Responsible antibiotic use starts with producers, veterinarians, doctors

The first pre-summit webinar for the Come Together for Animal Ag, Animal Agriculture Alliance’s 2022 Summit was held April 6. One of the speakers during the panel was Dr. Rick Sibbel, president and owner of Executive Veterinary and Health Solutions.

Sibbel retired from a long career in animal health in 2018 and is currently a consultant to the animal health and human health professions and antimicrobial resistance and antibiotic stewardship.

Sibbel gave the audience a couple things to think about when looking at antibiotics, antibiotic use and misuse, and the interplay between animal welfare and antibiotic use. He started by giving a little bit of background.

“Antibiotics are without question the largest single tool that is shared between human, veterinary and environmental medicine,” he said. “And along with that shared tool comes major challenges going forward.”

The innovation and finding of new antibiotics over the past 10 to 15 years has slowed tremendously.

“We don’t have new antibiotics on the horizon that we used to have 20 years ago,” Sibbel said. “What that means is the tools that we have today must be very, very cherished, and good decisions made about how we use them, not only in human medicine, but in veterinary and environmental medicine, as well.”

Sibbel is part of a leadership council, National Institute of Antimicrobial Resistance Research and Education, or NIAMRRE. The council is coordinated through Iowa State University and is tasked to look at the spectrum of interface in One Health human medicine, veterinary medicine, environmental medicine and provide leadership and guidance, plus help people to make decisions going forward.

“Our goal is just coordinating action to look at the global threat of antimicrobial resistance,” he said. “It is a big deal. There’s resistance to antibiotics in every corner of the globe, because antibiotics, one—they’re used, they do create resistance. So we have to be very closely attuned to the impact going forward.”

When talking about antibiotic use, Sibbel believes it’s important on several levels. The first is research. There’s current research going on right now, but it’s not nearly as high as it was 15 years ago. And there’s a couple reasons for that.

“If we invented and licensed and commercialized a brand new broad spectrum antibiotic today that worked against multiple kinds of bacteria, gram positive, gram negative we would expect the medical personnel to leave it on the shelf and only use it as a last resort,” he said. “Because that’s the way new innovations in this space have to be used going forward.”

There’s a problem with the business model, Sibbel said, especially when there’s multi-millions or even billions of dollars invested in getting a new antibiotic to the market—and it doesn’t get used. There’s no economic return doing it that way. Instead, things are moving “very quickly” to a business model where the development of antibiotics at multiple levels are going to have to be public funded.

There is a degree of accuracy that’s “absolutely essential.”

“We have taken for granted for a very long time that every time that we go to see our general practitioner or we have a health problem the expectation by the public is that we should get an antibiotic given to us or scripted,” he said.

Data says no more than 50% of the time the ailment needs some kind of health management process and antibiotics are not needed.

“That is a huge, huge paradigm shift for those of us that are trying to sort through how to use antibiotics in the best possible way going forward,” he said.

Animal agriculture, especially in North America, but many western countries the last few years have still been figuring out how to use less antibiotics in food animal production for protein.

“Can we do more? Yes,” he said. “Do we have a risk going forward? Yes.”

This tool—antibiotics—has been over used by nearly every section of the country in every category of human, animal and environmental medicine, Sibbel said.

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“The risk that we have going forward and it’s one of the things that I want this audience to consider heavily—it is very easy for politicians and it is very easy for policymakers to determine quickly that antibiotics should only be used in human medicine as we go into the future,” he said. “And in fact, we have organizations and countries that believe that to the point that they’re pushing very hard against the use of antibiotics in all of veterinary medicine, not just food animals.”

The consequences to this kind of thinking could be apocalyptic, according to Sibbel.

“If we do not have a tool to continue to raise animals in a very humane way, so that they’re healthy and they provide the necessary animal protein, we are going to have a global food shortage of a very large proportion,” he said. “So we have to be very diligent in communicating to our colleagues in human medicine, that we are in this together.”

One sector cannot be removed and expect the other sector to thrive like it’s been doing in the past.

In a program at NIAMRRE, they’re looking at multiple pieces of the puzzle for animal welfare Sibbel said.

“Then as animal welfare is worked through the amount of antibiotics needed for improving and continuing to improve animal welfare status,” he said.

There are several core principles that Sibbel calls a One Health system that appears to work well. Disease prevention is one.

“More vaccines need to be used going forward in the future and the good news is significant advancement is being done on more and more vaccines that can prevent disease,” he said. “It’s very clear that veterinarians need to be involved in the process.”

Producers need to be informed enough to make the decision to use antibiotics on their livestock, as well as justify it.

“It’s very clear that there are places where we can continue to use less antibiotics, because we’ve done better husbandry practices,” he said. “We have improved genetics, we’ve had improved feed systems, etc., etc.”

Producers also have to pay attention to a lot of “what are we doing to the bugs in the environment?”

“Are we taking care of the runoff? Are we are we making sure that we’re not getting any antibiotics into the water supply?” Sibbel said. “Interestingly enough, three or four studies that have come out in the last five years indicate that there is a significant amount of antibiotics from humans (who are) throwing away used antibiotics into the septic systems of cities and there is a bigger problem there that’s going to have to be addressed going forward.”

Those who have been involved with and part of antibiotics in the last seven years, have begun to realize that when a bacteria is submitted to a human diagnostic lab versus a veterinary diagnostic lab the same organism ends up with decision points that do not match.

“And now we know very clearly that if it’s a shared bug like E. coli and it happens to come from cattle or happens to come from humans, and you ask two different diagnostic systems to look at the relevance of resistance,” he said. “You get two different answers.”

Sibbel said veterinarians have seen resistance patterns just like they have in human medicine. But it’s apples to oranges comparisons.

“There’s some very new research looking at determining the actual resistance of the bug independent of the target species and independent of the dose, looking at just the bacteria in question and it’s is some of the newer science that we can look at going forward,” he said.

Sibbel believes organizations like NIAMRRE are going to have a bigger impact on the One Health collaboration.

“So that advice, policy and understanding that comes out into the mark into the world that we all live in for both human, veterinary medicine, environmental Medicine, has a balanced approach to using antibiotics,” he said. “Just enough, just in time, and just for the right amount of time.”

Communication will end up being a big part of how long antibiotics can be used in animal agriculture. Antibiotic resistance and use is one area where it’s difficult to get the science right and communicate in a sustained, meaningful way. Sibbel has been involved with connecting restaurant-retail-food service type brands and large-scale distributors when it comes to antibiotic use policies. From those conversations he’s learned a few things.

“The communication is really, really difficult because—there was a quote that I love to hear—if you think you know anything about antibiotic resistance, you actually haven’t been paying attention,” he said. “It’s extremely complicated.”

Going forward, people, doctors, veterinarians and all involved in the health care industry, are going to have to do a good job of letting people know antibiotics need to be protected as a tool.

“And all of us have a very major role to play in the protection of that tool,” he said.

When it comes to the role of the farmer and rancher in shaping the animal welfare conversation, every one has to be at the table.

“We have to be open minded, not defensive and listen to their sort of bias at that moment in life,” he said. “Everybody forms their opinions based on all kinds of inputs and we can argue till we’re blue in the face, whether social media is making that more difficult to have real information or less difficult.”

Those who raise food are such a minority in the population, and it’s become a “very, very large uphill battle to communicate what we’re doing well, and good or bad.”

“We love to defend what we’re doing as opposed to listening and figuring out how what we’re doing is helping the people that need to be more informed,” he said. “We’ve got to be less defensive because we’ve sort of been a problem about that. But that’s easier said than done. I understand.”

Sibbel wants everyone to know the future lies in the hands of those administering and using antibiotics.

“The ability to have antibiotics for generations after us we’ll be determined on how well we are to educate ourselves and use them more appropriately going forward,” he said.

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Kylene Scott can be reached at 620-227-1804 or [email protected].