Policy Recommendations

After an extensive review of the scientific evidence pertaining to the human health effect of antimicrobial use in agriculture, the Facts about Antimicrobials in Animals and the Impact on Resistance (FAAIR) Scientific Advisory Panel makes the recommendations listed below. In many cases, legislation by Congress or direct changes in policy by the Center for Veterinary Medicine at the Food and Drug Administration, the US Department of Agriculture, the Environmental Protection Agency, and other government agencies will be necessary to implement the recommendations of the Panel. Increased appreciation of the risks associated with antimicrobial resistance on the part of medical professionals, food producers, and the general public will also facilitate implementation. Appropriate use of antimicrobials in food animal production should be limited to therapy for diseased animals and prophylaxis in healthy individuals when disease is documented in the herd or flock. Use of antimicrobials for economic purposes such as growth promotion or feed efficiency should be discontinued (with the exception of ionophores and coccidiostats). Where possible, alternatives such as changes in management, use of probiotics or competitive exclusion products, and vaccines should be encouraged. Pathogen reduction programs should also be continued or implemented where appropriate. Because of their critical role in treating human disease, fluoroquinolones and third-generation or higher cephalosporins should not be used in agriculture except to treat refractory infections in individual animals. Professional societies of veterinarians should develop and revise formularies according to prudent-use guidelines and should consider the likelihood that a given drug will promote resistance. These new formularies should be distributed to all veterinarians. Antimicrobials should be prescribed and administered in accordance with established guidelines concerning recommended dosage, interval, and duration to treat disease. Economic incentives that promote inappropriate prescription of antimicrobials in animals should be eliminated, and positive incentives should be introduced to encourage prudent use. Education efforts should target the elimination of specific areas of antimicrobial misuse. Similar guidelines and practices should be established and adhered to by plant pathologists, who guide antimicrobial use in plant agriculture. Pharmaceutical manufacturers and importers should report the quantities of antimicrobials produced, imported, and sold. Reported data should include agent, formulation, intended animal species, and route of administration. Frequent end-user surveys should be conducted to assess the use of antimicrobials in agriculture. An ecological perspective considers processes by which antimicrobial resistance spreads and persists in bacterial communities and the complex interactions between organisms, including pathogens, commensal bacteria, food animals, humans, and their environments. Risk assessment procedures should take into account both direct and environmentally mediated human health effects of agricultural antimicrobial use. Regulatory agencies should partner with research organizations to obtain scientifically valid information for use in risk analysis. When data are scarce, regulators should invoke the precautionary principle, and regulatory procedures should be revised when more data become available. Surveillance programs should be harmonized to allow for linkage and joint analysis of data, particularly between animal and human data. Specific improvements should include standardization of sampling, culture, identification, and susceptibility testing methods. Protocols should be available to interested parties. Surveillance systems, including the National Antimicrobial Resistance Monitoring System, should be expanded to obtain greater numbers and more geographically diverse isolates of both commensal and pathogenic bacteria of humans, animals, and plants. Results should be published frequently and archived in databases. More funding should be allocated for the purpose of antimicrobial resistance in agriculture. Priorities for research funding should include the following: Understanding the effects of antimicrobials as environmental contaminants, especially in areas adjacent to farms where antimicrobials are used. Increasing the understanding of the genesis and flow of resistance elements among bacterial populations and communities, including the role of commensal microorganisms as reservoirs of resistance. Increasing knowledge of the transfer of resistance among bacteria associated with humans, animals, and plants. Developing new approaches to infection control and growth promotion, such as vaccines, probiotics, improved management practices, and growth-promoting feed supplements without antimicrobials. Developing more accurate, cost-effective, and rapid laboratory techniques that will enable characterization of microbial isolates by serotype and strain. Developing and testing new risk-assessment models. Regulatory agencies should provide for rapid review of alternatives to antimicrobials.