Archive for the ‘RUMA News’ Category

Response to new study in the British Medical Journal: RUMA urges farmers and vets to complete animal medication courses

RUMA’s independent Scientific Group has urged caution over a new article published in the British Medical Journal (BMJ) (26 July), which concludes there is little evidence that failing to complete a prescribed antibiotic course in human medicine contributes to antibiotic resistance.

The Scientific Group has advised farming and veterinary communities to continue following current prescription guidelines and completing courses of animal treatments until more research is carried out.

Mark Fielder, Professor of Medical Microbiology with Kingston University London and member of the RUMA Scientific Group, says:

“While it is right to debate and question current practice in science in medicine, it is also important to ensure the continuation of best practice unless new evidence suggests otherwise.

“In line with the comments made by Public Health England, it is imperative for patients to follow the instructions given by their prescribing physician or pharmacist in relation to antibiotics. The same applies to farmers and their prescribing vets.

“It is imperative that the full course of antibiotics are used following culture and sensitivity testing to ensure that the drug has had the opportunity to act against the invading organism and achieve the best outcome.

“This will also help in the prevention of resistance development as if the correct antibiotic is prescribed and administered in the most appropriate way, then it follows that there is the best opportunity for the organism to be killed, dead organisms do not mutate and so develop resistance.”

This mirrors the advice from the chief medical officer Dame Sally Davies, who has said the message to the public on medical use of antibiotics should remain unchanged until there is further research.

 

European antibiotic report links antibiotic use and resistance

A European report issued this week (27 July), analysing use of antibiotics and occurrence of resistance in bacteria from humans and food-producing animals, confirms UK farm animal use is comparatively low against many of its European neighbours. But it also highlights the potential for more responsible use in both humans and animals to reduce antibiotic resistance.

The report, the second of its kind produced jointly by the European Centre for Disease Control (ECDC), the European Food Safety Authority (EFSA) and the European Medicines Agency (EMA), indicates that in 2014, UK antibiotic use for humans was about average within Europe (Europe: 124mg/kg; UK: 129mg/kg) but 60% below average in animals (Europe: 152mg/kg; UK: 62mg/kg).

UK farm animal use of the highest-priority Critically Important Antibiotics was also very low, particularly colistin, where average consumption by farm animals in the UK was significantly below the European average.

Resistance to fluoroquinolones in Salmonella and Campylobacter bacteria from humans is identified in the report to be related to consumption of fluoroquinolones in animals – ratifying one of the priorities of the UK poultry meat sector in achieving a 72% reduction in fluoroquinolone use between 2012 and 2016. However, it is stressed that resistance is complex, and factors other than the amount of antibiotics used can influence the level of resistance found.

The report also notes a clear link between total antibiotic consumption and the occurrence of antibiotic resistance in both humans and farm animals. This suggests that measures to encourage responsible use should target all classes of antibiotics to reduce the risk of ‘co-selection’, where use of one type of antibiotic produces resistance to another.

John FitzGerald, Secretary General of RUMA, welcomed the report, but said the situation was likely to change rapidly as awareness grew of the contribution farming can make in a One Health approach to antibiotic stewardship.

He said: “The UK’s most recent Veterinary Antimicrobials Resistance and Sales Surveillance (VARSS) report on 2015 sales data saw a 10% drop in antibiotics sales into food-producing animals compared with the previous year.

“This, alongside significant reported reductions in usage in the poultry and pig sectors – released via the recent British Poultry Council Antibiotic Stewardship Report and AHDB’s e-Medicine Book data – will have changed the picture again.”

He added the report underlines the importance of the most recent falls in use and the need for further reductions in use across the board. Those in farming needed to be aware that changing their use of antibiotics could not only help manage the global risk of antibiotic resistance, it could lower the risk of drug-resistant infections developing among UK livestock.

“However, as highlighted in an EFSA/EMA report produced earlier this year, each local situation in each country needs its own multifaceted approach.

“There has been a tendency for critics to promote alternative farming systems or demand blanket implementation of rules in other countries, when what we actually need is to reduce use in a sustainable way that safeguards animal welfare,” added Mr FitzGerald.

The report says its conclusions are in line with those of the first report published in 2015. However, the availability of better quality data has allowed for a more sophisticated analysis.

It is expected that the VARSS report analysing 2016 sales data for food-producing animals, due for issue later this year, will show further reductions. A new One Health report comparing sales of antibiotics in the UK for humans and animals, also using 2016 data, is due to be issued after that.

Letter submitted to The Guardian 19 July 2017 – ‘Mega-farms’

Sir

Reports on ‘mega farms’ (Guardian 17, 18 July) persist in linking large scale farming with high antibiotic use – despite featuring poultry farmer Richard Williams who says no antibiotic has been used on his site since it was set up two years ago.

Richard is not alone. Since 2012, members of the British Poultry Council’s Antibiotic Stewardship scheme, representing more than 90% of UK poultry meat production, have achieved a 71% reduction in total antibiotic use. The latest UK data highlight a 10% fall in antibiotic sales for farm animals. Sales of highest priority antibiotics to farming have also fallen and new pig industry data shows use of colistin dropped by over 70% between 2015 and 2016 – despite UK farming already being one of the lowest users in Europe.

It may suit campaign groups to add antibiotics to the list of issues they have with larger scale farming, but resorting to global or European data and analogies because the UK data doesn’t back their case is disingenuous. In the UK, scale of farming is not a factor in antibiotic use.

Gwyn Jones
Chair, Responsible Use of Medicines in Agriculture (RUMA) Alliance

New Red Tractor antibiotic rules outlined

Standards affecting the use and recording of antibiotics are being bolstered across all Red Tractor Assurance livestock sectors this October, supporting the UK farming industry’s commitment to play its part in tackling antimicrobial resistance. Here’s a summary of what’s changing.

Beef and lamb: Animal medicines

A recommendation has been added that the highest priority critically important antibiotics (Colistin, third and fourth generation Cephalosporins, Fluoroquinolones) are only used as a last resort under veterinary direction. For farm to farm sales, animals under statutory withdrawal periods for medicines must be accompanied by a withdrawal period declaration.

Dairy: Documented medicine records

Medicine records must provide an annual collation of total antibiotic used for the unit either by a vet from prescription data or completed by a farmer from medicine records. An annual review of antibiotics used must be undertaken by a vet. For farm-to-farm sales, animals under statutory withdrawal periods for medicines must be accompanied by a withdrawal period declaration.

Poultry: Antibiotics

Broiler producers must only use antibiotics to treat a problem and total antibiotic use should now be recorded in mg/PCU*. The use of third and fourth generation Cephalosporins, Glycopeptides and Colistin are not permitted, but Macrolides and Fluoroquinolones are allowed if backed up by a vet and with written permission from the company purchasing the birds.

Pigs: Responsible use of medicines

In addition to the new requirement that all antibiotic use is recorded on the national e-Medicines Book, vets are required to sign a quarterly declaration to confirm they are prescribing antibiotics in accordance with the PVS Prescribing Principles for Antimicrobials. Use of antibiotics classified as Class 3 (products of last resort, namely Colistin, third and fourth generation Cephalosporins and Fluoroquinolones) must be justified in the veterinary health plan.

*PCU = Production Corrected Unit, calculated to provide a common comparative unit for each livestock sector.

2016 Antibiotic Stewardship Report: poultry meat sector

Following the publishing of its 2016 Antibiotic Stewardship Report today, RUMA welcomes the incredible progress made by the poultry meat sector since it first set up its programme in 2011. Their sustainable use approach has made possible a reduction of 71% in weight of antibiotics used between 2012 and 2016, and shows what is achievable with determination and courage.

While the integrated nature of the poultry meat sector compared with other sectors has helped it gain consensus and action at farm level, it nonetheless continues to be a source of inspiration and advice for many other sectors within RUMA which have more segregated or complex supply chains. These are also now on their own paths to reductions through similar stewardship programmes.

The reductions outlined within the poultry meat sector will also undoubtedly help the whole UK farming industry on its path towards achieving the Government target of average cross-sector antibiotics use of 50mg/PCU by 2018. However, this will not lessen each sector’s focus on reduction, refinement or replacement of antibiotics with their own sector-specific targets due to be released at RUMA’s conference on 27 October.

RUMA Task Force confirms targets timetable

The RUMA Targets Task Force has announced its timetable for publishing sector-specific targets relating to antibiotic use later this year.

The Task Force was set up by RUMA, the agricultural and food industry alliance which promotes responsible use of medicines in farm animals, in December 2016 to identify meaningful objectives to reduce, refine or replace antibiotic use in all UK livestock sectors.

Having held a series of workshops over winter and spring, Task Force members are currently consulting with specialists and organisations within their sectors to finalise draft proposals by the end of June.

The regulator, the Veterinary Medicines Directorate (VMD), will provide initial feedback on the proposals to confirm whether they would meet Government expectations for targets, timescales and rationale. It will also be important to have mechanisms in place to ensure animal health and welfare is not impacted by these measures, as set out in the Government’s response to the O’Neill report.

Once these responses have been received, each livestock sector has until the end of September to finalise their objectives, which will be compiled into a report for release at the RUMA conference on 27 October.

The Targets Task Force was originally proposed by RUMA after the O’Neill Review on Antimicrobial Resistance’s final report was published in May 20161.

RUMA chair Gwyn Jones explains that while the UK Government response2 to the O’Neill report challenged UK agriculture to reduce average antibiotic use by around 20% to 50mg/kg by 2018 (compared with the 2014 usage figures of 62 mg/kg), Government wants the industry to develop its own sector-specific targets, asking for these to be confirmed by the end of 2017.

“The challenge in every sector is very different according to structure, number of producers and the way it engages with the market,” says Mr Jones. “Some have already made significant strides in reducing and refining use, others have further to go. But the Government is clear that every sector is expected to act and have a set of measureable objectives in place by the end of the year.

“There are encouraging signs of engagement and progress. Antibiotic sales data for food producing animals showed a 10% reduction between 2014 and 20153, and the pig sector has recently announced a halving of in-feed antibiotics for young pigs and a 70% reduction in colistin use. We hope further reductions and refinements in other sectors will be evident when the 2016 sales data are released by the VMD later in the year.

“Despite this, we all understand the message that we must further reduce antibiotic use where it’s possible to do so without impacting animal welfare.”

Mr Jones says the benefit of the Targets Task Force became apparent at the very first meeting in the sharing of information, ideas and motivation. “We are confident that by learning and getting inspiration from each other across different sectors, we can bring about the step change needed.”

Tickets for the RUMA conference are now available on Eventbrite and the event programme will be confirmed shortly.

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1] The O’Neill report: Tackling Drug-Resistant Infections Globally can be downloaded here http://amr-review.org/Publications.
2] Antimicrobial resistance review: Government response. https://www.gov.uk/government/publications/government-response-the-review-on-antimicrobial-resistance
3] VARSS Report (2016). UK Veterinary Antibiotic Resistance and Sales Surveillance 2015. https://www.gov.uk/government/publications/veterinary-antimicrobial-resistance-and-sales-surveillance-2015

Scientific breakthrough in farming could alleviate human antibiotics time bomb

The discovery of an organism able to target harmful bacteria and leave ‘good’ bacteria intact in pigs could be poised to drive a long term change in how people with drug-resistant infections are treated.

The ground-breaking agricultural research, which was carried out by Professor Martha Clokie and her team at the University of Leicester and funded by farmers through levy body AHDB Pork, isolated 20 bacteriophages – or bacterial viruses – that target 72 strains of potentially drug-resistant bacteria that can cause gut problems in pigs.

The discovery suggests that bacteriophages could accompany or replace antibiotics used to treat bacterial disease across all types of livestock, helping safeguard the future of some drugs of ‘last resort’ in human medicine that the farming industry has already voluntarily restricted.

The breakthrough could also help speed the development of similar applications in human medicine, addressing the rise in antibiotic resistant bacteria that a report1 last year suggested could be killing as many as 10 million people a year by 2050 through drug-resistant infections.

The development has been welcomed by RUMA, the agricultural and food industry alliance which promotes responsible use of medicines in farm animals.

RUMA Secretary General John FitzGerald says: “The issue of antibiotic resistance is one shared by human and animal medicine, and a number of initiatives across medical and veterinary sciences are attempting to understand and reduce the spread of resistance genes in bacteria.

“Phage technology is in fact fairly old, but its development stalled because antibiotics were – until recently – very effective against a broad spectrum of bacteria. However, the build-up of resistance has created new opportunities for phage technology; a discovery such as this could be a real game-changer, not just helping the farming industry to steward antibiotics more effectively but potentially speeding up the development of human medical applications.”

Dr Charlotte Evans, Technical Senior Manager with AHDB Pork, explains bacteriophages are found everywhere in the environment, in humans and animals, so they can be regarded as a ‘natural’ defence.

She says: “There’s still a long way to go in terms of trials and licensing but we are very pleased this research, which was started two years ago, has already yielded such promising results.

“Bacteriophage treatment is about using increased volumes of something that is already present to target harmful bacteria. Research suggests they do not harm other organisms because the relevant receptor is not present.”

She adds that the next step is to determine whether bacteriophages could be applied via spray, injection or vaccination, or by adding to feed or water.

Around 37% of the UK’s antibiotics are currently used for treating disease in farm animals. The latest sales data shows there was a 10% fall in sales of antibiotic products into farming between 2014 and 2015.

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[1] O’Neill Review on Antimicrobial Resistance: Tackling Drug-Resistant Infections Globally. May 2016

Colistin use in pig sector falls by over 70%

New figures collated by the British pig industry and released by RUMA indicate use of Colistin, an antibiotic of last resort which treats a number of bacterial infections in both humans and animals, fell significantly in the sector during 2016.

The latest available UK sales data from 2015 shows Colistin sales into veterinary medicines were already low at around one tenth of the EU recommended limit. But preliminary analysis of data received via the new pig e-Medicines Book (e-MB), which was developed and launched by AHDB Pork last year and has now collected the 2015 and 2016 ‘medical’ records of more than two-thirds of the national herd, suggests that use of Colistin in pigs decreased more than 70% in 2016.

Mandy Nevel from AHDB Pork says the news is important as Colistin use in humans has increased in recent years for the treatment of specific serious bacterial infections that are resistant to other antibiotics.

“This is why the European Medicines Agency has classified Colistin as a highest priority ‘Critically Important Antibiotic’ for the treatment of a number of human bacterial conditions, despite it being a very old drug,” she explains.

“But crucially, the regulators have retained access for animal use because it also has importance as a last-resort drug to safeguard welfare in livestock. It’s very positive to see the pig sector – vets and farmers together – responding to the responsibility of having continued access to this drug as a last resort and reducing use where possible.”

RUMA chair Gwyn Jones has welcomed the news and says the findings mean that once 2016 sales data are released, the UK could be one of the five lowest users of Colistin in Europe.

He says: “We were looking for significant reductions in 2016 following the best practice guidelines issued by the Pig Veterinary Society at the end of 2015, but this has exceeded our hopes.

“It also follows hot on the heels of the announcement in February that prescribed antibiotics administered in feed for young pigs have halved, with more than two thirds of that reduction taking place in 2016.

“This shows the pig industry is really engaging with this issue and making some very strong progress in reducing, refining and replacing antibiotics use.”

More e-MB data will be made public later this year in line with the publication of sector-specific targets at RUMA’s conference in association with the Veterinary Medicines Directorate on 27 October.

RUMA adopts European Medicines Agency ‘highest priority’ antibiotics list

The European Medicines Agency’s (EMA’s) list of highest priority ‘critically important antibiotics’ (CIAs) – identified because of degree of risk to human health should antimicrobial resistance develop after use in animals – has been officially adopted by RUMA, the agricultural and food industry alliance which promotes responsible use of medicines in farm animals.

Slightly different lists of highest priority CIAs are published by the World Health Organisation, the US Food and Drug Agency and the EMA, generating keen debate within farming and the food chain about which should be observed. The decision for RUMA to adopt the EMA list was made after discussions with its members and with the Veterinary Medicines Directorate, which itself follows the EMA’s recommendations.

This means that under the One Health banner, the UK farming industry should be aiming to reduce use of fluoroquinolones, 3rd and 4th generation cephalosporins, and colistin, and only be using these antibiotics where no other product will be effective for the condition being treated.

These antibiotic groups will also therefore be one of the key elements of focus for RUMA’s ‘Targets Task Force1’ which is due to report goals for reducing antibiotic use in each livestock sector in October this year.

John FitzGerald, Secretary General of RUMA, explains that different agencies produce their own priority lists as they assess different risks. “And the conclusion is that in the UK, the list of highest priority CIAs should reflect the recommendations of the EMA’s Antimicrobial Expert Group,” he explains.

“This group, comprising a wide range of specialist European organisations2, has made its recommendations after examining the impact the use of antibiotics in animals has on public and animal health in the EU, and measures to manage the possible risk to humans. Most importantly, the EMA’s recommendations are reassessed as new science emerges.

“However, in some cases particular sectors may choose to add other classes of antibiotics where they feel additional monitoring is needed,” adds Mr FitzGerald.

Sales of antibiotics on the EMA’s highest priority CIA list make up a small proportion of the 56mg/PCU total antibiotic use in livestock and UK veterinary sales data show the industry is already acting with reductions in sales of both fluoroquinolones and 3rd and 4th generation cephalosporins between 2014 and 2015.

While colistin sales were static between 2014 and 2015, this was at almost 1/10th of the EMA’s recommended level of use. RUMA understands that voluntary restrictions brought in at the end of 2015 following the development of resistance to colistin internationally mean that 2016 sales data, to be published at the end of the year, should show reductions in colistin use.

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Notes:

[1] The AMEG is composed of representatives and experts from the European Medicines Agency (EMA) and its Committee for Medicinal Products for Veterinary Use and Antimicrobials Working Party (CVMP/AWP) and its Committee for Medicinal Products for Human Use and Infectious Disease Working Party (CHMP/IDWP), the European Food Safety Authority (EFSA), the European Centre for Disease Prevention and Control (ECDC) and the Joint Interagency Antimicrobial Consumption and Resistance Analysis Report (JIACRA).

[2] The Targets Task Force was proposed by RUMA after the O’Neill Review on Antimicrobial Resistance’s final report was published in May 2016. The Government response to the O’Neill report supported the move for the industry to develop its own sector-specific targets, asking for these to be confirmed by the end of 2017.

RUMA response to inaccurate and misleading statement on meat testing from Grand National sponsors Randox Health

A press release issued by Grand National sponsors Randox Health (now removed) about testing meat at Aintree for antibiotic residues has been strongly criticised for inaccuracies, misrepresentation and its potential to cause confusion.

The RUMA Alliance, which promotes responsible use of medicines in farm animals, says Randox Health has failed to acknowledge that all use of antibiotics in farm animals in the UK is strictly regulated, with withdrawal periods observed to avoid presence in meat, milk and other products from food-producing animals.

It also confuses residue testing with the separate issue of antibiotic resistance and provides incorrect information on antibiotic use in food-producing animals which is, in fact, reducing rapidly in the UK.

RUMA Secretary General John FitzGerald says: “In what appears to be an ill-conceived PR stunt by Randox Health’s food diagnostics division, the wrong risk and the wrong facts have been communicated.

“It is irresponsible and incorrect to imply a consumer would be harmed by antibiotics from any farm produce when residue levels have been very tightly controlled for decades.

“Regarding the altogether different issue of antibiotic resistance, its relationship to the testing of the meat for residues is bewildering. Antibiotic resistance is complex enough already; it should be a moral duty to clarify the facts rather than cause further confusion or, worse still, seek to use it for economic gain.”

Other concerns are expressed around sensationalist wording such as ‘epidemic’, and the incorrect attribution of a rise in human prescriptions for critically important antibiotics to food animals, when in fact farm animal sales of all antibiotics, including high priority ones, have fallen.

RUMA has contacted Randox Health, seeking to urgently clarify its concerns, but no response has been received.

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