Four years ago, Dr. David Patrick and his colleagues sounded the alert about the overuse of antibiotics in BC. Dr. Patrick was especially critical of the widespread use of antibiotics in food production and what he saw as a lack of oversight: “Antibiotics were being used too liberally, with no prescriptions. This increased the risk of organisms in our food that were antibiotic resistant. It was a huge problem.” These days, Dr. Patrick is a lot more optimistic. He says good progress is being made both in agriculture and health care.
In BC’s farm sector, many changes are underway to reduce antibiotic use and to better measure it. The poultry sector was a main area of concern. Four years ago, antibiotics – often the same ones that were prescribed for humans – were routinely given to chickens to promote growth, prevent disease, and treat disease. This meant antibiotic resistance could be transferred up the food chain, as resistant organisms on chicken made their way to humans through improper handling or under cooking.
Poultry producers are voluntarily doing away with the use of antibiotics to promote growth in animals. And they will no longer routinely use so-called Category 1 antibiotics – those of high importance for humans. Those types of antibiotics will require a prescription.
The changes, and greater awareness, have already produced encouraging results: in 2012, 40% of the organisms found on retail poultry in BC had resistance to commonly used cephalosporin antibiotics. In 2014, that resistance dropped to 6%.
And tracking antibiotic use in agriculture will be easier. Pharmaceutical manufacturers will need to report drug use by species, not just by sector as they did before. With fully three quarters of the antibiotics in Canada used on animals, it is important to be able to know exactly where they are going.
Health Care Progress
Dr. Patrick says there is also cause for optimism in health care practice. Antibiotic awareness initiatives like “Do Bugs Need Drugs” have yielded results. The rate of prescribing antibiotics has dropped by 15% in the past 10 years.
“Every year we spend $53 million less on antibiotics that nobody needed in the first place.”
Dr. Patrick says pharmacists in the Provincial Academic Detailing Program in BC are also working on projects to reduce antibiotic use in long-term care. Hospital teams are taking action too. The Vancouver Coastal Health Antimicrobial Stewardship Program initiative has made significant gains in reducing antibiotic use in hospitals like VGH, Lion’s Gate and Richmond in the past few years.
On the so-called Superbug front, Dr. Patrick says he is cautiously optimistic. “We have been tracking resistance in some common organisms – like E. coli and Staphylococcus aureus – and the situation has stabilized. For E. coli the resistance may even be declining. And infections like Streptococcus pyogenes are still responding to penicillin.” Details of these trends can be found on the BC Centre for Disease Control website.
Dr. Patrick says they still need to keep a close eye on some very rare and very resistant bugs that carry genes resistant to last resort antibiotics, but he was encouraged to see these superbugs were a smaller problem in 2015 than in 2014, when there was an outbreak in a facility in the Fraser Valley Health Authority.
Next week is World Antibiotic Awareness Week – a new mobilization effort from the World Health Organization. And last month the United Nations convened a special meeting on superbugs. Dr. Patrick says these international efforts have pushed Canada to focus on the antibiotic resistance problem: “I sense there is now the political will to tackle this as a priority.” Dr. Patrick recently met with federal health officials in an effort to come up with a national strategy on antibiotic use and expects more progress to be made.