Adjuncts and alternatives in the time of antibiotic resistance and in‐feed antibiotic bans

At first glance, it might surprise when an editorial series in a scientific journal asks how science will help to create companies and jobs. However, a recent ‘Nature’ editorial has encouraged ‘research leaders in the United States and elsewhere to address the needs and employment prospects of taxpayers who have seen little benefit from scientific advances’ (Editorial, 2017). Therefore, mundane as it sounds, the question of whether microbiome research can be a source of new enterprise and job creation matters not only for microbiologists with respect to work opportunities (this might amount to preaching the already converted), but also to a wider audience, which needs to be convinced that science can better the lot of society. In the current editorial, I want to explore where microbiome research can contribute in finding and developing alternatives and adjuncts to antibiotics. The public health incentive for alternatives is indeed high: the Centers for Disease Control and Prevention (CDC) calculated 23 000 deaths per year in the USA attributed to infections with antibiotic-resistant bacterial pathogens (https://www.cdc.gov/drugresistance/), and a UK government report estimated that antibiotic-resistant infections kill 700 000 people each year worldwide (https://amr-review.org/). An increase to worldwide 10 million deaths per year is projected for 2050 if antibiotic resistance continues unabated (https://amr-review.org/). Therefore, curbing antibiotic resistance is a major public health priority as also dramatically formulated by the World Health Organization (http://www.who.int/mediacen tre/news/releases/2014/amr-report/en/). The media report cases of patients dying in local hospitals from hitherto relatively harmless pathogens if they turn out to be antibiotic resistant and drastic surgical interventions remain the only option. Therefore, ‘Alternatives to Antibiotics’ became research calls of major grant organizations and the title of international conferences. In January 2017, the US Food and Drug Administration (FDA) set new rules (https://www.fda.gov/Animal Veterinary/GuidanceComplianceEnforcement/Guidancefor Industry/ucm216939.htm) to limit antibiotic use in farm animals. FDA now bans the use of ‘medically important’ antibiotics (which are also used in humans) as antibiotic growth promoters (AGP) in animal husbandry. FDA has also launched discussions to change the status of antibiotics for disease prevention in farm animals from an over-the-counter to a veterinary prescription status. Until recently, a farmer could buy a 50-kg bag of antibiotics in a veterinary feed supply store without a prescription while a personal use of 200 g antibiotic needed a prescription by a doctor. According to a recent FDA report, 62 per cent of antibiotics given to animals in 2015 were medically important for human health (https://www.fda. gov/downloads/ForIndustry/UserFees/AnimalDrugUserFe eActADUFA/UCM534243.pdf?source=govdelivery&utm_ medium=email&utm_source=govdelivery) and could thus contribute to the selection of antibiotic-resistant pathogens particularly when used at subtherapeutic doses. The amounts of antibiotics used in agriculture are huge: 17 million kg of antibiotics were used in farm animals compared to an estimated 4 million kg in human per year in the USA. A major part of these antibiotics is given in small doses to healthy chicken, cattle and pigs to accelerate weight gain, or in slightly larger doses (but still smaller than needed for treating an infection) to healthy animals for preventing infections. With the ban on antibiotics as growth promoters and the proposed regulation to put disease prevention under prescription, the FDA hopes to see less selection pressure for pathogens to develop antibiotic resistance. It is currently not clear whether the FDA ban is binding or only a recommendation. In the USA, change might also be encouraged by consumer groups who put pressure on fast food restaurants to use meat from chicken raised with minimal or no antibiotics and who publish reports about compliance by the different companies. The US in-feed antibiotics ban creates also new business opportunities for the animal feed industry and job *For correspondence. E-mail: [email protected]; [email protected]; Tel. +41 21 785 8676; Fax +41 21 785 8544. Microbial Biotechnology (2017) 10(4), 674–677 doi:10.1111/1751-7915.12730