Antibiotic Battle Is Personal, Potentially Deadly And Involves Everyone

Like all young parents in rugged occupations like farming, Alistair James Hicks works hard, often in less than perfect working conditions. One day, surrounded by nothing more threatening than dirty water, he cuts his hand. Less than a week later, Mr Hicks is dead.

This short and very sad true story is told with deep emotion by a grandson he never met, Aled Rhys Davies, as often as he can get in front of an audience of livestock farmers. It is not exaggerating, he points out, that one day soon, anyone reading this could themselves die, or lose a family member, due to a drug-resistant infection.

“Everyone, please realise this is personal,” he told an audience of dairy farmers, vets and supply trade at a recent ‘Reducing Antiobiotic Use’ conference. It was staged by Innovation for Agriculture – the non-profit body dedicated to ‘helping farmers make best use of emerging and exisiting knowledge to improve business performance and personal fulfilment’ – and the Royal Bath & West Society.

Back in 1950, within months of Mr Hicks’ untimely death, penicillin became available to doctors and could have saved him. Grandson Aled continues: “A return to this pre-antibiotic era really scares me, possibly more than others, because the consequences remain within my family’s living memory.”

Prompted by this, he applied for and won a 2015 Nuffield Scholarship to study alternatives to antibiotics for farmers. Today in livestock farming, his one overriding conclusion is that keeping drug-resistant infections at bay is, without exception, everyone’s personal responsibility. More details about where his study has led can be found on his website, pruex.co.uk.

Meanwhile, Peter Borriello from Veterinary Medicines Directorate told delegates how two of the most serious concerns were bacteria resistant to multiple antibiotic types and that resistance can transfer between different bacteria species.

He also cautioned against hoping for new molecules. “Even if a new antibiotic is found that turns out to be unusable in humans, it would take up to 20 years for it to be licensed for animal use,” he said. “The only answers are better husbandry, reduced sickness, evidence-based and effective treatment when required, and continuous improvement in all these areas and more.”

As evidence supporting this approach, Tom Clarke from Synergy Farm Vets said very high yielding dairy herds tended to have lower than average antibiotic use. “This is probably because good health is essential to very high yields,” he explained.

Rather than reaching for an antibiotic at the first suspicion of ill health, his practice is helping clients identify when and how to run diagnostic bacterial cultures, then make treatment decisions based on the results.

“Among the options, ‘no-treatment’ is an appropriate decision when a culture suggests self-cure is probable,” he added. “A good example is smelly vaginal discharge post-calving. Start by taking the cow’s temperature and looking carefully at daily milk yields before deciding whether to give an antibiotic. Some cows will be OK dealing with it themselves, without antibiotic. For mastitis, a number of dairy farm clients now have an incubator to culture milk samples and identify if and what bacteria are present. Using this diagnostic-led approach, some dairy clients have reduced mastitis antibiotic use by 50 percent.”

In collaboration with XLVets and RAFT, his practice is also developing DataVet, a large scale data library connected with smartphone apps to help farmers and vets reduce antibiotic use without compromising animal health or productivity.

Right now, today or tomorrow, one thing farmers could ask their vets is how to ensure justified use of antibiotics, according to Phil Elkins from Westpoint Farm Vets. “The only good reason for farmers to give antibiotics to animals is that they think treatment is needed and the animal will recover,” he said. “We are treating to get a specific, desired clinical response, and this depends on making the right choice of antibiotic with high probability of killing the target pathogen.

“Faced with a sick animal, we need effective treatments to still be available. But unless we all, vets and farmers alike, take steps to minimise the conditions that encourage drug-resistant bacteria, some treatment choices will be taken away. A good example is that antibiotic footbaths are 100 percent unnecessary.”

Westpoint’s sister business Kingshay has recently developed its Health Manager service to include an Antimicrobial Report, which monitors a farm’s ongoing antibiotic use, comparing current and previous years alongside an anonymous peer group benchmark.

Although major changes take time to make sense of, Dr Kristen Reyher from Bristol University reassured farmers at the conference that the time would come when minimal treatment based on diagnostics has become second nature. “Just like wearing a car seat belt or not smoking in public places, new social norms will become established,” she said. “However, in this particular example we really don’t have long.”

Closing the event, Aled Rhys Davies said: “This battle is personal, potentially deadly, and involves every one of us. My hope is that the Alistair James Hicks story helps speed us up and get everyone involved.”

 

More about IfA including details of more reducing antibiotic use events can be found at www.i4agri.org

Innovation for Agriculture’s Antibiotic Reduction Project is funded by the Esmee Fairbairn Foundation.