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Evolution of Antibiotic Use and Veterinary Feed Directive Changes
Sonia Mumford DVM & Guppy Blair DVM Olympia Fish Health Center & Idaho Fish Health Center
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History
Alfred Eisenstaedt/Time Life Pictures/Getty
Weebly.com
Ernest Chain Howard Florey
1945 – Nobel Peace Prize
http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/chain-bio.html
1928 – Alexander Fleming
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Alexander Fleming:
“I hope this evil can be averted.”
“The thoughtless person playing with penicillin treatment is morally responsible for the death of a man who succumbs to the infection with the penicillin resistant organism”
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And so begins the battle….
http://cooper.imb.uq.edu.au/community_background.html
http://www.mtaofnj.org
http://thelightmedia.com/posts/21787-top-10 -best-accidental-scientific-discoveries-and-inventions
From January to May 1943, only 400 million units of penicillin had been made; by the time the war ended, U.S. companies were making 650 billion units a month.
http://www.pbs.org/wgbh/aso/databank/entries/dm28pe.html
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How did we do?
Mid1930s 1937 1938 1940 1943 1950’s
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How are we doing now?
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When did this chemical warfare begin?
Doctorbhatia.com
http://cooper.imb.uq.edu.au/community_background.html
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How many soldiers in the battle?
Most abundant & diverse life form on earth 36 x 1028 species in sea-water alone (Discover Magazine 2007) Estimated:
#bacterial cells in a gram of soil
#bacterial cells in a milliliter of water
1 billion 1 million
We are not alone….
(with a wide variation) (Nature 2016)
Cell Type Aprox. # Cells Human Cells In Human Body 30 trillion Bacteria in and on Human Body 39 trillion
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Use of Antibiotics: applying a selective pressure for resistance
en.wikipedia.org
From ANTIMICROBIAL PHARMACODYNAMICS: CRITICAL INTERACTIONS OF ‘BUG AND DRUG’ George Drusano Nature 2004
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If bacteria come into contact with other bacteria, they can trade genetic information (DNA)
And it isn’t even a fair fight….
http://mrsa-research-center.bsd.uchicago.edu/images/Cartoon_antibioticresistance_joke.jpg
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Surely we’re prepared….
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The problem:
“The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century.”
Estimated 10 million fatalities globally.
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What is causing the problem?
Exact mechanisms unknown… But….
47 million excess prescriptions annually…
157 million human medicine prescriptions…….. to patients that may not take the antibiotics as directed…
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An estimated* 70% (by weight) of antibiotics sold in 2011 was for use in animals
*not all antibiotics sold are actually used
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How about world aquaculture use of antibiotics?
Chile is the second largest producer of farmed salmon and the only important developing country producer--300 tons of antibiotics per year
The largest salmon producer, Norway, uses less than 1 ton per year(relying instead on vaccination and husbandry measures to control diseases).
http://www.fao.org/antimicrobial-resistance/background/what-is-it/en/
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Antibiotic use in US Aquaculture?
No solid numbers……
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We don’t know exact mechanisms or what group(s) to blame…
But we know it’s complicated…
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Dissemination of antibiotics and antibiotic resistance within agriculture, community, hospital, wastewater treatment, and associated environments.
Julian Davies, and Dorothy Davies Microbiol. Mol. Biol. Rev. 2010;74:417-433
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How much of these antibiotics are used in our hatcheries?
My guess….
But, we should do our part of antibiotic stewardship….
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Most hatchery fish fall under “Food Animals”
FDA changing how medically important antibiotics can legally be used in feed/water for food-producing animals. Eliminate use for production purposes Bring remaining therapeutic uses under the supervision of
a veterinarian
And we must comply with the new regulations
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Veterinary Feed Directive(VFD) Rule
Veterinarians must be licensed in the state the VFD is issued*
Requires a Valid Client Patient Relationship (VCPR) (varies state to state)
Veterinarian requirements: Sufficient knowledge of the patient(s) Assume responsibility of diagnosis, treatment Provide follow up
Client requirements: Agrees to follow veterinarian’s instructions.
*Some specific exceptions
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Recommendations for timely & smooth VFDs
Especially for hatcheries medicated feed/ immersion (marking) are anticipated, PRIOR to the need: Work with a veterinarian to establish a Valid Client
Patient Relationship (VCPR) with hatchery Confirm that you have a source for medicated
feed/immersion (must be authorized distributor)
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How the process could work once a VCPR is established:
2 yrs
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Optional Information
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No refills. A treatment using a VFD
must be completed prior to the expiration date set by the veterinarian.
Must display prominently on feed bag:
More on VFDs
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Which fish drugs need a VFD?
Generic Name Examples of Brand Name Florfenicol Aquaflor® Oxytetracycline Terramycin® 200, Pennox® 343,
Terramycin® 343 Sulfadimethoxine & Ormetoprim Romet 30, Romet TC
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Can you legally Extra-label a VFD?
NO. But, under a specific set of circumstances, for minor species, FDA use “enforcement discretion” and may not prosecute. Veterinarian takes on the liability and responsibility for additional documentation and requirements.
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What is a minor species?
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What isn’t a VFD drug?
Investigational New Animal Drugs (INADs)
Treatments used to kill microorganisms that are not medically important for Humans:
(ie: Chloramine T, Formalin, Hydrogen Peroxide)
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What additional FDA measures will be taken? Working to change label for remaining antimicrobial
drugs with no limit on duration for administration to a food animal
Proposed rule: Drug sponsors include species specific information in reporting requirements to FDA
Working to obtain more information on indication, dose, and duration of antibiotics given by species
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One last thing…Not VFD….
Remember, a veterinarian must have a valid VCPR to write extralabel prescriptions. If using an approved drug, know the labelled use(s). ANY deviation from label (ie dose, duration, indication, species etc.) requires a prescription.
Drug Indication Deviation from Label Formalin Ich Longer duration Formalin Fungal Infection Treatment of fish, not eggs
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QUESTIONS???