Doctors are losing resources in the fight against antimicrobial resistance
A blog post by Doctors for Greener Healthcare (DfGH) member Dr Tomica Ancevski, Specialist of internal medicine, General Hospital Kumanovo, North Macedonia
We are still figuring out the full impact of COVID-19, but we urgently need to also assess a significant growing threat to global health - antimicrobial resistance (AMR). In 2019, AMR killed more than one million people, making it one of the leading causes of death globally.
As doctors, we use all available resources to treat our patients and secure the best possible outcome for them. Antimicrobials are one of the greatest achievements in medicine and losing their efficacy is therefore one of the greatest threats to our health.
Human lives are increasingly lost to resistant infections as the effectiveness of antimicrobials is declining. We need to change our relationship with antimicrobials to preserve them as the essential tool they are.
Setting our priorities straight
Antimicrobials are a shared tool for the treatment of infections in human and animal health. This means that the same antibiotics that save human lives are also used in animals, not only companion animals, but also those intended for food production. Unfortunately, many of the antimicrobials that are being used in farming are not strictly used to treat infections or are not used responsibly – they often serve as a tool to compensate for poor farming practices.
A recent 43% decrease of antimicrobials used in animals in Europe between 2011 - 2020 suggests that there is still room to decrease antimicrobial consumption by promoting prudent use in farming. Intensive farming practices lead to increased productivity, but this is linked to a higher, unsustainable consumption of antimicrobials.
Human lives are increasingly lost to resistant infections as the effectiveness of antimicrobials is declining. We need to change our relationship with antimicrobials to preserve them as the essential tool they are.
This is particularly worrying when it comes to the so-called “last-resort” antimicrobials. The WHO has designated five antimicrobial classes as Highest Priority Critically Important Antimicrobials for human health (HPCIAs) - they are considered critical for human health and our last line in the defence against bacterial infections. In 2018, 14% of antimicrobials sold for animal use in Europe were HPCIAs. The drug colistin (a polymyxin), is of particular concern - 99% of colistin sold for veterinary use was in forms suitable for group treatment, mainly used to indiscriminately treat infections in large groups, typically caused by early weaning in piglets. Despite the fact that these infections can usually be mitigated or avoided through non-therapeutic practices.
Not only has colistin consumption increased by 67% in European hospitals between 2011-2020, but we’ve also seen a significant increase in carbapenem-resistant E.Coli bacteria from 2016 to 2020. Both these factors indicate that colistin is becoming an increasingly important treatment against resistant infections in humans. Yet the overuse and misuse of colistin in farming seriously threatens its clinical utility. Evidence also suggests that colistin-resistant bacteria spread from animals to humans.
Continuing the irresponsible use of last resort antimicrobials in animal farming risks a significant loss of a crucial live-saving resources and threatens to accelerate a large-scale global health crisis, leading to more preventable deaths.
Systemic change is needed
This trend is not irreparable. The prudent use of antimicrobials reduces resistant bacteria, so it might not be too late to preserve the efficacy of colistin, but we need to change the way we use antimicrobials in food production.
Continuing the irresponsible use of last resort antimicrobials in animal farming risks a significant loss of a crucial live-saving resources and threatens to accelerate a large-scale global health crisis, leading to more preventable deaths.
We already see positive trends in the use of colistin in EU food production, with Italy and Spain dramatically decreasing its use in the last 10 years, but more work needs to be done. Colistin is banned in food production in countries such as Australia, Argentina, and India to preserve its effectiveness so that it can treat potentially deadly infections in humans. The EU had the chance to preserve the efficiency of this antimicrobial but failed to reserve colistin for human health and continues allowing its use in animals.
This raises serious questions about the efficiency of EU legislation to preserve critically important antimicrobials. None of the antimicrobials reserved for human health are being used in food production in Europe and only one of the five HPCIAs was proposed to be reserved for human use only. We need effective action against antimicrobial resistance - we are watching a new global health crisis in the making.
