A Review of Antibiotic Use in Food Animals: Perspective, Policy, and Potential

Inappropriate antibiotic use in food animals is considered a significant contributor to increasing antibiotic resistance. Consumers can play a critical role in reducing it through purchasing choices, demand, and policy advocacy. This systematic review aimed to synthesize all published literature investigating consumers’ perspectives (i.e., knowledge, perceptions, and attitudes) on antibiotic use and antibiotic resistance in food animals. We conducted a comprehensive literature search in PubMed, Web of Science, Scopus, and Google Scholar on November 14, 2022, and an updated search on April 30, 2024. We limited findings to original peer-reviewed journal articles published up to 2023 (inclusive), were written in English, and focused on knowledge/perceptions/attitudes of antibiotic use and antibiotic resistance in food animals. Of the 3815 articles identified, 39 were included. The findings suggested that consumers were concerned about antibiotic use in food animals, thus they were willing to pay more for food products with antibiotic-free or reduced-antibiotic use. However, consumers lacked deep understanding of antibiotic use practice and antibiotic stewardship in food animals as well as transmission risks of antibiotic-resistant bacteria. These findings offer valuable insights for policymakers and livestock industries to implement policy and practice changes to ensure responsible antibiotic use in food animals.

Physicians and medical centers are the front lines of the battle against antibiotic resistance in infectious bacteria. Government agencies, professional organizations, and health care corporations have developed various directives and control mechanisms to help guide physicians toward prescribing practices that minimize the development and dissemination of antibiotic resistance. But as Jeffrey Ritterman, MD, points out in “Preventing Antibiotic Resistance: The Next Step,” (page 35) the quantity of antibiotics routinely administered to livestock and poultry as feed additives appears to dwarf human use. The evidence that using antibiotics as feed additives contributes significantly to the problem of antibiotic resistance in humans has been acknowledged by the major medical associations, including the American Medical Association, American Academy of Family Physicians, American Academy of Pediatrics, and dozens of others, leading them to call for an end to this practice. No economic sector is as directly affected by the challenge of antibiotic resistance as the health care sector. Physicians have taken many necessary steps to curtail unnecessary uses of antibiotics in humans, but what can they do about antibiotic practices on farms? Plenty. Doctors provide a trusted, authoritative voice to the public. Greater awareness of this misuse among physicians can translate into greater awareness and concern among their patients. And an educated, mobilized public can help counter industry denial and government inaction. Just as important is the role physicians play as leaders within medical centers and other large health care institutions. Medical centers have an impact on society that goes well beyond the health services they provide. They are universally among the largest employers in any given region: Kaiser Permanente (KP), as an example, has been the largest private sector employer in Los Angeles County for the past three years. Over the past decade, medical centers have recognized their significant role and responsibility in broader environmental and societal issues through organizations like Health Care Without Harm (HCWH) and Hospitals for a Healthy Environment (H2E). These organizations are reducing the health care industry's environmental footprint and changing markets by getting medical centers to adopt standards and purchasing policies to minimize use of toxic materials, such as mercury. With 140,000 employees, 30 medical centers and over 8 million enrolled patients, KP's actions and policies will influence the nation's economy. And among health care institutions, KP is known as a pioneering leader. KP's adoption of a purchasing policy that minimizes use of antibiotics in agriculture would help educate other hospitals, food services, and members of the public about the need to take similar steps. The adoption of purchasing policies that curtail antibiotic overuse in food animals—notably use of medically important antibiotics as feed additives—is already affecting the market. Environmental Defense has helped McDonald's (the world's largest meat purchaser), as well as Compass America and Bon Appetit (two of the nation's largest food-service companies) craft policies that restrict certain antibiotic uses in chicken. The Compass America policy also addresses the use of antibiotic feed additives in pork.2 While these policies are only first steps, they are having some real impacts. Indeed, earlier this year USA Today1 reported that several of the nation's largest chicken producers had dramatically cut their overall antibiotic use; Tyson's reported a drop of 93%. However, it's not clear to what extent similar steps have been taken throughout the chicken industry, and there is still much to be done in reducing antibiotic use in pork, cattle, and other food animals. It's possible that we are approaching a tipping point on this issue, but we are not there yet. Moreover, there are no regulatory or legislative guarantees that any of the progress made so far in reducing nonessential antibiotic use will be maintained. This is why it's so important for the medical profession and the health care sector to put their money where their mouths are, so to speak, and join these major food companies in setting purchasing policies to move the market away from routine uses of antibiotics in food animals. No economic sector is as directly affected by the challenge of antibiotic resistance as the health care sector. And no other sector's action has the same authority and influence on this issue. As comedian Marty Feldman has said, “the pen is mightier than the sword and much easier to write with.” Physicians, while restraining their pens from writing unnecessary antibiotic prescriptions, should employ them to help move the food industry away from unnecessary antibiotic use in food animals.

This paper examines diverse perspectives around the concept of responsibility concerning antibiotic use in animal agriculture. Antibiotic use in agriculture has been identified as a source of antimicrobial resistance, one of the largest public health threats today. In the United States, efforts to curb antibiotic use in farming draws on a diverse range of actors—including farmers, veterinarians, consumers, and public health advocates—and relies on a mix of industry standards and federal guidelines around responsible use. The paper selects a similarly diverse range of people and employs Q methodology to query the points of disagreement and consensus around the practices that constitute responsible antibiotic use in animal agriculture, and who is responsible for antimicrobial resistance. We find a diverse mix of actor types across three discourses, but with clear differences between farmers and public health advocates. We also argue that, in some cases, points of disagreement and agreement are often based on different interpretations of ideas, indicating points of common ground where there might appear to be disagreement, and areas of difference where there appears to be agreement. We argue that these flexible interpretations of some of the key issues around antibiotic use are nevertheless grounded in durable differences in views of what agriculture is and what it should be.

The irrational use of antibiotics in humans and animals is highly related to the emergence and increase of antibiotic-resistant bacteria worldwide. A cross-sectional survey aimed at evaluating the current level of practices regarding antibiotic use in farm animals in Rwanda was carried out countrywide. Interviews were conducted on 229 farmers rearing different types of animals. The study has revealed that almost all respondent farmers could name at least one antibiotic used in farm animals and peni-streptomycin was named by most of them (95.6%). The use of antibiotics in farm animals was observed in the majority of respondents (97.4%). It was found that 44.4 and 26.5% of respondents reported that they used antibiotics for disease prevention and growth promotion, respectively. The use of non-prescribed antibiotics in animals was also reported by more than the half of respondent farmers (55.6%). The majority of farmers had a moderate level of practices regarding antibiotic use in farm animals (73.5%), very few had a high level (26%) and only one respondent had a low level. The high level of practices in regard to antibiotic use in animals was associated with the location of the farm, the type of reared animals, and the rearing system. The results of this study give an insight into antibiotics usage practices in farm animals in Rwanda. The generated information can guide sensitizations and promotions of the prudent use of antibiotics among farmers in order to limit the increase of antibiotic resistance in the country.

Antibiotic use in animal agriculture contributes significantly to antibiotic use globally and is a key driver of the rising threat of antibiotic resistance. It is becoming increasingly important to better understand antibiotic use in livestock in low-and-middle income countries where antibiotic use is predicted to increase considerably as a consequence of the growing demand for animal-derived products. Antibiotic crossover-use refers to the practice of using antibiotic formulations licensed for humans in animals and vice versa. This practice has the potential to cause adverse drug reactions and contribute to the development and spread of antibiotic resistance between humans and animals. We performed secondary data analysis of in-depth interview and focus-group discussion transcripts from independent studies investigating antibiotic use in agricultural communities in Uganda, Tanzania and India to understand the practice of antibiotic crossover-use by medicine-providers and livestock-keepers in these settings. Thematic analysis was conducted to explore driving factors of reported antibiotic crossover-use in the three countries. Similarities were found between countries regarding both the accounts of antibiotic crossover-use and its drivers. In all three countries, chickens and goats were treated with human antibiotics, and among the total range of human antibiotics reported, amoxicillin, tetracycline and penicillin were stated as used in animals in all three countries. The key themes identified to be driving crossover-use were: (1) medicine-providers’ and livestock-keepers’ perceptions of the effectiveness and safety of antibiotics, (2) livestock-keepers’ sources of information, (3) differences in availability of human and veterinary services and antibiotics, (4) economic incentives and pressures. Antibiotic crossover-use occurs in low-intensity production agricultural settings in geographically distinct low-and-middle income countries, influenced by a similar set of interconnected contextual drivers. Improving accessibility and affordability of veterinary medicines to both livestock-keepers and medicine-providers is required alongside interventions to address understanding of the differences between human and animal antibiotics, and potential dangers of antibiotic crossover-use in order to reduce the practice. A One Health approach to studying antibiotic use is necessary to understand the implications of antibiotic accessibility and use in one sector upon antibiotic use in other sectors.

Are we using too many antibiotics during pregnancy?

Antimicrobial resistance (AMR) is one of the major challenges faced by society, with the real threat of the failure of many medical procedures. Antibiotics are also used in livestock production and provide a potential pathway to increasing AMR. The central challenge involves ensuring animal health and welfare while securing the long-term effectiveness of antibiotics. This paper reports the results of a survey of 5693 respondents from the customer panels of four major UK supermarkets regarding preferences and attitudes towards antibiotic use in food animals, and their perspectives on how the balance between animal welfare and human benefit can be achieved. The results of these surveys are consistent with those from other countries that found that consumers generally have limited knowledge about antibiotic use in agriculture and AMR, with around 50% responding "don't know" to many questions. There was agreement about the benefits of antibiotics outweighing harm, with 40% agreeing that, overall, the use of antibiotics to treat disease in farm animals delivers more benefit than harm. However, 44% neither agreed nor disagreed, indicating a high level of uncertainty and a situation that is potentially unstable. The seriousness of the AMR challenge is such that continued action for the more discriminating use of antibiotics must continue.

Superbugs: the ever growing threat in our food supply

BackgroundAntimicrobial resistance is a public health threat. Because antimicrobial consumption in food-producing animals contributes to the problem, policies restricting the inappropriate or unnecessary agricultural use of antimicrobial drugs are important. However, this link between agricultural antibiotic use and antibiotic resistance has remained contested by some, with potentially disruptive effects on efforts to move towards the judicious or prudent use of these drugs.Main textThe goal of this review is to systematically evaluate the types of evidence available for each step in the causal pathway from antimicrobial use on farms to human public health risk, and to evaluate the strength of evidence within a ‘Grades of Recommendations Assessment, Development and Evaluation‘(GRADE) framework. The review clearly demonstrates that there is compelling scientific evidence available to support each step in the causal pathway, from antimicrobial use on farms to a public health burden caused by infections with resistant pathogens. Importantly, the pathogen, antimicrobial drug and treatment regimen, and general setting (e.g., feed type) can have significant impacts on how quickly resistance emerges or spreads, for how long resistance may persist after antimicrobial exposures cease, and what public health impacts may be associated with antimicrobial use on farms. Therefore an exact quantification of the public health burden attributable to antimicrobial drug use in animal agriculture compared to other sources remains challenging.ConclusionsEven though more research is needed to close existing data gaps, obtain a better understanding of how antimicrobial drugs are actually used on farms or feedlots, and quantify the risk associated with antimicrobial use in animal agriculture, these findings reinforce the need to act now and restrict antibiotic use in animal agriculture to those instances necessary to ensure the health and well-being of the animals.

Antibiotic use in food animals worldwide, with a focus on Africa: Pluses and minuses.

On September 18, 2014, President Barack Obama issued an Executive Order titled Combating Antibiotic-Resistant Bacteria. The order demands a ‘strategic, coordinated, and sustained effort’ to detect, prevent, and control antibiotic resistance. According to the Centers for Disease Control and Prevention (CDC), antibiotic-resistant infections are a rising health concern that result in at least two million illnesses and 23,000 deaths each year in the United States. The Executive Order and accompanying documents have been criticized for taking a weak stance against the use of antibiotics in agriculture; however, they include goals to promote antibiotic stewardship on farms, better surveillance of antibiotic use, and the development of alternatives to antibiotics. The criticisms are also unwarranted based on the current state of scientific evidence; nevertheless, there remain compelling reasons to limit the use of antibiotics in agriculture, and if fully implemented, the executive action is set to achieve this goal. This paper will explore why the criticisms are unwarranted, present the conflicting evidence on whether antibiotic use in farm animals poses a significant health threat to humans, offer other reasons to limit the use of antibiotics in livestock, and suggest ways that the government can maximize the efficacy of the proposed actions.

Antibiotics are widely used to prevent healthy animals from getting diseases in livestock industries. Such practice has greatly contributed to the increase in antibiotic-resistant pathogens in animals and in the environment, which poses severe health threats to humans. This study aims to investigate consumers' purchase intention towards meat produced without preventive antibiotic use, and to identify key factors influencing this purchase intention. An online survey of 1123 participants was conducted in China. Descriptive statistical analysis, correlation, and regression analysis were conducted. The results suggested that consumers had a negative attitude towards preventive antibiotic use in food animals and a strong purchase intention towards meat produced without it. The key drivers of this purchase intention included health consciousness, trust in responsible antibiotic use in farming, objective knowledge about antibiotics used in food animals, subjective knowledge about preventive antibiotic use, concerns over antibiotic residues, and attitude towards preventive antibiotic use. These findings can provide deep insights for policymakers and livestock industries who seek to promote responsible antibiotic use and develop effective communication strategies with consumers.

Antimicrobial resistance exacts worldwide an increasingly significant clinical and economic toll. Despite the international calls for urgent action, antimicrobial use and resistance have been low on the Mexican government's policy agenda. In early 2010, a multidisciplinary group of experts launched a national initiative for containment of antimicrobial resistance that was endorsed by major medical, veterinary and public health institutions. The initiative called for seven priority actions including the creation of an ad hoc intersectoral advisory group, a requirement that human and veterinary antibiotics be dispensed only with prescription, and the establishment of effective surveillance systems. A consensus document was disseminated among key decision-makers at the ministries of Health and Agriculture and the legislature. The Ministry of Health (MoH) enacted a decree effective as of August 2010, which enforced the regulations that required medical prescriptions for the sale of human antibiotics. While the information disseminated by the MoH did focus on the dangers of self-medication, it failed to highlight the inherent perils of antibiotic resistance or the consequences of antibiotic use in food-animals. Following the decree, there was a surge of medical offices controlled by retail pharmacies. In the veterinary sector, voluntary guidelines were developed for good husbandry practices, including antibiotic use in food animals; five antimicrobials for use in food-animals were banned. No intersectoral advisory group or surveillance systems were established. This study describes a bottom-top approach in Mexico for the development of a national strategy to improve antibiotic use and contain antimicrobial resistance. Its experiences suggest that, in countries such as Mexico that lack strong regulatory systems and surveillance capacities, a more systemic approach is warranted. Future efforts should begin with early involvement of key stakeholders and informing policy makers, professionals and the population at large about the critical importance of antibiotic resistance.

The looming concern of antimicrobial resistance (AMR) has prompted the government of many countries of the world to act upon and come up with the guidelines, comprehensive recommendations and policies concerning prudent use of antibiotics and containment of AMR. However, such initiatives from countries with high incidence of antibiotic-resistant bacteria in food animals are still in infancy. This review highlights the existing global policies on antibiotics use in food animals along with details of the various Indian policies and guidelines. In India, in spite of availability of integrated policies for livestock, poultry and aquaculture sector, uniform regulations with coordinated initiative are needed to formulate strict policies regarding antimicrobial use both in humans and animals. In an attempt to create effective framework to tackle the AMR, the Indian Council of Medical Research initiated a series of dialogues with various stakeholders and suggested various action points for urgent implementation. This review summarizes the recommendations made during the various consultations. The overarching aim of this review is to clearly delineate the action points which need to be carried out urgently to regulate the antibiotic use in animals.

Antibiotic use in food animals results in people being infected with antibiotic-resistant bacteria (WHO 1st Joint FAO/OIE/WHO Expert Workshop on Non-human Antimicrobial Usage and Antimicrobial Resistance: Scientific assessment, Geneva, 1–5 December 2003, http://www.who.int/foodsafety/micro/meetings/nov2003/en/). The recent article by Hurd (Microbe, March 2006, p. 115–119), however, gives an unrealistically low estimate on the risk to people from macrolide use in food animals in the U.S. (1 in 10 million per year). Hurd presents little data in his article, and thus readers can't assess how he arrived at his estimate. Data is available in his prior publication (H. S. Hurd et al., J. Food Prot. 67:980–992, 2004), but his assumptions appear frequently to underestimate likely risks (P. Collignon, J. Food Prot. 67:2369–2370, 2004; L. Tollefson et al., J. Food Prot. 67:2368–2369, 2004).