Antimicrobial Resistance (AMR) Frequently Asked Questions
Questions
- What are antimicrobial agents?
- What is antimicrobial resistance and why is it a key issue?
- What is antimicrobial cross-resistance?
- How does antimicrobial resistance develop and how is it disseminated?
- Can the use of household disinfectants or antiseptics contribute to resistance?
- Is it true that meat purchased from supermarkets contains antibiotic-resistant bacteria?
- Is antimicrobial use in farm animals responsible for the spread of resistant bacteria?
- Why are antimicrobials used in food-producing animals?
- What is the current status of the monitoring program on antimicrobial resistance?
- Who is responsible for approving the use of agricultural antimicrobials in Canada?
- What is the role of Health Canada in controlling antimicrobial resistance stemming from animal uses?
- If AMR has been an emerging issue for a number of years, why is Health Canada only responding now?
- Is Health Canada considering banning the use of antimicrobial growth promotants in food-producing animals?
- Are there alternatives to the use of antibiotics in farm animals?
- What should the public do to maintain the usefulness of antibiotics currently available for treatment of human infections?
Answers
The terms "antimicrobials" or "antimicrobial agents" simply refer to all types of natural and synthetic drugs which may kill or slow down the growth of microorganisms. These include antibiotics, anti-fungals, and household disinfectants. Antimicrobial agents are widely used for the treatment and prevention of human and animal diseases, and in the agriculture industry they are also used to promote growth.
Antimicrobial Resistance (AMR) occurs when a specific antimicrobial drug is ineffective in killing or slowing down the growth of a targeted microorganism. Development of resistance stops or reduces the effectiveness of antimicrobial agents intended to treat human/animal infections caused by microbial pathogens. The emergence of AMR threatens our ability to fight human and animal diseases with potentially serious public health implications. This could narrow the line of defense against bacterial infections to only a few antibiotics and increase health care costs.
Cross-resistance to an antimicrobial drug may develop when bacteria associated with animals treated with one drug, develop resistance to other drugs of the same family.
- Over-use and/or inappropriate use of antimicrobial drugs generally lead to increased AMR. Time plays an important role in determining the likelihood of resistance since the probability that an organism will develop resistance increases with the length of exposure. Some bacterial species are naturally resistant to a wide variety of antimicrobials. However, resistance can also be acquired by mutation in the genetic constituents of microorganisms which contain antibiotic resistance genes. The ability of resistant microorganisms to transfer these resistance genes to drug-susceptible ones makes AMR a potentially critical public health issue.
- Antimicrobial resistance is disseminated through a variety of ways such as exchange of resistant genes among different bacterial populations in animals and humans. For example, resistant microorganisms can spread from animals to humans through the food supply and can also persist in the environment as a result of the use of antimicrobial drugs in animal husbandry (farming).
The association between the use of household disinfectants/antiseptics that contain antibacterial agents and the development of AMR has been widely reported. Widespread use may lead to increased emergence of resistance in microorganisms. Resistance may develop not only against the disinfectants, but cross-resistance to antimicrobials used in human medicine may also appear.
There have been recent reports of antimicrobial-resistant bacteria in or on some meat but little is known about the extent of any such contamination. The National Integrated Surveillance System for Antimicrobial Resistance being developed by Health Canada's Laboratory for Food-borne Zoonoses will monitor the development of antimicrobial resistance in zoonotic pathogens. Information from these surveillance and research activities is crucial to dealing with the possible spread of antimicrobial resistant bacteria to humans through the food supply.
The use of antimicrobial drugs in agriculture is a contributing factor in the emergence of resistant pathogenic bacteria. However, there are other significant factors, such as the overuse and inappropriate use of antibiotics in human medicine.
Antimicrobials are prescribed and used therapeutically for the treatment of animal diseases. Antimicrobials are also added to the feed of food-producing animals to promote growth, to increase feed efficiency, and to prevent infections.
A fundamental knowledge gap associated with the AMR issue is the lack of appropriate surveillance data. For this reason, Health Canada's Laboratory for Food-borne Zoonoses (LFZ) is working to develop a national integrated surveillance system to track antimicrobial use and the spread of AMR in agri-food and aquaculture. Preliminary steps have been undertaken to develop the necessary infrastructure for surveillance. Health Canada's Veterinary Drugs Directorate (VDD), the Bureau of Microbial Hazards and the Bureau of Chemical Safety of the Food Directorate, as well as the Laboratory for Food-borne Zoonoses are working together undertaking research and surveillance activities.
In Canada, the regulation of agricultural antimicrobials is the shared responsibility of Health Canada's Veterinary Drugs Directorate (VDD) and the Pest Management Regulatory Agency (PMRA). In turn, the Feeds Section of the Canadian Food Inspection Agency (CFIA) ensures compliance of the manufacturing and sale of livestock feeds medicated with these antimicrobials.
11. What is the role of Health Canada in controlling antimicrobial resistance stemming from animal uses?
The issue of antimicrobial resistance, and the development of an evidence-based and comprehensive regulatory policy on the same is considered one of the highest priorities for the Veterinary Drugs Directorate of Health Canada.
The 1997 consensus conference on Controlling Antimicrobial Resistance: An Integrated Action Plan for Canadians, led to the establishment in 1999 of The Advisory Committee on Animal Uses of Antimicrobials and Impact on Resistance and Human Health. On June 28, 2002, the Committee submitted its final report to Health Canada's Veterinary Drugs Directorate (VDD). The Committee's role was to provide advice and assistance to Health Canada in the development of policy options related to animal uses of antimicrobial agents. In addition to the financial support and secretariat services provided to this Committee, VDD has been spearheading a variety of other activities aimed at developing a strategic policy framework on AMR. Some of these initiatives are:
- The Veterinary Drugs Directorate is resourcing antimicrobial resistance surveillance and research activities being conducted by Health Canada's Laboratory for Food-borne Zoonoses, as well as in the Bureau of Chemical Safety and Microbial Hazards of the Food Directorate.
- VDD has established its intra-directorate AMR team to look into a variety of regulatory/data requirement issues related to approved and new veterinary antimicrobial submissions.
- The Interdepartmental AMR Policy Committee established in January 2002 is working to develop risk management strategies and policies for human and non-human uses of antimicrobial agents. This Committee's membership is drawn from Health Canada, the Canadian Food Inspection Agency (CFIA), Environment Canada, and Fisheries and Oceans Canada (DFO).
- The Directorate also plays a lead role internationally by:
- reviewing actions recommended by the World Health Organization (WHO);
- collaborating with the FDA Centre for Veterinary Medicine;
- participating as an observer on VICH (International Cooperation on Harmonization of Technical Requirements for Registration of Veterinary Medicinal Products) ; and
- participating as a member of the FAO CODEX Committee on Residues of Veterinary Drugs in Food.
12. If AMR has been an emerging issue for a number of years, why is Health Canada only responding now?
Due to the complexity of the issue it was essential that we establish the capacity required to address AMR. We now have the specific expertise and competencies in place. We have established an infrastructure to collect new data that will be essential to the development of AMR policies and action plans. Health Canada's Veterinary Drugs Directorate (VDD) is leading the federal interdepartmental efforts on both the science and policy aspects of Antimicrobial Resistance and has carefully reviewed comments received from stakeholders on the final Report of the Advisory Committee on Animal Uses of Antimicrobials and Impact on Resistance and Human Health. VDD's proposed response to the 38 recommendations contained in this Report was released in December 2002. Prior to making final decisions on the implementation of any of the recommendations put forward by the Advisory Committee,VDD is planning to hold a consultation process early in 2003 to ensure that stakeholders views are taken into consideration.
13. Is Health Canada considering banning the use of antimicrobial growth promotants in food-producing animals?
The use of antimicrobial growth promotants (AGPs) in food-producing animals and the possible contribution to resistance in human pathogens is a subject of intense international debate within the scientific community and in the animal health industry. The Veterinary Drugs Directorate of Health Canada is responsible for the approval of veterinary antimicrobials in Canada and is supporting surveillance activities to evaluate possible public health impacts of the use of AGPs. Evidence from the surveillance data is currently being collected and analyzed and will be crucial in the development of new policies and approaches.
Health Canada is aware that the use of four antimicrobials to promote growth (tylosin, spiramycin, bacitracin, and virginiamycin) in farm animal production has been banned in the European Union. These AGPs were banned for this purpose because of their structural similarity to antimicrobial drugs used in human medicine. Other countries, including Canada are reviewing available data and considering similar approaches.
Antibiotics remain the most powerful weapons against disease-causing bacteria in veterinary and human medicine. They are also being used to promote growth in animals. Researchers are studying a number of alternatives to antimicrobial uses in food-producing animals.
15. What should the public do to maintain the usefulness of antibiotics currently available for treatment of human infections?
AMR is recognized as a global public health issue requiring urgent and concerted action by individuals, governments, physicians, veterinarians, farmers, pharmaceutical industries, as well as national and international public health organizations. You can take some of the following precautions:
- If you handle livestock, make sure conditions are hygienic so that antibiotics are not needed as often. Follow label instructions for the use and disposal of animal medications.
Farmers are encouraged to improved hygiene on their farms to avoid the need to use antibiotics or other antimicrobials. - Don't take antibiotics for the treatment of colds, flu and other viral infections. Be aware that not all antibiotics are effective for everything. For example, 90 percent of colds and flus, and the accompanying coughs, sore throats, aches and pains are caused by viruses. Antibiotics won't help.
- Take drugs as directed by your doctor or pharmacist. Don't stop taking a drug part way through the course of treatment, unless you are having a serious adverse reaction, without first discussing it with your doctor. Always take all of the prescribed antibiotics. Sometimes the infections or symptoms disappear earlier, but the bacteria may not be gone. The surviving bacteria can recover and will be stronger and more resistant to the antibiotic.
- Don't share your prescriptions with anyone else. Don't use a prescription for any other purpose other than what it is prescribed for. Using an inappropriate drug can make the resistance problem worse.
- Do not flush out-of-date or unused medication down the toilet, pour it down the sink, or put it in the garbage. Disposing of medication using any one of these methods means that the active ingredients will end up in the water table. This could increase resistance. Ask you pharmacist if they have a drug recycling program. Many pharmacies provide this service so your unused drugs can be disposed of in an environmentally safe manner.
- Avoid use of antibacterial soap and "bacteria-fighting" household cleaning products. They are proven to be no more effective than regular soap and can lead to antimicrobial resistance.
- Wash your hands regularly with plain soap and water for at least 20 seconds. It is the most effective way of preventing any type of infection.
- Store, handle and prepare food safely. When you're preparing food, be sure to wash cutting boards and knives with soap and water. Thoroughly wash all fruits and vegetables that will be eaten raw.
Glossary
Drug-susceptible:
microorganisms that can be killed or stopped from growing by antibiotics
(Question 4)
Microorganism:
an organism of microscopic size, including bacteria, yeast, protozoa, algae and virus
(Question 1) (Question 2) (Question 4) (Question 5)
Mutation:
alteration or change in the genetic material
(Question 4)
Pathogen:
an agent that causes disease
(Question 2) (Question 6) (Question 13)
Zoonoses / Zoonotic pathogens:
animal pathogens that can cause disease in human beings
(Question 6) (Question 9) (Question 11)
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