The industry’s next challenge: ‘‘careful use of ... · RESISTANCE TO ANTIBIOTICS • The...

The industry’s next challenge: ‘‘careful use of antibiotics’’, a global issue! Dr. Frederic Beaulac, veterinary medicine December 9, 2014

Using Antibiotics Wisely

• Wise • Cautious • Rational • Adequate • Responsible • Reasonable … whatever the descriptive, it is a global trend

• Why the call to arms in ‘‘Using Antibiotics Wisely’’? Answer: RESISTANCE TO ANTIBIOTICS

2

RESISTANCE TO ANTIBIOTICS

DEFINITION OF THIS RESISTANCE: • Bacteria’s natural defence

mechanism against an antibiotic attack used to destroy the bacteria

• ‘‘ADAPTATION Mechanism’’:

bacteria acquiring resistance through selection or genetic mutation, which is then passed down to future generations …

rédigé par Dr Frédéric Beaulac -2014/05/10

Before Selection

After Selection

Final Population

Resistance Level


QUESTION:

ONE “bacterial” day is equivalent to how many “human” years?

ANSWER: 2000 years!! Imagine the powers of adaptation of such a life form…

4


Therefore… if exposure to antibiotics = ↑ chance of resistance • ISSUE No. 1: 80% of total antibiotics are used on animals (food-producing animals >>>> household pets)

• ISSUE No. 2: Zoonosis: Animal-to-human communicable disease (Ex.: salmonella, streptococcus suis, red fever) • ISSUE No. 3: Cross-transmission of resistance (Ex.: animal bacteria => environmental bacteria => human bacteria )



• RESULT: Animal production is taking the blame …

6


• The reality is not as ‘‘cut-and-dry’’…

• The Institute of Food Technologists believes that the risk to human health, linked to certain antibiotics in food-producing animals, remains low.2

• A panel of experts believes that 96% of the problems related to antibiotic resistance in humans are the result of antibiotic use in humans and not in animals.1

• 1- Casewell and Bywater, Journal of Antimicrobial Chemotherapy,46: 639-645, 2000 • 2- Institute of Food Technologists, www.ift.org, Antimicrobial Resistance: Implications for the Food System, July 14, 2006

7


• The reality is not as cut-and-dry…

• Most of the antibiotics used in swine are not the types of antibiotics that are highly important in human health.

• The majority of humans have no direct contact with livestock: 80%+ of the Canadian population lives in cities; they can, however, be exposed indirectly (food chain, environment)

• The most commonly prescribed antibiotics for cats and dogs are the same as prescribed to humans.3

• In Canada, over 50% of households own at least one cat or dog (direct contact).4

3- European Medicines Agency (EMA). Committee for Medicinal Products for Veterinary Use (CVMP). Reflection paper on the risk of antimicrobial resistance transfer from companion animals. EMA/CVMP/AWP/401740/2013. Draft (10octobre 2013) 4-The Business of Urban Animals Survey: The facts and statistics on companion animals in Canada, Can Vet J. Jan 2009; 50(1): 48–52.

8


• The reality is not as cut-and-dry… but still!

HUMAN CONCERNS • Health Canada • Ministère de la Santé et des services sociaux du Québec

(M.S.S.S.) • Media • Consumer groups AND RIGHTLY SO…

9

The Increase in Antibiotic Resistance – A Genuine Threat



The Increase in Antibiotic Resistance – a Global Issue


The Increase in Antibiotic Resistance

0 2 4 6 8

10 12 14 16

1983- 1987

1988- 1992

1993- 1997

1998- 2002

2003- 2007

2010 à 2012

Number of new antibiotics approved in the U.S.A. from 1983 to 2012

• And new weaponry is fewer and farther between …

12

Consequences of Antibiotic Resistance in Humans

13

Source: Antibiotic resistance threats in the United States, US Dept. of Health, C.D.C., 2013


14



15


The Increase in Antibiotic Resistance – A Reality in Animal Production

The increase in antibiotic resistance is not only a problem in humans, it affects our livestock as well: • In Québec, 57% of salmonella strains in swine,

submitted to the Mapaq in 2013 are resistant to at least 3 antibiotics.

• In Québec, a significant increase in the resistance to ceftiofur (Excenel, Excede, Ceftiocyl) has been found in swine E. coli since 2000. From 0% in 1994 to 20% in 2013

16

Health Canada Antibiotics Classification Main Categories in Antimicrobial Types Human Medicine

I Highest Importance

(serious human infections AND scarcity/absence of effective products)

Baytril® Excenel®, Excede®, Ceftiocyl®

II High Importance (serious human infections but available

alternatives)

Lincomycin® Lincomix® Gentamycin® Apralan® Tylosine® Tylan® Aivlosin® Draxxin® Amoxicillin: Paracillin® Trim-Sulfa: Trimidox® – Poten-sulf® – Uniprim® Stafac® (virginiamycin 44®)

Penicillin: Depocillin® – Pen Aqueous® - PenG®

Pulmotil® Tilmovet®

III

Average Importance (non-serious human infections and/or cat. II and

cat. I are effective)

Tetracyclines: Aureomycin® - Chlor 100® - Onycin® - Liquamycin® - Oxy LA®

Spectinomycin: LS20®- LS100®- Lincomycin+spectinomycin 4,4%®

Néomed 325® Neomycin325® BMD® Bacitracin® Albac® Nuflor® Denagard® Tiamuline® Sulfa with no trimethoprim: Sulfamed® 3-sulvit®

IV Low Importance (not used on humans)

Saccox (salinomycin) Flavomycin (bambermycin)

17

Wise Use of Antibiotics in Europe

• Europe is in the lead… • Regulation on indications is already mandatory:

• Growth Stimulant Usage - FORBIDDEN • Preventive Usage - Limited • Therapeutic Usage - Permitted



Additional comments... • Let’s define …

– Growth Stimulant: • Giving a product to increase an animal’s growth rate (ADG =

Average Daily Growth) and/or feeding efficiency (A.G. = Accelerated Growth)

– Preventive Treatment (syn.: Prevention / Prophylaxis): • Giving a product to healthy animals to prevent signs of disease

usually present at a given time – Therapeutic Treatment:

• Giving a product to one or more sick animal(s) – Metaphylaxis Treatment (syn.: Group Treatment):

• Giving a product to a restricted group of sick and healthy animals when proximity presents a risk of disease propagation in healthy animals



• Europe is in the lead… • Close monitoring of use

– Most European countries have been measuring, identifying and publishing data on the sale and use of antibiotics for more than ten years.

– In recent years, these countries have refined their data collection and now classify them according to set parameters: animal species, production types, antibiotic groups, dispensing methods, etc.

– Consequently, they know the exact dosage of antibiotics that an average pig will consume, from birth to slaughter

– They have even developed advanced calculation methods …



• Europe is in the lead… • Calculation of usage – advanced method

• Evolution in calculation methods From: grams of active product / produced animal To: Daily dosage per animal per year (A.D.D. = Animal Daily Dose)... In other words, “Precise daily dosage for an animal of precise weight per year”

• What for? – In an effort to standardize comparisons among antibiotic

groups and among species… • Present finding

– Each country having developed their OWN calculation method, it is now time to standardize these methods if we want to compare ourselves among countries …



• Europe is in the lead… • Advanced calculation method on usage

• Evolution in calculation methods Example for three different treatments: • 7 days of treatment using 3 kg of Chlor 100 on a pig weighing 15 kg = 3 g of antibiotics • 7 days of injections using Excenel on a pig weighing 15 kg = 0.35 g of antibiotics • 7 days of treatment using 3 kg of Chlor 100 on a beef weighing 300

kg = 42 g of antibiotics However, with the ADD method, these 3 treatments will have the same value


The Advances In Europe

Europe is in the lead… • Implementation of a Usage Reduction Plan: • THE FRENCH EXPERIENCE: The objective to improve practices stems from a political will.

In France, it is made possible through a national plan on antibiotic resistance reduction in veterinary medicine, otherwise known as Ecoantibio 2017, implemented by the Department of Agriculture in 2012. This plan promotes a landmark goal of 25%, which is the five-year planned reduction in antibiotic use in France. rédigé par Dr Frédéric

Beaulac -2014/05/10

The Advances in Europe

• THE FRENCH EXPERIENCE: • France sets the example in the pork sector…

24

PROGRESS OF EXPOSURE ACCORDING TO SPECIES

In 2012, dogs, cats,rabbits, and swine are below 1999 levels of exposure, the year the survey began.

Dogs and Cats

Swine Cattle

Rabbits Poultry

Changes in the number of swine treated with cephalosporine

Pigs Sows

Expo

sitio

ns

The Advances in Europe e de

• The Netherlands (Holland)


The Use of Antibiotics

on Animals

The Dutch Policy

Chart: Gradual increase in the use of antibiotics, all species combined (2007)

The Netherlands (Holland)

• 2008–2011: Reduction Plan Development

26

Objectives of the plan:

Reduction

2009 Reference year

2010

2011 20%

2012

2013 50%

2015

Actual REDUCTION

obtained

-- 0% --

13%

32%

51%

New objective 70%

The Netherlands (Holland) 2009–2012 Reduction By Species


The Netherlands (Holland) in 2007…

28

Netherlands United Kingdom

Switzerland Germany Denmark Finland Sweden Norway

Tetracyclines B-lactamines Sulfamides and Trimethroprimes

Macrolides and Lincosamides

Others Aminoglycosides Quinolones

Source: Department of Agriculture of the Netherlands, 2007

mg/

kg o

f liv

e w

eigh

t

Czech Republic

France

The Netherlands (Holland) in 2012…

29

The Netherlands (Holland)

• The Netherlands in 2012: On average, a pig will receive 12 days of antibiotics*, from birth to slaughter

*with the ADD method

30

The Advances in Europe… okay but what about the impact on

performance?

31

The Advances in Europe and their Impact on Performance?

32

Data from DENMARK

Chart: Quantity of antibiotics used each year on swine and periods of illness

The Advances in Europe and Their Impact on Performance?

33

A.G.

ADG

Mortality

Chart: PERFORMANCE: FATTENING PIGS

Data from DENMARK

The Advances in Europe and Their Impact on Performance?

Three Studies from France Level of performance vs level of antibiotic use

#1- 83 farms (2010); #2- 750 farms (2009–2012); #3- 63 farms (2012)

• Summary: – A high mortality rate correlates with increased use of antibiotics, but in

these studies, – A very small portion of the technical and economic result variation can be

explained by the level of health care costs • Explanations:

• 1- this datum is watered down by other major users who do not have so many problems (over-user)

• 2- this datum is watered down by other users who neglect their herds and accept poor animal breeding performances, not using antibiotics (under-user)

• 3- several other parameters can influence technical and economic data

34

And What About Here, Are We Doing Anything?

2014/05/10


USA: • Excenel (Class l) is forbidden in strict preventive use (2012) • The FDA is working towards eliminating the use of Class l, ll

and lll as growth stimulants, providing for mandatory veterinary supervision, and no longer permitting over-the- counter sales of these products (Cf.: FDA guide 209 and 213 issued in 2012 for consultation)

• The USA still allows some use of Class l in group treatments, where justified

2014/05/10


Canada • 2013: Announcement of the ban on growth stimulants from

Classes l, ll and lll • Warnings on Class l product labels:

– Extra-label use is not recommended – Should not be used in mass treatment – Use of this product should be justified with an antibiogram

2014/05/10


QUEBEC: • Unlike the USA and other Canadian provinces, all

antibiotics dispensing is already carried out under veterinary supervision (prescription is mandatory)

38


QUEBEC: Recently, the AVIA (Association des Vétérinaires en Industrie Animale) put forward a number of positions. Among other considerations: • Advising against using Class I, ll and lll antibiotics as

growth stimulants. • Limiting the use of Class l antibiotics to specific

situations. • Not using Class l antibiotics in prevention. • Periodically questioning all antibiotic use in prevention.

39


QUEBEC: • The MAPAQ Strategic Plan (health and the ACA = Animal Care

Assessment) 1. Awareness campaign 2. Regulation issued in the Gazette officielle du Québec on October

22, 2014.

3. MONITORING Projet (quantify usage) • AQINAC and Les Éleveurs de porcs du Québec Initiative



QUEBEC: • AQINAC Initiative • Annual Survey • Quantifying the use of medicinal additives by

species, at the mill – 85% participation rate in 2013


AQINAC Initiative: Breakdown of Antibiotic Use by Species

Other 0.03%

Chick 0.1%

Turkey 1.0%

Dairy Cattle 2.3%

Beef Cattle 2.6%

Not Broken Down 13.7%

Broiler Chicken 16.2%

Pork 64.1%

* Other: sheep, rabbit, goat, etc. ** Breakdown by species not available.

AQINAC Initiative: Breakdown of Swine Medication According to Importance on Human Health

43

Category ll 11%

Category lV 4%

Other 1%

Tetracyclines

84% Category lll [PERCENTAGE]

Category II Category IV Others Tetracyclines

2013 AQINAC Study – data on PORK

NOTE THAT NO CLASS l ANTIBIOTICS ARE USED IN ANIMAL NUTRITION

And What About Here, Are We Doing Anything? 2013 Les Éleveurs de porcs du Québec /

CRSV INITIATIVE

QUEBEC: Les Éleveurs de porcs du Québec / CRSV initiative • Les Éleveurs de porcs du Québec and the Chaire de

recherche en salubrité des viandes (CRSV) conducted a joint study, in 2013, on the use of antibiotics in fattening using a sampling of 40 Québec producers.

• Objective No.1: comparison with similar study in 2006

rédigé par Dr Frédéric

Beaulac -2014/05/10


CRSV INITIATIVE

QUEBEC: Results of the 2013 Les Éleveurs de porcs du Québec / CRSV Study


Parameter 2013 Study Number of farms 40

Grams of antibiotics per fattening pig

Feed 17 g Water 5 g Injectable 0.08 g TOTAL 22 g


CRSV INITIATIVE

Comparison of the 2013 les Éleveurs de porcs du Québec /CRSV Study • 54% reduction in use between 2006 and 2013

– Factor No.1= reduction in tetracycline use

46

37

17

GRAMMES D'ANTIBIOTIQUES DANS LA MOULÉE / PORC PRODUIT

54% Reduction between 2006 and 2013

2006 2013 GRAMS OF ANTIBIOTICS IN FEED / PIGS PRODUCED


CRSV INITIATIVE

• In 2013, reduced use (-32%) of a ‘‘very important’’ Class Il antibiotic (Tylosine) in favour of a ‘‘not important’’ Class lV (+43%) antibiotic (salinomycin) versus 2006

• Class l antibiotic use (cephalosporines of 3rd/4th generation)

represents as little as 0.03% of the total use of antibiotics (6.5 mg/22 g)

• Batches that were declared PRRS virus positive needed twice as many days of antibiotic therapy than the negative batches

47

Antibiotic Consumption in Feed per Farm 2013 Les Éleveurs de porcs du Québec / CRSV

INITIATIVE

All antibiotics considered

Average: 20.1 g/pig Standard deviation: 13.2

Antibiotic Consumption in Feed per Farm (n=35)

g of antibiotic per pig

Antibiotic Consumption in Feed for the Average Pig (G/Pig Quantity in %)

2013 Les Éleveurs de porcs du Québec / CRSV INITIATIVE

Using Antibiotics Wisely

How do we go about it?

50

Using Antibiotics Wisely: How do we go about it?

1. Justify use, depending on the situation

2. Make the better choice on antibiotic to take

3. Use them less (or rather, use them better…)

1. Look for alternatives 2. Question the situation

51

L’utilisation judicieuse des antibiotiques: comment s’y prendre ?

1- HOW TO JUSTIFY USE • First, target the reason for use • ask … Why am I giving this?

– 2 main reasons are often mentioned: • Disease • Habit (prevention, comfort, ease, fear of change, insurance policy, etc,)

• 25% of producers use 50% of the total quantity (Inaporc study

in France)

52 Netherlands 2012

Using Antibiotics Wisely: How do we go about it?

1- HOW TO JUSTIFY USE (continued)

• Not all problems justify the use of antibiotics … Antibiotics do not treat mycotoxins, nutritional imbalances, viral infections or parasites … their use in such uncomplicated cases is not appropriate

• And if you doubt about ‘‘why am I giving this’’? – Stop using it and see… it’s the trial and error approach

53

How do we go about it? Make Better Choices

2- HOW TO Make better choices … – Conduct lab submissions to find out the antibioresistance pattern – Choose according to the Health Canada classification – Avoid Class l in empirical therapy (1st intention)

For example: • Ceftiofur (Excenel®/Excede®/Ceftiocyl®) in the nursery used

as a ‘‘catch-all’’… Is this wise? – These are Class l… Alternative: Nuflor (Class lll)

• Tylvalosin (Aivlosin®) or Tilmicosin (Pulmotil®) for treatment of mycoplasma or ileitis… Is this wise? – These are Class ll… Alternatives: Tiamuline (Class lll),

Chlortetracycline (Class lll), if withdrawal allows it …

54

How do we go about it? Better and Reduced Use

3- HOW TO Use them less (or rather, use them better…) • Do not start using less right away and at any cost

… winning conditions must be created A reduction cannot be achieved at the expense of animal welfare or zoonotic disease control. Certain conditions can be met tomorrow morning and with little effort, others only in the next three months and yet others may require a complete overhaul of your business… but one thing is certain: in the long run, use in less than ideal conditions will no longer be justifiable.

55

How do we go about it? Better and Reduced Use

3- HOW TO use them better ? 1. Promote individual treatments before starting a group

treatment

2. Exercise caution when using feed as a vehicle for treatment • Feed = less flexibility vs speed, duration and dose

administered Promote treatment via water consumption

• Water = flexible, fast, precise dose

3. Limit group treatments to the smallest possible number of animals Does your building allow it? ( ex.: 2nd water line, 2nd silo)

56


3- HOW TO use them better ? 4. Choice of dosage and duration

– Avoid subtherapeutic use o Ex.: 1.5 kg of Chlor 100 in fattening… Really?! o Ex: 1 kg of Linco44… Because they’re coughing?!

– Sufficient treatment for sufficient period (not too short, not too long)

5. Use vaccines

• Ileitis, salmonella, post-weaning diarrhea, PRRS, etc. vaccines work too … do you use them?

• Mycoplasma: do you give booster shots instead of a ‘‘single-shot’’ vaccine?

57


3- HOW TO use them better ? • 6. Improve health

– Improve management • Do you do two rounds per day, every day, specifically to detect diseased

animals? • Is the ventilation system modern and functional?

– Maybe the air inlet that is starting to warp needs attention? • Is the heating working properly and insulation adequate? • Would an All-In/All-Out or group management system work better for

you? – Weaning age

• Direct link with the post-weaning health level – Microbial level

• Do you use a degreaser? Do you check the washing and sanitation quality? Is it always dry and warm when the piglets come in.

– Food type and quality • Did you know that using cubed feed presents a risk of salmonella?

58


3- HOW TO use them better ? • 7- Improving the health status:

– Do you know the diseases that can be eradicated in a herd? – Do you limit the sources per building (and their status)? – Do you participate in health surveillance projects and ARC&E

projects?

• 8. Have you ever considered using alternatives to antibiotics? Some have a genuine preventive effect Examples: water acidification to prevent PWD, hyper-immune egg yolks, M.O.S., essential oils, etc…

59


3- HOW TO use them better ?

• 9. Did you know that some breeding and genetics companies make lineage selections for their resistance to disease? Have you considered this?

• 10. Did you know that sexing also improves pig health? • 11. Have you ever considered applying exclusively

seasonal prevention strategies?

60


3- HOW TO use them better ? • 12. Do you try your best to avoid any introduction of

pathogens on your farm (BIOSECURITY)? • 13. Is your medicine supply properly managed?

– Fridge in good working condition, fresh products, clean syringes, water medicator in working order, sharp needles, etc.

• 14. Are your books well kept? – Important for follow-up, for CQA, etc..

61

CONCLUSION

• The prevention of antibiotic resistance is a shared responsibility.

• The pork industry is on the right path, but we need to set an example.

• It is the responsibility of each and every one of us to make the effort.

• It is the responsibility of every stakeholder in the sector to be aware and to support the efforts that producers will have to make to overcome this challenge.

62

Thank you Frédéric Beaulac v.m.

• Acknowledgements: – Dr. Cécile Ferrouillet, CRSV – Mr. Michel Duval, AQINAC

63

The industry’s next challenge: ‘‘careful use of ... · RESISTANCE TO ANTIBIOTICS • The...

Documents

Transcript of The industry’s next challenge: ‘‘careful use of ... · RESISTANCE TO ANTIBIOTICS • The...