Antimicrobial resistance is a global public health threat. The Centers for Disease Control and Prevention estimates that each year in the U.S., antimicrobial-resistant bacteria cause at least 2.8 million infections and more than 35,000 deaths, including in children.
Furthermore, antimicrobial-resistant infections are estimated to cost between $21 billion and $34 billion annually, resulting in 8 million additional hospital days.
Any antibiotic use contributes to development of resistance, so judicious antibiotic use in all sectors, including in humans and in animals, is important for reducing emergence and spread of resistant pathogens. In the U.S., more antimicrobials are used in agriculture than in humans.
A revised AAP technical report describes how the use of antibiotics in animal agriculture contributes to development of resistance and can adversely affect child health. It also discusses U.S. initiatives to curb unnecessary use of antimicrobial agents in agriculture.
The technical report Use of Antibiotics in Animal Agriculture: Implications for Pediatrics, from the Committee on Infectious Diseases and the Council on Environmental Health and Climate Change, is available at https://doi.org/10.1542/peds.2024-068467 and will be published in the October issue of Pediatrics.
Health of humans, animals intertwined
One Health is the concept that the health of humans is closely related to the health of animals and our shared environment.
Antimicrobial-susceptible and -resistant animal pathogens can reach humans through the food supply, by contact with animals or through environmental contamination. Children also can be exposed to pathogens through interaction with colonized or infected adults or animals, including family pets.
Since the last version of the technical report was published in 2015, the Food and Drug Administration has issued guidance for industry that supports One Health approaches to antibiotic stewardship by outlining appropriate antibiotic use in animals. The 2018 Veterinary Feed Directive (#213) outlines how to voluntarily limit the use of medically important antimicrobial drugs in feed or water to only when necessary to ensure animal health. It also requires veterinary oversight for antibiotics used in food-producing animals. Guidance that took effect in 2023 (#263) requires veterinary prescription for all dosage forms of medically important drugs administered to non-food (companion) or food-producing animals through any route of administration
Recommendations
The following recommendations and key actions are included in the technical report.
- To prevent foodborne illness, use proper hand hygiene when cooking or handling raw meat, after visiting petting zoos or farms, after handling pet food or treats and after contact with companion animals.
- To support antimicrobial stewardship in agriculture, consider purchasing animal products raised without exposure to nontherapeutic antibiotics and encourage institutional purchasing initiatives to follow similar measures.
- To encourage judicious use of antimicrobials in humans and animals, support policies that strengthen oversight of antimicrobial use and require tracking and reporting of antibiotic use and resistance across human, animal, plant and environmental sectors.
Dr. Katz and Dr. Banerjee are lead authors of the report.
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