American Academy of Pediatrics Technical Report

Antimicrobial resistance is widespread. Overuse or misuse of antimicrobial agents in veterinary and human medicine is responsible for increasing the crisis of resistance to antimicrobial agents. The American Academy of Pediatrics, in conjunction with the US Public Health Service, has begun to address this problem by disseminating policies on the judicious use of antimicrobial agents in humans. Between 40% and 80% of the antimicrobial agents used in the United States each year are used in food animals; many are identical or very similar to drugs used in humans. Most of this use involves the addition of low doses of antimicrobial agents to the feed of healthy animals over prolonged periods to promote growth and increase feed efficiency or at a range of doses to prevent disease. These nontherapeutic uses contribute to resistance and create health dangers for humans. This report will describe how antimicrobial agents are used in animal agriculture and review the mechanisms by which such uses contribute to resistance in human pathogens. Although therapeutic use of antimicrobial agents in agriculture clearly contributes to the development of resistance, this report will concentrate on nontherapeutic uses in healthy animals. Pediatrics 2004; 114:862–868; antibiotic, antimicrobial, resistance, child, infant, agriculture, foodborne, epidemiology. ABBREVIATIONS. NARMS, National Antimicrobial Resistance Monitoring System; VRE, vancomycin-resistant enterococci; Q-D, quinupristin-dalfopristin. ANTIMICROBIAL USE IN ANIMAL FEEDS