Food Protection Trends - September/October 2016 - 392
writers and encouraging new groups to establish their own
platforms to dialogue with lay audiences offer other avenues
for spreading messages.
The food industry
Companies must manage animal production health
in ways that minimize antibiotic use. However, although
animal health (including immunization and good hygiene/
sanitation) is crucial, it isn't the total picture. Judicious use
of antibiotics early in an animal's life can reduce the need
for heavy antibiotic use later on. The food industry might
consider a certification for products from companies that use
antibiotics responsibly. Some large corporations are already
setting the standards, and they may drive a certification
process. The agricultural industry should continue to make
educational videos. For example, in February 2011, Cargill
aired a video on The Oprah Show detailing the processing
of cattle in the beef industry, and viewer response was
overwhelmingly positive (18).
The food industry must consider all uses of antibiotics,
including in grain crops and in the fermentation process of
producing ethanol, where antibiotics are used to control
overgrowth. Byproducts of fermentation are used in cattle
feed. An estimated 30-50 percent of the diet of cattle may
have low levels of antibiotics in it as a result of antibiotic use
in fermentation processes (14). In addition, stakeholders
must consider the liquid waste produced by these processes
that wind up in streams.
Medical professionals
While hospitals generally recognize the need for
antimicrobial stewardship programs, there are many
pressures working against such programs. For example,
health care providers are sometimes compelled to
prescribe antibiotics to increase patient satisfaction (8).
Other factors could include lack of clinician knowledge or
time, or their attitudes and beliefs (8). As professionals
in the field, the roundtable participants stressed the need
to improve surveillance of prescribing habits in order
to identify and remedy overuse and to track prescribing
practices of all health care professionals and provide
individual feedback.
Researchers
Studies should develop biomarkers to identify when to
stop antibiotic treatment in patients, thereby using the
minimum amount needed. Roundtable participants also
suggested that new rapid diagnostic tests are needed to
quickly identify the pathogen responsible for the disease
we need to treat. These tests would lead to targeted
(rather than broad-spectrum) antibiotic treatment.
The CDC's National Antimicrobial Resistance Monitoring System, Enteric Bacteria (NARMS) is a public health
surveillance system that tracks antimicrobial resistance in
foodborne and other enteric bacteria (4). NARMS helps
392
Food Protection Trends September/October
monitor changes in antibiotic resistance. It would also be
useful for hospitals to have more NARMS-type tests. In
addition, while resistance rates in local own medical centers
are known, resistance typically cannot be monitored by
region. CDC provides some state profiles, but data on resistance by smaller regions could impact prescriber behavior.
Next, waste management remains a largely unexplored
question. Both animals and humans may be contributing to
antibiotic resistance by way of excreted metabolites of antibiotics. It is important for researchers to help us understand
the extent of this underappreciated source of resistance.
The National Institute of Health's (NIH) National
Institute of Allergy and Infectious Diseases (NIAID)
is an important stakeholder in the research endeavor.
Many clinical trials are funded by industry, and there is
a pervasive attitude that such research findings may be
tainted (17). The roundtable recognizes that this attitude is
counterproductive, while also recognizing that NIH and its
various institutions such as NIAID need to play key roles.
Policymakers
Developing strategies that address the National Action
Plan for Combatting Antibiotic Resistant Bacteria is
paramount for policymakers, given the national and global
(WHO) strategies that are in place or being developed.
Developing safeguards is a key aspect of our strategy to
protect antibiotics. The FDA has maintained a central
role in the elimination of use of antibiotics for growth
promotion in food animals. In a 2010 congressional
testimony, FDA Director Dr. Janet Woodcock for the
Center for Drug Evaluation and Research reported,
"Preserving the effectiveness of current antimicrobials
and encouraging the continued development of new
ones is vital to protecting human and animal health
against infectious microbes" (9). The report led to U.S.
FDA Guidance #209, which established two voluntary
principles (10):
* Use of medically important antimicrobial drugs in foodproducing animals should be limited to uses considered
necessary for animal health.
* Use of medically important antimicrobial drugs in
food-producing animals should include veterinary
oversight/consultation.
This guidance led to FDA Guidance #213, establishing
procedures for voluntarily phasing out growth promotion
indications for medically important antibiotics in alignment with Guidance #209, and proposing changes to the
Veterinary Feed Directive (VFD) regulation (12). As a
result, the use of antibiotics in animal feed for growth
promotion has been eliminated. The FDA could play a
role in helping consumers identify food companies using
antibiotics responsibly. Worldwide, policy makers can
work to demand regulatory oversight of food production.
Table of Contents for the Digital Edition of Food Protection Trends - September/October 2016
Contents
Food Protection Trends - September/October 2016 - Cover1
Food Protection Trends - September/October 2016 - Cover2
Food Protection Trends - September/October 2016 - Contents
Food Protection Trends - September/October 2016 - 342
Food Protection Trends - September/October 2016 - 343
Food Protection Trends - September/October 2016 - 344
Food Protection Trends - September/October 2016 - 345
Food Protection Trends - September/October 2016 - 346
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Food Protection Trends - September/October 2016 - 358
Food Protection Trends - September/October 2016 - 359
Food Protection Trends - September/October 2016 - 360
Food Protection Trends - September/October 2016 - 361
Food Protection Trends - September/October 2016 - 362
Food Protection Trends - September/October 2016 - 363
Food Protection Trends - September/October 2016 - 364
Food Protection Trends - September/October 2016 - 365
Food Protection Trends - September/October 2016 - 366
Food Protection Trends - September/October 2016 - 367
Food Protection Trends - September/October 2016 - 368
Food Protection Trends - September/October 2016 - 369
Food Protection Trends - September/October 2016 - 370
Food Protection Trends - September/October 2016 - 371
Food Protection Trends - September/October 2016 - 372
Food Protection Trends - September/October 2016 - 373
Food Protection Trends - September/October 2016 - 374
Food Protection Trends - September/October 2016 - 375
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Food Protection Trends - September/October 2016 - 377
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Food Protection Trends - September/October 2016 - 381
Food Protection Trends - September/October 2016 - 382
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Food Protection Trends - September/October 2016 - 384
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Food Protection Trends - September/October 2016 - 391
Food Protection Trends - September/October 2016 - 392
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Food Protection Trends - September/October 2016 - Cover3
Food Protection Trends - September/October 2016 - Cover4
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