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Vets calls for proportionate response to Chinese antibiotic resistance findings

The British Veterinary Association acknowledged a risk assessment is likely to be carried after worrying new findings of resistance in a Chinese study but said this should not lead to the withdrawal of antibiotics.
The Chinese study found new evidence of drug resistance in pigs
The Chinese study found new evidence of drug resistance in pigs

The British Veterinary Association (BVA) has called for a proportionate response to worrying new evidence of antibiotic resistance to a key group of drugs used to treat humans and livestock.


A study in China published last week found high levels of antimicrobial resistance (AMR) to an important antibiotic, colistin, used to treat E.coli on farms and in human patients.


The study prompted fresh warnings the world could be on the brink of a ‘post-antibiotic’ era and renewed scrutiny over the use of drugs in livestock also used to treat humans.


Prof Timothy Walsh, University of Cardiff, who collaborated on the study, was reported to be meeting China’s agricultural and health ministries to discuss whether colistin should be banned for agricultural use.


Prof Laura Piddock, from Antibiotic Action, said the same antibiotics ‘should not be used in veterinary and human medicine’.

Risk assessments

BVA senior vice-president John Blackwell acknowledged, in light of the evidence, ‘it would be pragmatic to carry out new risk assessments’.


But he added: "Yet this shouldn’t create a reaction that leads to the withdrawal of antibiotic use in animals as it is essential to maintain the health and welfare of both companion and food animals.


"Rather the China study reinforces the need for responsible antibiotic use in both human and animal medicine."


John Fitzgerald, general secretary of the Responsible Use of Medicines in Animals, agreed it was likely the use of colistin in food-producing animals would be re-evaluated.


He said: In 2013, a group of veterinary and human medical experts found that on the scientific evidence available there was no evidence to show use of colistin in veterinary medicine had resulted in transfer of colistin resistance from animals to people or vice-versa.


"However, the group stated that if horizontal transmission of colistin resistance was found (this is what was reported in the Chinese study) then a new risk assessment would be needed."

Is the use of ‘critically important’ antibiotics rising in UK livestock?

The pressure was further ratcheted up this week when a coalition of senior figures from the medical profession and groups campaigning on antibiotics called for an end to ‘routine, purely preventative antibiotic use in groups of healthy animals’.


In a letter to The Times, the 20 signatories, who include the presidents of the Royal Society of Medicine and the UK Faculty of Public Health, citing figures in a Veterinary Medicines Directorate report suggesting antibiotic usage in livestock in the UK was on the rise.


The VMD report indicated:


  • Total UK veterinary sales in 2014 of antibiotics classified as ‘critically important in human medicine’ increased by 3 per cent to a record high
  • Veterinary sales of these antibiotics, the fluoroquinolones and the modern cephalosporins, have almost doubled since 2005
  • Total sales of antibiotics licensed for food animals only also increased by 4 per cent, according to the VMD report


Commenting on the figures, Mr Fitzgerlad said, when using the most appropriate measure for comparison, milligrams of antibiotic per kg livestock, Fluoroquinolones sales reduced slightly in 2014 compared with 2013 and third/fourth generation cephalosporins went up slightly. "Neither set a record high in the UK," he said.



He pointed out the letter to the Times discussed group medication of animal through in-feed and in-water medication.


Veterinary medicines for livestock containing Fluoroquinolones are available as in-water formulations but there are no in-feed formulations authorised.


There are no veterinary medicines for livestock containing third or fourth generation cephalosporins available in an in-feed or in-water formulation, he added.

Responsible use

Mr Blackwell said it was difficult to draw an appropriate comparison between human and animal use from sales figures alone.


He said BVA worked with our members within the wider veterinary community to promote the responsible use of antibiotics in all animals and had created ’clear prescribing guidance’.


It advises that ’certain critically-important antibiotics should not be used prophylactically or as a first line treatment and, preferably, following the culture of the organism involved and interpretation of its sensitivity profile’.


He cited the UK Government’s five-year AMR strategy which ‘clearly states AMR in human medicine is primarily the result of antibiotic use in people, rather than animals’.


But he said BVA recognised that the veterinary profession was ’part of a multidisciplinary approach to ensure effective stewardship of these important medicines for future generations’.

Resistance problem

The campaign to end preventative use of antibiotics has received the backing of Shadow Defra Secretary Kerry McCarthy.


She said: "If we are to truly tackle the resistance problem, which the Prime Minister has said he is committed to, routine dosing of groups of healthy animals must stop.”


A Defra spokesperson said: “Reducing the risk of animals developing antibiotic resistance is essential to ensure these medicines are effective in the fight against disease.


“That is why we are ensuring antibiotics are only used on farms when absolutely necessary."


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China study - the key findings

  • The study, published in the Lancet, found resistance in E coli isolates collected from more than one in five, 166 out of 804, animals tested between 2011 and 2014.
  • Resistance was found in 15 per cent of more than 500 samples of raw meat tested.
  • It was also found in 16 out of 1322 samples (1 per cent) of human inpatients with infection.
  • The researchers said the emergence of MCR-1, the resistance mechanism identified in the study, ‘heralds the breach of the last group of antibiotics, polymyxins, by plasmid-mediated resistance’.
  • While resistance to colistin has been detected before, this study prompted extra concern because of the way the mutation that causes the resistance is known to be easily shared between bacteria.
  • Although currently confined to China, the researchers warned MCR-1 was likely spread around the world and make previously treatable infection untreatable.
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