the amount of antibiotics fed to animals, believes that there is significant illegal use of vancomycin in US agriculture, while Dr Levy believes that VRE originally reached the USA from Europe. 80. We raised at FDA the case of virginiamycin, which was approved for animal use before human use of cognate antibiotics became a possibility. Dr Sundlof replied that the FDA could not block all veterinary drugs for fear of compromising possible human uses of substances cognate to the drug in question but as yet undeveloped. They are trying to find ways to predict resistance in advance of approval, by examining data from clinical trials; but these are of limited predictive value. As Dr Sundlof put it, such cases present a “difficult regulatory challenge”; Dr Levy regards this issue as a major weakness in the Swann regime. 81. Until 1991, FDA approved most animal drugs for sale over the counter. All approvals since then have been for prescription only. The most vocal protesters have been the fish-farmers. We encountered widespread concern about the use of antibiotics in aquaculture (fish-farming); Dr Levy commended Norway for best practice in moving from overuse of antibiotics towards vaccines. 82. Several of those we met commended the conclusion of the recent WHO meeting on this issue in Berlin, that growth promoters should be progressively removed from the agricultural scene. Dr Levy described the meeting as a “historic moment”. In his view, the low-level long-term use of growth promoters is much more damaging than veterinary prophylaxis. He told us how Sweden banned all growth promoters at a stroke, without destroying Swedish agriculture. Sweden is a rich country, with a highly centralised agricultural industry; Dr Levy acknowledged that such a step would be much harder for, say, China. The agricultural industry has for too long “refused to admit that we are on the same planet’, and hidden behind the difficulty of proving that resistant strains induced in animals are the same as those which cause human disease (the “show me a dead body”