Antibiotics appeal

The emergence of antimicrobial resistance (AMR) is a natural process: microorganisms - such as bacteria - develop defence mechanisms against substances and agents - such as antibiotics - that have a harmful or even lethal effect on them. This inherently natural process can be accelerated by overuse, misuse or abuse of antibiotics. Initial studies also show rising resistance rates due to higher temperatures - the resistance problem is thus further fueled by climate crisis. 

Health problem for humans

Antibiotic-resistant pathogens can cause infections that are difficult to treat and make effective antibiotic treatment of other infections more difficult. Both human and veterinary medicine must therefore take decisive action against antibiotic resistance. Otherwise, antibiotics will become increasingly ineffective and even the simplest infections will be almost impossible to treat in the near future - a post-antibiotic era looms.

Animals bred for high performance are particularly susceptible to disease. Keeping animals in large groups and herds, as well as other intensive husbandry practices, promote high and regular antibiotic use and increased resistance rates.

Highly problematic: group treatment of animals

The regular administration of antibiotics to large groups of animals via feed or drinkers is considered particularly problematic. This is a treatment practice that is used even when only a few animals are sick, and it poses problems:

Antibiotic residues and resistance can be carried in the piping and plumbing systems. In addition, because an animal's individual feed and water intake cannot be checked in large groups, inaccurate dosages are risked. Especially with underdosing, pathogens risk not being completely killed and repellents and ultimately resistances develop.

Transmission paths

The transmission of antibiotic resistance from animals to humans can occur in various ways:

1. via the environment: exhaust air from animal houses and manure or fermentation residues contaminate the air, soils, surface waters and ground water
2. via products such as meat in particular, but also raw milk
3. via direct contact with the animals.

Consumption volumes in the EU and Germany

In 2018, 6,358 tons of antimicrobials were used in 31 European countries in so-called food-producing animals - compared to "only" 4263 tons in humans (JIACRA III report). (JIACRA III report).

Specifically in Germany, antibiotic dispensing to human medicine in 2019 was 339 tons - to veterinary medicine 670 tons. For 2020, the Federal Office of Consumer Protection and Food Safety (BVL) again reported an increase in dispensing to veterinarians of almost 5% to 701 tons.

Comparison in mg/PCU

In order to ensure better comparability for different animal species and reporting countries of the EU, the unit mg/PCU* (* Population Correction Unit, equivalent to 1 kg biomass of food-producing animals or 1 kg total body weight of the population) is used for antibiotic use in addition to the figure in tons.

The relative consumption of antibiotics in food-producing animals (104,6 mg/kg) is now lower than the consumption for humans (133,3 mg/kg). However, there the long lifespan of humans in particular must be taken into account in comparison with the mostly short lifespan of food-producing animals.

In a European comparison (2017), Germany's level of around 89.9 mg/kg for food-producing animals is many times higher than it is in countries such as Norway (2.9 mg/kg), Sweden (12.5 mg/kg), Denmark (38.2 mg/kg) or the Netherlands (57.5 mg/kg).

Current Situation

Even though the use of antibiotics in veterinary medicine has tended to fall overall within the last ten years, a shorter period of observation shows a certain stagnation. For individual antibiotics and countries, use is even increasing again. Efforts to reduce antibiotic consumption now appear exhausted. Without a drastic improvement in animal breeding and husbandry, including a significant group and herd reduction, a further reduction of antibiotics will hardly be achieved.

The development and spread of resistance to the antibiotics that are often the last or only means available to humans can be considered extremely worrying. The "highest priority critically important antimicrobials" (HPCIA or also CIA HP) can be classified as so-called reserve antibiotics.

The World Health Organization (WHO) uses the term CIA HP* (* Cephalosporins of the 3rd and higher generations, quinolones incl. fluoroquinolones, glycopeptides, macrolides and ketolides, polymyxins such as colistin)to describe the antibiotic drug classes that are to be given the highest priority for global containment of resistance via more prudent and restrictive use. In its guidelines for the use of antibiotics in food-producing animals, the WHO explicitly recommends that CIA HPs no longer be used in this area.

Consumption quantities of the CIA HP

At the European level, CIA HP accounted for 14% of total antibiotic dispensed to food-producing animals in 2018 (ESVAC report). In Germany, the total amount of CIA HP dispensed to veterinary medicine in 2019 was 130.7 metric tons, representing approximately 20% of the total antibiotics dispensed to veterinary medicine in Germany that year. 

European data also clearly show (ESVAC report) their main use in problematic group animal use (see above "What role does industrial animal husbandry play?").

The European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA) pointed out in a joint report (2021) that "resistance among bacteria causing foodborne infections remains high," a finding that was confirmed again in the most recent report (2022). A previous report (2020) already warned that infections with foodborne bacteria are becoming increasingly difficult to treat. And the European Court of Auditors also reiterated the major challenge facing the EU in its special report on "Combating Antimicrobial Resistance" (2019). A joint ECDC, OECD, EFSA, and EMA policy paper (2022) generally notes that "resistance to commonly used antibiotics is still high (>20% to 50%) or very high (>50% to 70%) in bacteria" derived from food-producing animals.

Resistances to CIA HP

This ECDC and EFSA reports show widespread resistance to ciprofloxacin (fluoroquinolones) in humans. In addition, there is also resistance to cephalosporins, macrolides as well as polymyxins, and in some countries co-resistance to specifically ciprofloxacin and erythromycin (macrolides).

Of great concern is that pathogens such as Salmonella or Campylobacter, which cause infections in humans very frequently, show resistance to the antibiotics that are used to treat them. A large proportion of Salmonella bacteria are already multi-resistant - that is, three or more antimicrobial agents are no longer effective.

Situation in Germany

The current resistance situation in Germany is regularly monitored by the zoonoses monitoring. The current report states that "there has been no significant improvement with regard to the occurrence of resistance in bacterial isolates from the broiler, fattening turkey and fattening pig food chains [...]."Resistance rates were highest in broilers and fattening turkeys”, according to the report, "reflecting the frequent use of antibiotics in these animal groups."

Similar concerns were raised in the previous monitoring regarding the "occurrence of resistance in bacterial isolates from the food chains of fattening pigs, fattening calves, and young cattle, as well as from tank milk and fresh beef."

Both reports refer to various multi-resistant germs and warn overall to significantly increase efforts to reduce antibiotic use in livestock and to reduce resistance rates. A necessary focus: the reduction of CIA HP (see above).

A (short) chronology of resistance evidence

In addition to regular governmental and European monitoring and reports (see above "Current resistance situation"), the results of individual investigations by NGOs, media and universities repeatedly point to the problem of antibiotic resistance. The following is a brief overview (without claim to completeness):

Already today, the first (multi-)resistant strains of pathogens can be detected in various places around the world. Such spread occurs primarily through human travel and through imports and exports of goods. With regard to resistance from animal production, two things must be considered:

By exporting meat, the European Union (including Germany) also exports resistant pathogens to other countries. This often includes countries with weaker health systems. Conversely, we as well import meat products to Europe from countries with lower production standards and higher resistance rates.

This trade dimension makes it clear once again that the further development and spread of resistance, especially to reserve antibiotics (especially CIA HP), must be curbed as quickly as possible.

• Benning, R./Striezel, A.: „Recherche zu Reserveantibiotika bei Tieren die der Lebensmittelgewinnung dienen - Reserveantibiotika als Metaphylaxe und Gruppenbehandlung verzichtbar“ - English Summary: (2021)
   
• Bruhn, D.: Rechtsgutachten zum umfassenden Verbot des Einsatzes von Reserveantibiotika in der nahrungsindustriellen Tierhaltung (2021)
   
• BUKO Pharma-Kampagne: Resistente Erreger. Gefahr für Mensch, Tier und Umwelt, Pharma-Brief Spezial, Nr. 1, 2020.
   
• Bundesamt für Verbraucherschutz und Lebensmittelsicherheit (BVL):
  • Antibiotikaresistenzen in der Umwelt (o. J.)
  • Zoonosen-Monitoring 2019 (2020)
  • Rohmilch kann krankmachende Keime enthalten (2020)
  • Zoonosen-Monitoring 2020 (2021)
  • Abgabemengen von Antibiotika in der Tiermedizin leicht gestiegen (2021)
     
• Europäischer Rechnungshof: Addressing antimicrobial resistance: progress in the animal sector, but this health treat remains a challenge for the EU (2019)
   
• European Medicines Agency (EMA): Sales of veterinary antimicrobial agents in 31 European countries in 2018, Trends from 2010 to 2018, Tenth ESVAC report (2020)
   
• European Centre for Disease Prevention and  Control (ECDC):
  • Infographic: Antibiotic resistance – an increasing threat to human health (2018)
  • Antimicrobial resistance in the EU: infections with foodborne bacteria becoming harder to treat (2020)
  • Antimicrobial consumption and resistance in bacteria from humans and animals: Third joint inter-agency report on integrated analysis of antimicrobial agent consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the EU/EEA, JIACRA III 2016–2018 (2021)
     
• European Food Safety Authority (EFSA):
  • EFSA Panel on Biological Hazards (BIOHAZ): Role played by the environment in the emergence and spread of antimicrobial resistance (AMR) through the food chain (2021)
  • Resistance levels still high in bacteria causing foodborne infections (2021)
     
• European Food Safety  Authority and European Centre for Disease Prevention and Control (EFSA/ECDC): The European Union Summary Report on Antimicrobial Resistance in zoonotic and indicator bacteria from humans, animals and food in 2018/2019 (2021)
   
• European Public Health  Alliance (EPHA): Antimicrobial Resistance (AMR), EPHA Position Paper on the 2017 EU Action Plan on AMR (2017)
   
• Food and Agriculture Organization of the United Nations (FAO) et al.: Antimicrobial resistance and the United Nations Sustainable Development Cooperation Framework (2021)
   
• Food and Agriculture Organization of the United Nations (FAO): Drivers, dynamics and epidemiology of antimicrobial resistance in animal production (2016)
   
• Germanwatch e. V.:
  • Über Antibiotikaresistenzen, ihre Ursachen und Reduktionsstrategien in der Tierhaltung (Autorin: R. Benning) (2019)
  • Antibiotika in der Tierhaltung Fakten zur aktuellen Kontroverse über EU-Regeln (Autor: K. Tsilimekis)(2021)
• Krzemiński, P./Markiewicz, Z./Popowska, M.: Entry Routes of Antibiotics and Antimicrobial Resistance in the Environment, in: Muhammad Zaffar Hashmi (ed.): Antibiotics and Antimicrobial Resistance Genes, 2020, S. 1-26.
   
• MacFadden, D. R. et al.: Antibiotic resistance increases with local temperature, in: Nature Climate Change volume 8, S. 510–514 (2018)
   
• Rodríguez-Verdugo, A. et al.: Compounding Effects of Climate Warming and Antibiotic Resistance, in: iScience. Volume 23, Issue 4 (2020)
   
• PAN Germany: „Antibiotika in  der  Tierhaltung Wie lassen sich Umweltbelastungen reduzieren und Resistenzen vermeiden?“
   
• The Review On Antimicrobial Resistance Chaired by Jim O’Neill: TACKLING DRUG-RESISTANT INFECTIONS  GLOBALLY: FINAL  REPORT  AND RECOMMENDATIONS (2016)
   
• Umweltbundesamt (UBA): Antibiotika und Antibiotikaresistenzen in der Umwelt. Hintergrund, Herausforderungen und Handlungsoptionen (Antibiotics and Antibiotic Resistances in the Environment. Background, Challenges and Options for Action) (2018)
   
• Wallmann, J. et al.:
  Abgabemengenerfassung von Antibiotika in Deutschland 2018, in: Deutsches Tierärzteblatt 67 (8), S. 1082 ff. (2019)
  Abgabemengenerfassung von Antibiotika in Deutschland 2019, in: Deutsches Tierärzteblatt 68 (9), S. 1102-1109 (2020)
   
• WHO:
  • WHO guidelines on use of medically important antimicrobials in food-producing animals (2017)
  • World leaders and experts call for significant reduction in the use of antimicrobial drugs in global food systems (2021)
     
• Wissenschaftlicher Dienst der AOK (WldO): Jedes zweite verordnete Antibiotikum  ist ein Reservemedikament (2020)
• Wissenschaftlicher Dienst der AOK (WldO): Jedes zweite verordnete Antibiotikum ist ein Reservemedikament (2020)