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Antibiotics Awareness Day

18 November 2012 is the EU’s Antibiotic Awareness Day and RUMA is urging farmers and vets to use this day to review whether they are using antibiotics responsibly.

RUMA Secretary General, John FitzGerald, said antibiotics are key medicines in both human and animal health. They should not be used as a substitute for good farm management which helps prevent disease but when they are used they help to maintain animal health and welfare and provide safe food for the consumer.

Antibiotic Awareness Day provides an ideal opportunity for everyone using antibiotics in agriculture to ensure they are doing so responsibly which means:

  • only using antibiotics prescribed by your vet and supplied by the vet or from an approved source under a veterinary prescription. If buying medicines over the internet only use an approved VMD website or you could waste your money on a substance that does not work or worse could harm your animals
  • using the antibiotic in accordance with the instructions on the label. It is vitally important to give the full dose for the whole treatment period to avoid increasing the risk of resistance
  • not using antibiotics as a substitute for good farm management
  • vets should prescribe antibiotics under the cascade as a last resort
  • where there are older alternatives, vets should use susceptibility testing before prescribing modern antibiotics.

Mr FitzGerald said that antibiotic resistance is an important one-health issue and those using veterinary antibiotics must play their part in helping tackle it. The EU will be reviewing the veterinary medicines legislation in 2013 and is likely to propose changes to reduce the risk of antibiotic resistance. UK farmers and vets need to be aware of the risks to the availability of antibiotics to treat their animals and to continue to show that they use them responsibly.

NOTES FOR EDITORS

  1. RUMA is an alliance of organisations representing every stage of the “farm to fork” process which aims to promote a co-ordinated and integrated approach to best practice in the use of medicines on farm. A full list of RUMA members is at paragraph 4 below. For further information contact RUMA Secretary General John FitzGerald (rumasec@btinternet.com) or see the RUMA website www.ruma.org.uk
  2. European Commission proposals to amend the Veterinary Medicines Directive (2001/82) are expected by March 2013. They could include:
    • banning or limiting the use of the modern antibiotics e.g. fluoroquinolones, 3rd and 4th generation cephalosporins which are regarded as critically important to human medicine
    • banning or limiting the use of antibiotics under the cascade
    • banning vets from supplying antibiotics (they would be allowed only to prescribe them)
    • banning or limiting the preventive use of veterinary antibiotics

RUMA Comment on the Early Day Motion in the House of Commons on the Use of Antibiotics in Intensive Farming

The following early day motion has been laid in the House of Commons:

“That this House recognises that the overuse of antibiotics in intensive farming adds to the serious public health threat from antibiotic resistance and the rise of superbugs; welcomes the Government’s efforts to reduce over-prescribing by doctors; calls for parallel action to reduce the use of antibiotics by veterinary surgeons and farmers; and further calls on the Government to take steps to ensure that the routine prophylactic use of antibiotics on UK farms is phased out and that specific controls are introduced on the use in livestock of antibiotics that are critically important in human medicine.”

Sponsors: Zac Goldsmith (Con, Richmond Park) Peter Bottomley (Con, Worthing West) Martin Caton (Lab, Gower) Adrian Sanders (LD, Torbay) Graham Stringer (Lab, Blackley and Broughton) Stephen Williams (LD, Bristol West)

RUMA COMMENT

John FitzGerald, RUMA Secretary General, said “RUMA is disappointed by this EDM which repeats and relies on some of the myths on the use of antibiotics in agriculture and the impact this has on antibiotic resistance in humans.”

Antibiotic resistance is an important one health issue and RUMA supports the initiatives on responsible use in both human and animal medicine. Antibiotics are important for maintaining the health of both humans and animals and it is important that all parties should work together to ensure that antibiotics remain an effective tool in the treatment of humans and animals so that when they need to be used they can be. There is, however, scientific consensus that use of antimicrobials in human medicine rather than antibiotic use in the veterinary sector is the driving force for antibiotic resistant human infections.

RUMA supports the responsible use of all medicines and is concerned that simplistic numerical targets of reduced use can encourage irresponsible use e.g. reduced dosage or time of treatment, which would increase the risk of resistance. RUMA’s responsible use guidelines stress the need for good farm management and disease prevention strategies to minimise the risk of disease but encourage the proper treatment of animals that become ill.

RUMA believes that “prevention is better than cure” and cautions against actions to ban preventive treatment. Antibiotics are used in both human and veterinary medicine to prevent bacterial infections that have occurred in some members of a group or that are likely to occur. RUMA does not consider the delay of treatment until the development of clinical signs of disease is always appropriate. Indeed, allowing people or animals to become ill and then treating them is not considered good practice by RUMA. Such a practice in human medicine would be considered negligent and the same consideration applies to animals at risk as well.

There are many disease scenarios in livestock animals where prophylactic use of antibiotics is an essential part of responsible veterinary care for the protection of animal health and welfare. It must be emphasised that any such preventive and control treatment of animals is always under the control of the prescribing veterinary surgeon who will use diagnostic, clinical and epidemiological (i.e. knowledge of when and where disease is likely to occur) information to inform their prescribing decisions.

RUMA acknowledges that some antibiotics are critically important for human treatments. Although the use of such antibiotics in animals is already small, RUMA encourages vets to use such antibiotics only where there is no alternative treatment available. This is accepted practice by all members of RUMA, including the veterinary profession, as reflected in their respective guidelines on responsible use

Mr FitzGerald said that RUMA would be pleased to meet with any or all of the MPs sponsoring this EDM to discuss their concerns about how antibiotics are used in animals.

NOTES FOR EDITORS

  1. RUMA is an alliance of organisations representing every stage of the “farm to fork” process which aims to promote a co-ordinated and integrated approach to best practice in the use of medicines on farm. A full list of RUMA members is at paragraph 4 below. For further information contact RUMA Secretary General John FitzGerald (rumasec@btinternet.com) or see the RUMA website www.ruma.org.uk

Antimicrobial Use in Veterinary Medicine – Paper for the European Commission

RUMA welcomes the Commission’s aims for the current review of the Veterinary Medicines Directive 2001/82 and Medicated Feedingstuffs Directive 90/167/EEC and especially to deliver a regulatory system that can address appropriately the antimicrobial resistance (AMR) challenge. RUMA also welcomes the Commission’s willingness to receive advice and comments from those working in the field as evidenced by the far reaching consultation and the experts’ meeting on antimicrobial resistance held in Brussels on 8 June 2012. At that meeting RUMA understands that the Commission invited further comment and is pleased to provide this paper.

Click here to see the paper …

RUMA comments on the story about the use of Antibiotics in Food Producing Animals, and alleged link to the obesity epidemic in Western Europe and other parts of the World

RUMA COMMENTS ON STORY ABOUT THE USE OF ANTIBIOTICS IN FOOD PRODUCING ANIMALS AND THE ALLEGED LINK TO THE OBESITY EPIDEMIC THAT IS OCCURRING IN WESTERN EUROPE AND OTHER PARTS OF THE WORLD

RUMA notes that a recent study in mice, attempting to assess the potential mechanisms by which antimicrobial growth promoters work in animals, found that low level exposure to antibiotics of very young mice altered the microflora in the gut and also affected the metabolism of these animals resulting in treated mice having more fat tissue than untreated mice. Other studies on humans in this area have led to the suggestion of a possible link between antibiotic treatment in children at a very young age and their ability to gain weight and potentially become obese at a later stage in life. RUMA acknowledges this is an important area of research.

However, RUMA is disappointed by an additional suggestion reported in the UK press, which is not supported by the research. The article(s) in question imply that antibiotic use in animals may have affected the bacterial balance in the human gut and the way food is digested by humans and that this could be a reason for the increase in human obesity. The implication is that long term exposure to residues of antimicrobials resulting from sub-therapeutic administration of these compounds to animals is going to impact on gut micro-flora of children thus leading to obesity.

The sub-therapeutic administration of antibiotics for growth promotion was banned in the EU on 1 January 2006. As the original US study says, such use is still permitted in the USA. However, any antimicrobial product for use in animals in the EU and USA has to meet Maximum Residue Limit (MRL) requirements in order to gain marketing approval. To set the MRLs, independent scientific experts determine an Acceptable Daily Intake (ADI) which is based on a No Observable Effect Level (NOEL). In the case of antimicrobials this has to be a microbiological ADI based on extensive studies to demonstrate unequivocally that there are no effects on gut flora extrapolated to the human situation to simulate life-long exposure. The adherence to withdrawal periods after the use of antibiotics together with rigorous residue surveillance programmes that are carried out by government bodies ensure that the risk of food that might contain potentially harmful residues entering the food chain is exceptionally low – 11 (0.2%) of the 5,122 samples tested in the UK for antimicrobial residues in 2010 were above the MRL.

RUMA is disappointed by the reporting of a factually inaccurate statement attributed to Prof Brendan Wren, Professor of Microbial Pathogenesis, London School of Hygiene & Tropical Medicine that antibiotics are used indiscriminately in livestock and often used to fatten animals. The use of antibiotic growth promoters has been illegal in the EU since 2006 and so they have not been used for several years. Antibiotic use in livestock is permitted only for treatment and control of disease under a veterinary surgeon’s prescription and not for growth promotion. This makes it highly unlikely that farmers will be able to use antibiotics indiscriminately.

In conclusion, the suggestion that long term exposure to residues of antibiotics resulting from administration of these compounds to animals is leading to obesity in humans is not based on the results of the studies in mice, is not substantiated by any other data, ignores the quality and safety mechanisms built into our food chain and could cause unnecessary consumer concerns.

Response to Soil Association Report “E. Coli Superbugs on farms and food”

RUMA (the Responsible Use of Medicines in Agriculture Alliance) is disappointed and saddened by the tone of the latest report and press release from the Soil Association on Antimicrobial Resistance. The Alliance believes that these documents do not support the views expressed in the foreword by Helen Browning, the Soil Association’s Chief Executive, that she wants a collaborative approach to tackle the issue of antimicrobial resistance.

“RUMA welcomes constructive dialogue and suggestions to promote the responsible use of all medicines across the whole farming spectrum,” said RUMA Secretary General John FitzGerald. “We fully support the responsible use of antimicrobials – for example through our detailed species guidelines – and believe it is essential to maintain their effectiveness. However, once again the Soil Association has produced a report of cherry-picked comments from other papers and very small sample numbers extrapolated to the whole UK to provide alarmist and scaremongering comments for their press release. This is very unfortunate and does not encourage others to enter any debate with them on antimicrobial resistance.

“Antimicrobial resistance is an internationally important issue that affects both veterinary and human medicine and decisions should be taken on good scientific evidence rather than propaganda produced to support one type of farming system,” he added.

Rather than enter into a tit for tat discussion on the detail in the report, RUMA would offer the following comments on the report’s recommendations. The RUMA Alliance remains available to join in rational and sensible discussions on the responsible use of medicines, including antimicrobials, on farm.

Soil Association Recommendations

Recommendations to the Government and retailers

  1. The UK’s regulatory system for farm antibiotics was designed to limit the level of antibiotic residues in food and needs significant upgrading to address the issue of antimicrobial resistance as well. We recommend that the Government establish the factors that lead to the development of resistant strains of bacteria in farm animals and in the food chain, consider the approaches adopted in other EU countries and draw up a blue print for an improved regulatory system that is appropriate for addressing the farming dimension of one of the key emerging health concerns of the 21st Century.

    RUMA believes that this reflects the Soil Association’s misunderstanding of the medicines regulatory system which is driven by EU legislation. Since the Veterinary Medicine Regulations (which replaced the old Medicines Act) were first introduced in 2005 to implement the over-arching EU directive, they have been regularly reviewed. RUMA is aware that the Government has already invested heavily in research to determine how antimicrobial resistance develops, and supports continued scientific research.

    Other EU member states have unilaterally introduced additional controls on farm to address resistance problems caused by the irresponsible use of antimicrobials on their farms. There is no such evidence of this type of irresponsible use in the UK.

    The Soil Association statement shows a distinct lack of understanding of the risk posed by the presence of any antimicrobial residues in food derived from animals in terms of resistance development and its potential transfer to man. In determining the maximum residue limits (MRLs) for antimicrobial residues in food the sponsor has to demonstrate a microbiological acceptable daily intake (ADI) by which a residue limit threshold is set internationally which poses no threat to man. The incidence of violative residues for antimicrobials in the UK as evidenced by VMD reports is very low and in 2010 was around 0.05%.

  2. The Government should take back control of policy work to address the use of antibiotic resistance in farm animals and the food chain. It was not appropriate to hand this responsibility, as the Government did last year, to the Veterinary Medicines Directorate, an executive agency which is largely funded by the pharmaceutical and farming industries.

    RUMA considers that this is an inappropriate comment against a highly effective and efficient Government Agency which is held in high regard by other regulatory bodies across the EU and worldwide.

  3. The Government should set a target to halve the overall use of antibiotics on farms within five years, and develop policies to ensure the target is met. There should be enhanced monitoring and greater transparency of veterinary prescribing and farm use of antibiotics.

    RUMA supports the call for enhanced monitoring and more information on veterinary prescribing and how antibiotics are used on farm. This would provide more evidence on which to base decisions.

    However, RUMA does not support an arbitrary reduction in the amount of antibiotics to be used on farm as this takes no account of the need to maintain animal health and welfare so that good quality food can be produced from UK farms in the quantity and at the price required. Indeed, this recommendation could be counter-productive as reducing the quantity of antimicrobials used by, for example, halving the dose or the treatment time would achieve the reduction but increase the risk of resistance development. RUMA believes antimicrobials should be used responsibly ‘as little as possible but as much as necessary’ and always in accordance with the veterinary prescription and for the full course of treatment.

  4. The Government should actively support proposals currently under discussion by the European Commission to phase out the preventative use of antibiotics in groups of healthy animals and prohibit all off-label use of modern cephalosporins and fluoroquinolone antibiotics.

    RUMA comments that antibiotics are used preventatively in both human and veterinary medicine, where population medicine is required. This is less common in human medicine where we are normally treated as individuals but, for instance, bacterial meningitis outbreaks lead to the treatment of whole school or university populations to prevent the healthy individuals becoming ill. Individual prophylactic use is also carried out in humans, for instance, to prevent infection from forthcoming surgery and in nursing homes where a recent study on behalf of the European Surveillance of Antimicrobial Consumption Project Group found that more than 25% of antimicrobial use in nursing homes across the EU was to prevent urinary and respiratory tract infections. Farm animals normally live in close groups so it is good practice to treat therapeutically all the animals in the group when clinical or sub-clinical symptoms are displayed in some of the group. This maintains good health and welfare and reduces suffering. All treatments with antimicrobials have to be done in accordance with a veterinary surgeon’s prescription.

    RUMA considers that veterinary surgeons should remain able to prescribe off-label the 3rd and 4th generation cephalosporins and fluoroquinolone, in exceptional circumstances, for the benefit of the health and welfare of the animals concerned.

  5. Leading retailers should ensure that the farms that supply them phase out the preventative use of antibiotics in groups of healthy animals and do not use modern cephalosporins and fluoroquinolone antibiotics off-label or as first line treatments.

    RUMA is pleased to include the British Retail Consortium amongst its members and welcomes retailer support for the responsible use of medicines. RUMA believes that the Soil Association proposal would impact on animal health and welfare and would inevitably lead to a reduction in the availability of food supplies from UK farms without a consequent reduction in demand. Retailers would be likely to fill the gap by using other sources where the animal health and welfare requirements – and, indeed, medicine use requirements – may not be as stringent as the UK.

  6. The Government should explore the possibility of encouraging farming systems with low use of antibiotics per tonne of meat, litre of milk etc. or dozen eggs, though EU farm payments.

    RUMA promotes the responsible use of medicines on farm regardless of the farming system used.

  7. The Government must make sure there are adequate funds for the Food Standards Agency to undertake comprehensive testing to establish the levels of ESBL E. coli on retail food in the UK.

    RUMA has no comment on this recommendation.

  8. The Government should ensure there are adequate funds for the Animal Health and Veterinary Laboratories Agency to increase its monitoring of ESBL E. coli of farms and also maintain an adequate level of research in this area. Defra’s budget for this work should be considered in the context of the potential costs to the NHS if the problem of ESBL E. coli is allowed to escalate further and, in particular, if it becomes widely established in Salmonella as well.

    RUMA welcomes the data provided by the work of the AHVLA as this helps evidence based decisions to be made on antimicrobial resistance but RUMA has no comment to make on how the Government should use its funds.

  9. The Government should work constructively at a European level to define more precisely the circumstances under which antibiotics can be used on a herd, flock or group basis.

    RUMA supports this recommendation.

  10. If the use of modern cephalosporins and fluoroquinolones cannot be greatly reduced by voluntary measures, the farm use of modern cephalosporins should be banned and the use of fluoroquinolones restricted to mammals in life-saving situations.

    RUMA believes that veterinary surgeons need to maintain a full range of antimicrobials from which to choose the most appropriate to prescribe in any given circumstance. This means that 3rd and 4th generation cephalosporins and fluoroquinolones should be available for use in animals. They should be used responsibly which means they should not be used on farm when an older antibiotic is also effective and they should not be used as the first line of treatment unless diagnostic testing has confirmed they are the right antibiotic to use.

  11. The UK should immediately prohibit the advertising of antibiotics to farmers. Advertisements to veterinary surgeons should be purely factual and not emotive in any way.

    RUMA has no comment to make on this recommendation.

  12. To prevent the development of ESBL E. coli in calves, current guidelines discouraging the use of milk containing antibiotic residues for the feeding of calves or other livestock should be given legislative force.

    RUMA has no comment to make on this recommendation.

  13. The Veterinary Medicines Directorate’s Inspections Administration Team should be given additional powers and training to undertake more thorough inspection of livestock farms which are permitted to incorporate antibiotics into feed. This should include unannounced visits and feed sampling to check that inclusion rates are not below full therapeutic levels.

    RUMA has no comment to make on this recommendation.

  14. All farmers should be required to compost farmyard manure thoroughly in order to kill off E. coli bacteria. Livestock slurry should be thoroughly aerated before spreading.

    RUMA has no comment to make on this recommendation.

    Recommendations to the farming and veterinary industries

  15. The British Poultry Council’s voluntary initiative to stop using cephalosporin antibiotics and to reduce the use of fluoroquinolones in poultry production is to be welcomed. Similar moves by other sections of the livestock industry should be encouraged.

    RUMA supports initiatives on the responsible use of antimicrobials. RUMA Guidelines encourage the adoption of farm management practices that reduce the risk of disease developing and then provide guidance on the responsible way to use medicine when this is necessary.

  16. The British Veterinary Association (BVA) should make renewed efforts to draw its 8-point plan to the attention of all veterinary surgeons. This provides excellent guidance on the prescribing of antibiotics and recommends using modern cephalosporins and fluoroquinolones in limited situations only.

    RUMA is pleased to have the BVA as one of its members and supports the BVA’s 8-point plan and encourages all veterinary surgeons to use in when prescribing antibiotics.

  17. Veterinary surgeons should agree not to prescribe modern cephalosporins for dry-cow therapy or for use in suckling cows, in order to prevent calves ingesting milk containing their residues.

    RUMA believes that 3rd and 4th generation cephalosporins should be used responsibly which means they should not be used on farm when an older antibiotic is also effective and they should not be used as the first line of treatment unless diagnostic testing has confirmed they are the right antibiotic to use.

  18. The BVA, Royal College of Veterinary Surgeons and the Government should consider how veterinary practices could best submit returns detailing the antimicrobials they have prescribed and the reasons they were needed. Results should then be analysed and summaries published annually, showing the key reasons for usage and how much of each antibiotic class was used in each species.

    RUMA would be pleased to take part in discussions with relevant parties on how more information can be obtained on how and why antimicrobials are used as this would provide more evidence on which to base decisions.

Notes to editors

  1. The Soil Association report “E. Coli Superbugs on farms and food” is available here: http://www.soilassociation.org/LinkClick.aspx?fileticket=yCT9su5iViQ%3d&tabid=313
  2. The European Surveillance of Antimicrobial Consumption Project Group paper “Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey” is available here: http://onlinelibrary.wiley.com/doi/10.1002/pds.3196/full
  3. For further information on RUMA please contact RUMA Secretary General John FitzGerald (rumasec@btinternet.com)
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