Antimicrobial Resistance (AMR) Frequently Asked Questions

Questions

  1. What are antimicrobial agents?
  2. What is antimicrobial resistance and why is it a key issue?
  3. What is antimicrobial cross-resistance?
  4. How does antimicrobial resistance develop and how is it disseminated?
  5. Can the use of household disinfectants or antiseptics contribute to resistance?
  6. Is it true that meat purchased from supermarkets contains antibiotic-resistant bacteria?
  7. Is antimicrobial use in farm animals responsible for the spread of resistant bacteria?
  8. Why are antimicrobials used in food-producing animals?
  9. What is the current status of the monitoring program on antimicrobial resistance?
  10. Who is responsible for approving the use of agricultural antimicrobials in Canada?
  11. What is the role of Health Canada in controlling antimicrobial resistance stemming from animal uses?
  12. If AMR has been an emerging issue for a number of years, why is Health Canada only responding now?
  13. Is Health Canada considering banning the use of antimicrobial growth promotants in food-producing animals?
  14. Are there alternatives to the use of antibiotics in farm animals?
  15. What should the public do to maintain the usefulness of antibiotics currently available for treatment of human infections?

Answers

1. What are antimicrobial agents?

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.

2. What is antimicrobial resistance and why is it a key issue?

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.

3. What is antimicrobial cross-resistance?

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.

4. How does antimicrobial resistance develop and how is it disseminated?

5. Can the use of household disinfectants or antiseptics contribute to resistance?

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.

6. Is it true that meat purchased from supermarkets contains antibiotic-resistant bacteria?

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.

7. Is antimicrobial use in farm animals responsible for the spread of resistant bacteria?

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.

8. Why are antimicrobials used in food-producing animals?

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.

9. What is the current status of the monitoring program on antimicrobial resistance?

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.

10. Who is responsible for approving the use of agricultural antimicrobials in Canada?

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:

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.

14. Are there alternatives to the use of antibiotics in farm animals?

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:

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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