Saving antibiotics: Consumer right to know would protect public health

Antibiotics have saved millions of lives since their introduction more than 70 years ago. However, their vital role in treating human infections is now severely threatened by emergence of antibiotic resistance. As infectious disease physicians, we experience this problem firsthand as we witness patients suffering and sometimes dying from drug-resistant infections that cannot be stopped. Each year, antibiotic resistance in the United States claims 23,000 lives and results in $20 billion in excess health care costs. 

Emergence of new drug resistance has outpaced the discovery of new antibiotics. Thus, our most powerful immediate weapon against this crisis is judicious use of the antibiotics we have now. Health care facilities across the country are prioritizing antibiotic stewardship through educational initiatives as well as new policies to prevent the improper use of essential antimicrobials. These strategies are reducing the rates of drug-resistant infections in hospitalized patients. But antibiotic use in humans is just the tip of the iceberg.

Seventy percent of medically relevant antibiotics used in the U.S. are administered to livestock, often when they are not sick. For decades, antibiotics have been given to animals to speed up growth and allow for survival in crowded and unsanitary conditions.  Indiscriminate antibiotic use increases the prevalence of resistant bacteria in our soil, water and food supply. When resistant microbes are ingested, the genes that cause resistance are silently transmitted to our gut bacteria. Infections due to antibiotic-resistant bacteria are becoming more widespread and unpredictable. Curbing unnecessary antibiotic use in livestock is essential to protecting the efficacy of antibiotics when humans need them most.

California took the lead in tackling antibiotic use in livestock by approving Senate Bill 27 in October 2015. SB 27 restricts antibiotic use to livestock with an infection or recent exposure to one. Antibiotic use in chicken, cattle and pigs for growth promotion and blanket disease prevention is prohibited. This is an important step. However, raw meat purchased from outside the state is not subject to SB 27. In fact, antibiotic usage patterns for livestock nationally are not monitored, leaving the American public in the dark about how antibiotics are used to produce their food.

A proposed ordinance, sponsored by Supervisor Jeff Sheehy, gives San Francisco the first opportunity to collect and distribute antibiotic use information relating to the meat sold in The City’s stores. The ordinance would require large grocery store chains in our city to disclose the antibiotic use practices associated with raw meat or poultry sold in their stores. This information would be publicly available, empowering consumers with data to make informed food choices and potentially motivating innovative new solutions for decreasing unnecessary prophylactic antibiotic use in animals.

Last January, our worst fears as infectious disease physicians were realized in Reno, Nev., where a woman died from a bacterial infection resistant to all approved antibiotics in the U.S. We exercise our power as consumers to stop the spread of antibiotic resistance. Supporting sensible reporting of antibiotic use in animals is a strong first step in controlling antimicrobial resistance in our community.
Chaz Langelier, MD, PhD, is an assistant professor in the Division of Infectious Diseases at UC San Francisco and a member of Bay Area Physicians for Social Responsibility. Erika Wallender MD, MPH, is an infectious diseases fellow at the UC San Francisco.

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