Obama Takes Antibiotics Fight From Pharmacy to Farm

June 02, 2015

The Obama administration today marshaled both the public and private sectors to fight the scourge of antibiotic resistance at livestock feed lots, federal cafeterias, and the nation's hospitals and physician offices.

The US Food and Drug Administration (FDA) also released final regulations today that, by the end of 2016, will end the practice of lacing feed for cows, hogs, poultry, and other animals with medically important antibiotics to promote animal growth. The use of antibiotics to treat bona fide health problems in livestock will come under the supervision of veterinarians.

Meanwhile, President Barack Obama signed a memorandum today directing federally operated cafeterias to gradually begin serving meat that is produced with responsible antibiotic use. This initiative, which takes advantage of the enormous purchasing power of the federal government, will support the emerging market for such meat.

In addition, the White House today convened a forum on antibiotic resistance that included more than 150 food companies, healthcare associations, retailers, drug manufacturers, and other groups with a stake in the issue. The list included the American Medical Association, AARP, AstraZeneca, Cargill, McDonald's, Kaiser Permanente, the National Cattlemen's Beef Association, Medscape/WebMD, Procter & Gamble, and Walmart. Each group has made commitments to combat the problem of so-called superbugs that cause 2 million illnesses and 23,000 deaths a year, according to the White House.

"It's not too late to turn it around," Thomas Frieden, MD, MPH, the director of the Centers for Disease Control and Prevention, told forum participants. "We don't want the miracle to be over — the miracle of antibiotics. Unless we take action now, that is a significant risk.

"There are now infections out there for which we have few or no antibiotics. We risk turning back the clock to when simple infections can kill."

"Not Just the Government's Problem to Solve"

Today's forum and administration announcements about antibiotic resistance build on a national strategy the White House put forth in September 2014, along with an action plan in March that set more specific goals, such as halving the incidence of Clostridium difficile by 2020.

Much of the campaign has focused on educating clinicians to judiciously prescribe antibiotics. Healthcare groups participating in the White House forum pledged their commitment to responsible stewardship of these drugs. Hospital Corporation of American said it would develop and implement new clinical decision support tools and real-time antibiogram tracking to rapidly respond to laboratory results and catch bug–bug mismatches, according to a White House news release. Intermountain Health promised to reduce inappropriate antibiotic use for upper respiratory conditions by 50% 5 years from now.

Judicious prescribing depends in part on faster, more precise tests. Accordingly, BD Diagnostics, another forum participant, will develop a test for tuberculosis that will simultaneously identify the bacteria and any drug resistance. The Obama administration, meanwhile, continues to offer a $20 million prize for the development of a rapid, point-of-care test to spot superbugs.

As evidenced by new FDA regulations on what should and should not go into animal feed, the problem of antibiotic resistance is as much a matter of farm as pharma. Livestock and poultry farmers, food producers, and retailers represented at the forum have been voluntarily phasing out the use of antibiotics for growth promotion, or have just committed to do so. Tyson Foods, for example, will stop using human antibiotics in its US broiler chickens by September 2017. Walmart is asking suppliers to follow antibiotic guidelines from the American Veterinary Medical Association. Panera Bread is adding roasted turkey, smoked chicken, breakfast sausage, ham, and bacon to its list of offerings labeled as protein "raised without antibiotics."

The turnout of corporate America at the antibiotic resistance forum "shows that this is not just the government's problem to solve," said Amanda Jezek, vice president for public policy and government regulations at the Infectious Diseases Society of America in an interview with Medscape Medical News. "The White House needs significant contributions from all stakeholders."

At the same time, Obama is taking advantage of his presidential bully pulpit by changing the menus at federal cafeterias to feature antibiotically correct meat dishes.

"He's sending a message to food producers that this is an important issue," Trevor Van Schooneveld, MD, a spokesperson for the Society of Healthcare Epidemiology of America, told Medscape Medical News.

More information about today's antibiotic resistance forum is available on the White House website.

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