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The overuse and abuse of antibiotics strengthens lethal, drug-resistant bacteria.
The world was once a place where a bad cut to your hand meant infection and the possibility of death, and surgical procedures that are now routine were life-threatening.
Poverty and poor healthcare infrastructure means this is still a reality in many parts of the world.
But even the future of wealthy countries could look a lot like the past. Medical experts and economists are warning that the rise of antimicrobial resistance (AMR), particularly to antibiotic drugs, could see as many as 10-million people die each year by 2050 and wipe out a cumulative $100-trillion in economic output.
These were the findings of a review on AMR, chaired by economist Jim O’Neill, famous for coining the term Bric with reference to the emerging economies of Brazil, Russia, India and China.
One of the key issues highlighted by the review was the unnecessary use of antibiotics in agriculture, which is unmonitored in many countries. The drugs used to treat animals and also to promote their growth are often important for human health.
In the United States, about 70% of antibiotics classed as medically important to humans are sold for use in animals, according to the review.
The inappropriate use of antibiotics is dangerous for both human and animal health because it is one of the factors driving AMR. It also has serious implications for food security and farmers’ economic wellbeing.
The estimates of global antibiotic consumption in agriculture vary considerably because of poor surveillance and data collection in many countries.
Figures range from 63 000 tonnes each year to more than 240 000 tonnes. But the review notes it is clear that use is widespread, on a scale “at least equivalent to humans”, and will rise.
The review cited estimates that the use of antibiotics in agriculture will rise by 67% between 2010 and 2030, and, in the Brics countries (including South Africa), it will increase by 99%.
The use of antibiotics to promote growth is a particular concern, with the report recommending the introduction of targets that will allow countries to decide how they can best reduce unnecessary use in farming.
In South Africa, there is little data available on the extent of antibiotic use in the production of pork, beef and poultry. Medical and veterinary experts believe that South Africa’s use reflects global trends.
According to Professor Moritz van Vuuren, a veterinary microbiologist in the faculty of veterinary sciences at the University of Pretoria, antibiotics are used for treating disease, preventing its spread and for growth promotion, with about 80% of antibiotics sold mixed into animal feed and water. About 20% are administered topically or by injection.
Of the 80% antibiotics mixed into feed and water, it is not clear how much is used for growth promotion.
“That kind of surveillance needs to be done in the future,” said Van Vuuren, “but you can take it for granted that a sizeable proportion is used for growth promotion.”
Antibiotics should only be used to treat sick animals and, where appropriate, to prevent the spread of disease, he said. But the prophylactic use of antibiotics – giving healthy animals drugs to prevent them getting sick – must be avoided.
Globally, there is a move away from the use of drugs to promote growth, a trend South Africa is likely to follow.
The difficulty of monitoring the extent of antibiotic use in agricultural comes down to cost; surveillance programmes are expensive and require a partnership between the government and other role players, he said.
The laws that govern how antibiotics are dispensed to farmers also play a role in how they are used. Two Acts govern veterinary medicines – the Fertilizers, Farm Feeds, Agricultural Remedies and Stock Remedies Act of 1947 and the Medicines Control Act of 1965.
Under the stock remedies Act, farmers can buy some antibiotics over the counter to use as they see fit and without the guidance of a veterinarian. The intention of the Act was to enable farmers in rural areas, with little or no veterinary services, to get access to medicines.
Over time, the list of over-the-counter antibiotics has expanded and includes a major group of antibiotics that can be used to promote growth, Van Vuuren said.
There is much debate in the sector about changing this, but South Africa is a developing country and many farmers still don’t have veterinary services, he said.
There is a tension between access and excess, which is pertinent for a country that has roughly 35 000 commercial farmers, between two and three million small-scale farmers, and eight- to 10-million subsistence farmers, Van Vuuren said.
The Medicines Control Act covers scheduled antibiotics, and only veterinarians can prescribe and dispense them.
Some more modern antibiotics are not registered for use in animals, Van Vuuren said.
Antibiotic use selects out resistant bacteria in animals, just as it does in humans, said Professor Marc Mendelson, co-chairperson of the South African Antibiotic Stewardship Programme.
“The more antibiotics are used, the more resistant strains are selected out and therefore can be transferred to humans during the journey from production to plate,” he said. Antibiotic residues end up in meat, and antibiotic residues and antibiotic-resistant bacteria enter the environment.
But the rise of AMR cannot be attributed to the use of antibiotics in agriculture alone.
The misuse of these drugs in human medicine is also a major contributor to resistance. It requires a global awareness campaign about antibiotic misuse and overuse in human and animal health, and in all other walks of life that introduce resistant bacteria into the environment, Mendelson said.
One of the few surveillance programmes of AMR in South Africa is provided by V-Tech, a veterinary pharmaceutical firm. The programme began in 2006 and covers poultry farms, cattle feedlots and piggeries countrywide, according to V-Tech’s chief executive and veterinarian, Johan Oosthuyse.
Earlier this year, the programme identified increasing cases of Colistin-resistant bacteria in poultry farms.
The early generation antibiotic, once not recommended for use in humans, has become a drug of “last resort”, because organisms have adapted to newer classes of antibiotics, leading to the rise of so-called superbugs.
Mendelson explained that a new mechanism to transfer a Colistin-resistant gene known as MCR-1 has been identified in bacteria, first in feed animals in China and later in other countries, including South Africa.
There is also a concern that this gene can now be transferred between different types of bacteria that cause more serious diseases in animals, and, according to Oosthuyse, potentially humans.
The cost and implication of reducing reliance on antibiotics in agriculture needs further exploration. The O’Neill review acknowledged the significant gaps in data for both surveillance of antibiotic use in agriculture and the economic costs.
It did note that a 2015 study by the US department of agriculture showed that producers that use antibiotics for production rather than treatment would suffer a decline of less than 1% in the value of what they produced.
The ability of the local agricultural sector to reduce its reliance on antibiotics can be done with better biosecurity or actions that safeguard the health of farm animals, Van Vuuren said. These include vaccinations, optimal nutrition for animals and access control on farms.
But the total elimination of antibiotics in agriculture is unrealistic, Oosthuyse said. South Africa has a “high animal disease challenge”, which is aggravated by informal farming.
The department of agriculture, forestry and fisheries did not respond to requests for comment.
Poultry industry wants responsible use of antibiotics
Chicken is a much-loved source of protein for South Africans. Antibiotics are commonly used both for preventing and treating disease and to improve growth, according to Dr Charlotte Nkuna, senior executive at the South African Poultry Association.
Growth promoters are simply a class of antimicrobials, not used in human medicine, to help manage the gut health of poultry. Better growth results because birds with healthier guts are able to use their food more effectively.
The organisation discourages the routine use of antimicrobials for prophylactic purposes unless a diagnosed disease is being managed, she said.
Farmers should monitor the effectiveness of the drugs used and avoid using the last-resort antimicrobials, unless the use of other drugs will prolong the disease.
Although Colistin was not used in poultry for many years, its use has increased after it was found to be more effective in treating some conditions.
Resistance is not unique to Colistin, Nkuna added, but the drug is used for the treatment of human conditions, which makes it a more serious issue.
The emphasis should not be on the reduction of antibiotic use in agriculture but on “responsible use”, she said.
Vaccines were alternatives for some diseases and there are alternatives for promoting gut health such as organic acids. Neutriciticals – herbal or natural products – are also being researched to assist in managing respiratory and gut health, Nkuna said. – Lynley Donnelly
The World Health Organisation has indicated that there are an increasingly limited number of antibiotics available to treat human diseases effectively, and have previously issued a list of critically-important medicines that need to be protected.
Click on the link below to watch an interview with V-Tech’s CEO, Johan Oosthyuse, discussing this subject on CNBC Africa.
The antimicrobial, Colistin, while not registered locally for human use, is said to be considered an important product in animal health and welfare when used prudently.
Animal pharmaceutical company, V-Tech, that developed and runs the AMR surveillance programme reportedly used by many poultry, feedlots and piggeries in SA, said that disease-causing bacteria’s resistance to Colistin was caused by the MCR-1 gene.
“What is worrying is that this gene is already being transmitted between bacteria, such as E. coli, which can cause urinary tract and many other types of infection, and Klebsiella pneumoniae, which causes pneumonia and other infections. This suggests the potential for it to spread between other bacterial populations, increasing the resistance to microbials, or antibiotics,” said V-Tech’s CEO, Johan Oosthuyse, in a statement.
V-Tech said that it had now amended its AMR surveillance programme to include routine scanning for the MCR-1 gene. This would enable the company to advise livestock operations where the gene was identified not to use Colistin, but instead to use alternative antimicrobials.
“A strict protocol for veterinarians to prescribe Colistin for use in animals in future will be presented by V-Tech to the Department of Health by the end of January 2016. This will limit the risk of further spread of the MCR-1 gene and the resultant risk to humans, which is of concern given the increasing threat of AMR,” Oosthuyse said.
Superbugs with an alarming gene have been found in South Africa in sick and dead poultry.
The bacteria are resistant to colistin, a last-resort antibiotic for humans, and have been multiplying rapidly in South Africa since 2014. The discovery of the MCR-1 gene, which makes common bacteria resistant to colistin, has raised global concerns for human health.
The MCR-1 gene in the superbugs in South Africa – identified for the first time in November in poultry and pigs in China – poses no immediate threat to consumers, since diseased birds do not go onto the shelves.
South African Poultry Association senior executive Dr Charlotte Nkuna said companies tested their birds at slaughter and retailers did regular audits on their products.
“People are unlikely to pick up anything and poultry has a mandatory withdrawal period from antibiotics before they are sold,” she said.
Resistant bacteria can spread to people through food and environmental contamination and humans can transmit them to animals.
In South Africa, the animal health company V-Tech – which has an antimicrobial resistance surveillance programme used by poultry producers, piggeries and feedlots – noted increasing colistin resistance but did not know the reason for this.
V-Tech CEO Johan Oosthuyse said: “There was a pattern of very low resistance to colistin, at about 2% to 4%, until about two years ago, when we started seeing resistance creeping up to just above 13%.
“As soon as The Lancet journal published the information about the gene, we took the resistant bacteria we had kept frozen and sent samples to the University of Bern in Switzerland.” The first results came back in January: 19 out of 25 samples with colistin resistance had the MCR-1 gene. The second batch of results came back this week: eight out of 15 samples had the gene.
“That would mean that around 6% of the sick or dead birds tested had E coli bacteria with the MCR-1 gene,” said Oosthuyse.
Professor Vincent Perreten at the Institute of Veterinary Bacteriology at the University of Bern who confirmed the MCR-1 gene in the samples, said the South African poultry industry was being proactive and courageous by sharing the results.
Theo Delport, MD of the poultry division for Astral, said: “For the past five to six years, sensitivity tests done on E colibacteria isolated from Astral’s operation have shown that colistin was a drug of choice.”
Veterinary microbiologist Moritz van Vuuren, professor emeritus at the University of Pretoria, said: “Bacteria resistant to colistin have always been present but the rate of resistance has increased, and, unfortunately, bacteria that carry mobile resistance genes against colistin.”
The scientists who picked up the gene in China reported that it can spread easily from one strain of bacteria to another.
“The MCR-1 gene is already being transmitted between common bacteria such as E coli, which can cause urinary tract and many other types of infection, and Klebsiella pneumoniae, which causes pneumonia and other infections,” Oosthuyse warned.
V-Tech has found lots of resistant bacteria among 4000 bacteria tested over the past five years but the colistin-resistant bacteria raised a red flag because colistin is critical in human medicine. In response to this threat, V-Tech stopped supplying colistin to farms where resistance to the antibiotic had been confirmed and it added routine scanning for the MCR-1 gene.
More than 60% of poultry producers in South Africa, including major producers such as Astral Foods, RLC Foods and Country Bird, use its surveillance programme.
Oosthuyse said: “A total ban on colistin use in animals will negatively impact meat production.”
Registrar of medicines Dr Joey Gouws said colistin use in humans and animals had been discussed at meetings in November and February and the matter was complex.
“The council [Medicines Control Council] required additional work and investigations to allow for further discussions [at a meeting] in June,” she said.
Department of Health spokesman Popo Maja said the department was very worried about antimicrobial resistance which, if not attended to, would become “an emerging catastrophe for human health”.
Detected in China in November 2015, the Colistin resistant bacteria has been identified in South Africa by animal pharmaceutical company, V-Tech. The company has extensive national antimicrobial resistance (AMR) surveillance programmes, used by poultry producers, feedlots and piggeries in South Africa.
© decade3d – 123RF.com
A new gene, which makes bacteria highly resistant to Colistin, what is commonly considered an antimicrobial of ‘last resort’, was found in poultry, pigs and people in China late last year and has already spread to other parts of Asia, as well as Europe and Africa, including the UK and Malaysia.
“What is worrying is that this gene, known as the MCR-1 gene, is already being transmitted between common bacteria such as E.coli, which can cause urinary tract and many other types of infection, and Klesbsiella pneumoniae, which causes pneumonia and other infections. This suggests the potential for it to spread between other bacterial populations, increasing the resistance to antimicrobials, or antibiotics,” says V-Tech CEO, Johan Oosthuyse.
This also comes at a time when concerns have been raised by the South African Poultry Association about poultry health standards in South Africa, as a result of the renewed terms of the African Growth and Opportunity Act (AGOA), strengthening the argument for surveillance programmes such as V-Tech’s, currently the only one of its kind in South Africa.
For the past eight years, V-Tech has conducted extensive surveillance of the use of antimicrobials in animals, and has promoted the responsible use of antimicrobials in animals. “Over 60% of poultry producers in the country use our surveillance programme, in which we manage the types of antimicrobials prescribed, the time needed to medicate the animals properly and the correct dosage to use.”
With this in mind, as soon as the threat of Colistin resistance was identified, V-Tech collaborated with bacteriologists in Switzerland and started developing a test to identify its presence using E.coli samples in its library. “As a result, we identified the presence of the MCR-1 gene in samples that have been collected from a number of South African poultry farms in the last quarter of 2015, as part of our programme.”
V-Tech has subsequently amended the surveillance programme to scan for the MCR-1 gene as routine going forward. This will enable the early identification of the E.coli that carries the gene and prevent the use of Colistin on farms where bacteria with the gene are present.
Oosthuyse says that Colistin may only be used in animals if prescribed by a veterinarian. “A strict protocol for veterinarians to prescribe Colistin for use in animals in future will be presented by V-Tech to the Department of Health by the end of January 2016. This will limit the risk of further spread of the MCR-1 gene and the resultant risk to humans, which is of concern given the increasing threat of AMR.”
He adds that V-Tech supports the prudent use of Colistin in animals. “Colistin remains an important antimicrobial in animal health and welfare and a total ban on its use in animals will negatively impact meat production, as there will be fewer treatment options available for sick animals. This will lead to even higher prices for meat and poultry, negatively impacting the consumer, who is already under severe pressure as a result of local economic conditions.”
Bloemfontein – An animal pharmaceutical company intends briefing the Department of Health by the end of the month on a strict new veterinary protocol it believes necessary to regulate the use of the antibiotic colistin.
Farmer’s Weekly reports that V-Tech, which also conducts surveillance of antimicrobial resistance (AMR), has identified and confirmed the first ever known case in South Africa of resistance to colistin.
The report states that bacterial resistance to colistin is caused by the MCR-1 gene. V-Tech CEO Johan Oosthyse said in a statement it is especially worrying that this gene is already being transmitted between bacteria such as E. coli and Klebsiella pneumoniae.
The AMR surveillance programme is utilised by numerous poultry producers, piggeries and feedlots across South Africa. V-Tech says it intends amending the programme to include routine surveillance for the MCR-1 gene so that alternate antimicrobials can be used if the gene is present.
Oosthyse says they also intend going to Government with new protocols for veterinarians prescribing Colistin in future so as to limit risks of spreading the gene, as well as limiting risks to humans.
What is the Rhino Orphanage?
“The Rhino Orphanage is a registered non-profit company based in the Limpopo Province and was founded by Arrie van Deventer in 2012. The orphanage is the first specialist, dedicated, non-commercial centre that cares for orphaned and injured baby rhinos with the only aim of releasing them back into the wild. It was created as the result of a lack of a specialized place for rearing baby rhinos who have been orphaned as a consequence of the current poaching crisis which feeds the illegal trade in horns.” http://therhinoorphanage.co.za/?gclid=CjwKEAjws7OwBRCn2Ome5tPP8gESJAAfopWsA-XDgXaFBu44iMnLQbKb7OKGrJo92u02yF8MAs_mbRoCqJzw_wcB
V-Tech is a supporter of the Rhino Orphanage and recently donated some Biotizer to them. Biotizer is a blend of lysed Lactobacillus Acidophilus and Bifidium bacteria in a palatable carrier with a bacteria count of approximately 8 billion per ml. The bacteria are extensively used in both humans and animals and are produced by the Agricultural Research Council, Irene, South Africa. The bacteria found in Biotizer plays a major role in aiding digestion and reducing excessive gas and acids, and weight gain.
For more information on the Rhino Orphanage visit their website or Facebook page.