Advocacy for Responsible Antibiotic Production and Use

Abstract

Antibiotic-resistant bacteria have become one of humankind's major challenges, as testified by the UN's Call to Action on Antimicrobial Resistance in 2021. Our knowledge of the underlying processes of antibiotic resistance is steadily improving. Beyond the inappropriate use of antimicrobials in human medicine, other causes have been identified, raising ethical issues and requiring an approach to the problem from a "One Health" perspective. Indeed, it is now clear that the two main issues regarding the subject of antibiotics are their misuse in the global food industry and their method of production, both leading to the emergence and spread of bacterial resistance.

Keywords: antibiotic production; antibiotic use in livestock; antimicrobial resistance; environmental impact.

Figure 1

Ecology of antibiotic resistance. Reproduced with permission from Andersson et al., 2014 [1]. An overview of the ecological impact of antibiotics, sowing how these drugs are cycled between different environments, such as the medical environment, agricultural settings, the aquacultural environment, the pharmaceutical industry, and the wider environment. A large percentage of the antibiotics that are used globally (20–80% depending on the antibiotic class) are released in the environment in an active form, via the excretion of drugs in urine and faeces and the intentional or accidental release of drugs. Thus, antibiotics will exert selective pressure on bacteria in humans, animals and plants, owing to international use, and in the wider environment, owing to unintentional spill-over. This imposes a widespread selective pressure on bacteria, leading to the selection of resistant strains, which are also capable of transmitting between different environments, thereby creating the potential for the global movement of antibiotic-resistant genes and determinants [1].

Figure 2

The complex circuits of antibiotic production. Reproduced and translated with permission from https://changingmarkets.org/portfolio/bad-medicine/ accessed on 16 May 2022 [28].

Figure 3

Examples of the chains of actions of different actor types to incentivize the action of other actors to improve the management of environmental–industrial antibiotic pollution. Reproduced with permission from Nijsingh, Niels et al. [37].