A report this week from the Food and Drug Administration (FDA) shows that sales of medically important antibiotics for use in food-producing animals in the United States fell by 3% from 2019 to 2020, following 2 years of rising sales.
Overall, there has been a 38% reduction in the sales of medically important antibiotics for use in livestock since 2015, the peak year of sales. "This suggests that continued efforts to support the judicious use of antimicrobials in food-producing animals are having an impact," the agency said in a press release.
But a closer look shows that much of that reduction occurred in 2017, when an FDA rule banning use of medically important antibiotics for growth promotion in food animals went into effect. Since then, the decline has essentially hit a plateau. In fact, medically important antibiotic sales in 2020, at just over 6 million kilograms (kg), were nearly 8% higher than they were in 2017 (5.5 million kg).
Advocates for better antibiotic stewardship on farms say that indicates the FDA has much more work to do.
"Any decrease in antibiotics sales to the meat industry is encouraging to see but it's a drop in the bucket compared to the decline we truly need to address antibiotic overuse," Matthew Wellington, director of public health campaigns for US PIRG (Public Interest Research Groups), said in a statement emailed to reporters.
Declining sales for chicken, cattle, swine
Overall, medically important antibiotics—those that are needed for human medicine—accounted for 57% of the more than 10.4 million kg of antibiotics sold for use in livestock in 2020, according to the FDA report.
Of the 6 million kg of medically important antibiotics sold for use on farms, 41% were used in cattle, 41% in swine, 2% in chicken, 12% in turkey, and 4% in other animals.
The class of medically important antibiotics most frequently sold for use in livestock in 2020 were tetracyclines, which accounted for 66% of sales. Penicillins accounted for 13% of sales, and macrolides for 7%. Sales of tetracyclines and macrolides fell by 4% and 11%, respectively, in 2020, while sales of penicillins rose by 6%.
The biggest decline in sales of medically important antibiotics continues to be seen in the chicken industry, which saw a 27% reduction from 2019 sales. Chicken producers have led the way on more judicious use of antibiotics in recent years, as consumer demand for antibiotic-free chicken has driven the country's largest chicken producers to dramatically limit antibiotics.
Sales of medically important antibiotics in cattle and swine fell by 3% and 5% from 2019 to 2020, respectively. But in both those animal groups, sales have risen overall since 2017. Meanwhile, sales of medically important antibiotics for use in turkeys rose by 7% in 2020, and by 12% in other animals.
The 2017 FDA rule that made the use of medically important antibiotics for growth promotion illegal, and required all remaining use of antibiotics in animal water and feed to be put under veterinary oversight, was part of an effort by the agency to promote more judicious antibiotic use in food-producing animals. Experts worldwide agree that overuse of antibiotics in food production is contributing to the rise in antimicrobial resistance.
While the rule was widely praised at the time, antibiotic stewardship advocates have long contended that the agency also needs to curb the routine use of medically important antibiotics for disease prevention in animals. That's a recommendation that was made by the World Health Organization in 2017. But under current FDA rules, farmers are allowed to administer antibiotics in feed and water to prevent herds and flocks from getting infections.
David Wallinga, MD, senior health officer with the Natural Resources Defense Council (NRDC), says the FDA's latest sales report provides more evidence that the agency is not fulfilling its pledges to bring about more judicious use of antibiotics in food-animal production.
"This kind of confirms what we'd suspected for a long time—the FDA is not actually doing what it claims to be doing," Wallinga told CIDRAP News. "They got rid of growth promotion, but many of the same drugs continue to be used in the same way in herds, even when animals are not sick, for disease prevention."
Lack of optimal data
The FDA notes that the sales data do not actually reflect how antibiotics are used on farms and should not be substituted for usage data. But that is currently the best measure the agency has for evaluating antibiotic use in livestock.
For Wallinga, the lack of data on how antibiotics are being used in food animals is precisely the problem, and where the FDA has truly dropped the ball. He points out that the agency is neither tracking on-farm antibiotic use nor reporting sales data that's adjusted to the weight of the animals in which they are used, as they do in Europe. That would allow for an "apples-to-apples comparison" with other countries.
As an example, while the FDA report shows that 92% of medically important antibiotics sold for use in livestock were administered in feed and water, it's not clear whether those antibiotics were being used therapeutically, or to prevent disease.
"They [the FDA] have made the decision…to not collect on-farm data, so we don't know why exactly those feed antibiotics are being used," he said. "If the United States was both committed to antibiotic stewardship in a One Health way, they ought to be collecting and tracking use wherever it occurs."
The National Academies of Science, Engineering and Medicine also made this point in a recent report on what the United States can do to boost efforts to address antibiotic resistance. The report, written by a committee of experts across the human, animal, and environmental health sectors, urged the FDA's Center for Veterinary Medicine to facilitate better tracking of antibiotic consumption in food-producing animals by promoting the use of electronic subscriptions and encouraging veterinarians to share prescribing data with the agency.
"This information would support the design and implementation of stewardship programs," the committee wrote.
UK, EU leading the way
Wallinga points to the United Kingdom (UK) and the European Union (EU) for a model of what the United States could be doing to further limit antibiotic use on farms, noting that sales of medically important antibiotics for use in livestock in the UK and several EU countries has fallen by 50% and higher from 2009 to 2020, while US sales have fallen by 21.9%. He attributes that, in part, to those countries tracking how antibiotics are being used on farms.
"What we hear from countries that are actually tracking use on farms is that it's relatively few farms that are accounting for most of the overuse," he said. "Well, you can't figure out where that is happening unless you're actually tracking the use."
The UK and several EU countries have also set targets for reducing medically important antibiotics in food-producing animals. In the UK, for example, targets set in 2017 by the Responsible Use of Medicines in Agriculture Alliance are widely credited for a 52% decline in sales of antibiotics for use in livestock since 2014. Wallinga noted that reduction targets have also been successful in the Netherlands and Denmark.
"In terms of setting a use reduction target, which has worked so well in the Netherlands and in Denmark, we think a US target to reduce sales by at least 50% from a 2009 baseline is reasonable and doable," he said. "With leadership and commitment, in fact, Europe's example suggests the US should be able to do this in just a few years, by 2026, for example."
In addition, Wellington noted that, starting next year, the EU will prohibit the routine use of medically important antibiotics to prevent disease in food-producing animals.
"That's the kind of bold action we need in the United States," he said.
