Antimicrobial Resistance in the Enviroment

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Antimicrobial Resistance in the Enviroment
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Antimicrobial Resistance in the Enviroment
or
Healthcare, Agriculture, and Economics
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Antimicrobial Resistance in the Enviroment
or
Healthcare, Agriculture, and Economics
or
Phobia of Phrightening Pharm Animals
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Basic Science of Resistance

• Mutation origin of resistance
• The simpler the microbe the more mutations
  explored.
• Destruction or Inactivation.
• Efflux Pumps, can be class specific or
  multidrug.
• Genetic Transfer spread of resistance
• Conjugation.
• Transformation.
• Transduction.
• http//www.fda.gov/cvm/antiresistvideo.htm

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Economic Costs

• Increased Cost to Treat Patient
• Length and intensity of Hospitalization is
  increased.
• Vancomycin up to 15 of Hospitals pharmacy
  budget.
• Ear infection treatment 20 increase in cost of
  due to resistance.
• Estimates of Economic Impact
• 350 million to 35 billion is often reported.
• Office of Technology Assessment 1.3 billion.
• US CDC Hospital-acquired infections cost 4.5
  billion.
• Trade Off
• A recovered patient wont transmit further.
• Vs.
• A future patient will encounter resistance.

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Contributory Economics

• Length and Scope of Patents
• Cost of bringing a new Abx to market 300-400
  Million.
• Price goes up with increasing resistance.
• Shorter patent life means no incentive for
  Pharmas to worry about resistance.
• Kefauver-Harris Drug Amendments, 1962 reduced
  patent life on Abx.
• Drug Price Competition and Patent Term
  Restoration Act, 1984 extends 5 years.
• General Agreement of Trade and Tariffs, 1995
  extended to 20 years.
• Discussion Points
• Think about developing countries.
• Arguments for extension and abbreviation of
  patents.
• Patent Scope Research classes not me toos.
• A Hybrid Solution?

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Antibiotics in Agriculture

• Degree of Use (or Abuse)
• Animal Health Institute 10.2 tons/year on 8 b.
  food animals.
• 87 is treating, controlling, and preventing
  disease.
• Union of Concerned Scientists 12,300 tons/year
  for nontherapeutic purposes.

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Antibiotics in Agriculture

• Degree of Use (or Abuse)
• Animal Health Institute 10.2 tons/year on 8 b.
  food animals.
• 87 is treating, controllinig, and preventing
  disease.
• Union of Concerned Scientists 12,300 tons/year
  for nontherapeutic purposes.
• Lets Discuss the Economics
• Who sees the negative externalities?
• How could we connect these costs back to the
  animal industry?

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Antibiotics in Agriculture
1 mg/kg 1ppm (Assuming dilution in whole body)
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Antibiotics in Agriculture

• Dr. Stuart Levys Pharm Experiment (mid 70s)
• 300 Chicks, 1/2 on subtherapeutic
  oxytetracycline.
• 24-36 hours E coli converted to tet resistant.
• 3 months resistance to Tet, Amp, Strept, and
  Sulfonamides.
• 6 months 18 Farm Workers, 1 UTI in locales.
• MDR/TAP Pumps ABCB1, Human and Microbe.
• Human transmission of resistant pathogens from
  treated livestock
• 1983 Salmonella newport, from hamburger to four
  Midwestern states.
• 1985 Salmonella newport, California.
• Subtherapeutic dosing of penicillin and
  tetracycline.
• 2 Died.
• Camplyobacter jejuni in Fluoroquinolone treated
  chickens.
• Vancomycin resistance Enterococcus faecum in
  Europe.

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Antibiotics in Agriculture

• Integrated Fish Farming, A clever idea with
  frightening implications

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Antibiotics in Agriculture Recovery

• Vancomycin and Macrolide Resistance decreased
  after ban in Switzerland.

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Antibiotics in Agriculture Recovery

• Growth Promoters in use and banned.
• All Fluoroquinolones banned by Animal Medicinal
  Drug Use Clarification Act (AMDUCA) of 1994

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Antibiotics in Agriculture Recovery

• Current FDA Resource List for Large Animal
  Veterinarians

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Antibiotics in Agriculture
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Antibiotics in Agriculture

• A raging debate
• E.U. adopts the Precautionary Principle.
• Avoparcin, virginiamycin, spiramycin, tylosin,
  and bacitracin banned.
• U.S. adopts the Principle of Proof
• One fluoroquinolone banned.
• Is each going to be banned after its too late?