a simple task, there is no doubt that the problem is of global concern and is creating dilemmas for the treatment of infections in both hospitals and community health care settings.

CDC, FDA, professional health organizations, academia, health care delivery systems, and industry should expand efforts to decrease the inappropriate use of antimicrobials in human medicine through (1) expanded outreach and better education of health care providers, drug dispensers, and the general public on the inherent dangers associated with the inappropriate use of antimicrobials, and (2) the increased use of diagnostic tests, as well as the development and use of rapid diagnostic tests, to determine the etiology of infection and thereby ensure the more appropriate use of antimicrobials.

Decreasing Inappropriate Overuse of Antimicrobials in Animal Husbandry and Agriculture

Clearly, a decrease in the inappropriate use of antimicrobials in human medicine alone is not enough. Substantial efforts must be made to decrease inappropriate overuse of antimicrobials in animals and agriculture as well.

Although estimates vary widely, the total amount of antimicrobials used in Europe and the United States in animal husbandry and agriculture far outweighs the total used in humans (McEwen and Fedorka-Cray, 2002). The majority of this use is for growth promotion or preventive therapy in healthy animals. Mounting evidence suggests a relationship between antimicrobial use in animal husbandry and an increase in bacterial resistance in humans (Alliance for the Prudent Use of Antibiotics, 2002), a view supported by an IOM committee that reviewed the use of drugs in food animals (IOM, 1999b). The use of antimicrobials in food animals leads to antibiotic resistance, which can then be transmitted to humans through the food supply (Swartz, 2002; Fey et al., 2000; Smith et al., 2002; White et al., 2001).

A study published in 2001 found that 20 percent of ground meat samples obtained from supermarkets in the Washington, D.C., metropolitan area were contaminated with Salmonella. Of these bacteria, 84 percent were resistant to at least one antibiotic and 53 percent to at least three antibiotics (White et al., 2001). This study supports previous findings that foods of animal origin are potential sources of ceftriaxone-resistant Salmonella infections in humans. Similarly, researchers found that between 17 and 87 percent of chickens obtained in supermarkets in four states contained strains of Enterococcus faecium that were resistant to quinupristin–



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