OPEN FORUM
Weak Links in the Food Chain
Antibiotic alert
Friday, February 21, 2003
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The serious outbreak of staphylococcus infections resistant to antibiotic treatment among gay men in San Francisco, especially those with HIV/AIDS ("Bacteria resisting drug treatment," Feb. 1), describes only the tip of the iceberg of an impending health crisis in the United States.
Antibiotic resistance is a growing health problem that threatens us all, but especially the approximately 900,000 people in the United States infected with HIV. People living with HIV/AIDS are at particular risk because HIV disrupts the body's own disease-fighting immune system.
Antibiotics are critically important for treating bacterial infections, which are a principal cause of death in AIDS patients worldwide. Protecting the efficacy of antibiotic drugs is critical for treating these infections in those living with HIV/AIDS.
For more than a half-century, antibiotic drugs have ensured that potentially life-threatening bacterial infections are treatable. Today, however, more and more bacterial infections fail to respond to antibiotic treatment. A federal task force recently warned that antibiotic resistance is "a growing menace to all people" and concluded that if nothing is done, treatments for common infections will become "increasingly limited and expensive -- and, in some cases, nonexistent."
The more an antibiotic is used, the more quickly bacteria mutate and develop resistance to the antibiotic. This resistance crisis is growing because of the overuse of antibiotics both in human medicine (the largest single cause of antibiotic resistance) and in animal agriculture (a lesser known but significant cause as well).
The medical community is starting to address this crisis by reducing inappropriate use of antibiotics. But we also need to address antibiotic resistance caused by the overuse of antibiotics in livestock and poultry. The Union of Concerned Scientists estimates that 24 million pounds of antibiotics are given to these animals each year in the United States to prevent them from getting sick in the unhealthy conditions typical of factory farms.
About half of those drugs are identical or closely related to medicines used in treating humans. This misuse speeds the development of antibiotic- resistant bacteria in the beef, pork and poultry that many Americans eat regularly. A recent study published in the January issue of Consumer Reports found that 40 percent of the chickens tested in supermarkets nationwide were contaminated with campylobacter and/or salmonella bacteria that were resistant to one or more antibiotics.
Compared with healthy people, those with HIV are at greater risk of developing serious food-borne bacterial infections. AIDS patients are particularly prone to getting salmonella infections, which kill about 1,000 people a year in the United States, according to the Centers for Disease Control and Prevention. In the 1980s, persistent infection with salmonella was identified as one of the infections defining AIDS. Unlike healthy people, who usually require no therapy for salmonella, AIDS patients need to take antibiotics daily to prevent recurrent infection of the bloodstream (septicemia). HIV-infected people are also more likely to have severe cases of campylobacter, the leading cause of food poisoning, which kills about 100 people each year, according to the CDC.
It is no coincidence that the staphylococcus infections reported in the article and many campylobacter infections are resistant to one of the newest and most popular classes of antibiotics, the quinolones. These medications have become one of the most widely utilized classes of antibiotics in human medicine because of their promise of potency and ease of administration. Quinolones are also used in livestock and poultry, and are now becoming less and less effective.
The American Medical Association, along with the American College of Preventive Medicine, the American Public Health Association and the World Health Organization, opposes the routine feeding of antibiotics to farm animals that are not sick.
The Centers for Disease Control and Prevention has observed that "decreasing inappropriate antibiotic use is the best way to control resistance. "
Key steps include:
Eliminating inappropriate agricultural use of medically important antibiotics: Producers and marketers of meat and poultry should -- following the lead of Tyson, ConAgra and other industry giants -- voluntarily agree to stop selling or buying poultry produced with the use of quinolone antibiotics. In addition, meat and poultry producers should phase out the routine feeding of other medically important antibiotics to animals that are not sick. Pharmaceutical companies should be prohibited by law from producing antibiotics for such use in animals.
Curbing overuse: The federal government should adopt policies aimed at limiting use of antibiotics in agriculture. Congress should phase out the routine feeding of medically important antibiotics to healthy livestock and poultry as well as other inappropriate uses of antibiotics that are identical or similar to vital antibiotics used on humans. Sen. Edward M. Kennedy, D-Mass. , and Rep. Sherrod Brown, D-Ohio, said that they will reintroduce bills that they authored in the last Congress to accomplish these goals.
Educating the public: Programs should be established to educate patients, parents and physicians about the need to use antibiotics more sparingly, in addition to those already available on the CDC's Web site (www.cdc.gov/drugresistance).
Enlisting consumers: Those who decide which meat products to purchase -- whether an individual shopper buying a few pounds of meat during a weekly trip to the grocery store, or a food-service corporation that purchases millions of pounds in a single transaction -- should select meat produced without the inappropriate use of antibiotics. (For a list of where you can buy such products, visit www.KeepAntibioticsWorking.com/EatWell.)
Unless we act now, we face a future of untreatable bacterial infections. People living with HIV/AIDS will be among the first to pay the price.
Stephen E. Follansbee, M.D., is director of HIV services at Permanente Medical Group's Department of Medicine in San Francisco and chairman of the disaster/bioterrorism task force for the San Francisco Medical Society.
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