A seven-day-old sample of MRSA, an antibiotic-resistant ‘superbug.’Ryan Carter/The Globe and Mail
It was bound to happen. Someone was going to take Health Canada and the Public Health Agency of Canada to task on the subject of antibiotic resistance. But few would have expected it would come from the Auditor-General of Canada. This is a big deal.
In the two decades since antibiotic resistance was first recognized as a problem, Canada's regulatory agencies have done quite a bit of talking but haven't followed up with action. This is clear from the three findings contained in Auditor-General Michael Ferguson's spring report released on Tuesday. The country lacks a nationwide strategy to address the spread of organisms, and it also has weaknesses in the structure of its surveillance programs. These two issues involve regulation, however, and do not have much to do with the average Canadian.
But Ferguson's third finding – that Canadians need to be more "prudent" in their use of antibiotics both in medicine and in agriculture – is where the public can, and should, get involved.
Still, conveying what is prudent when it comes to the use of antimicrobials is no easy task. In fact, it's too open to interpretation and can be misused to allow banned practices to continue.
In medicine, for example, the concept of prudent use may be extrapolated to include faster treatment by a doctor. If a patient presents with an illness that appears to be bacterial, it is prudent to give a broad-spectrum antibiotic. This not only speeds up the process of primary care but also ensures the patient leaves satisfied. But this process is not accurate and can lead to a failure of treatment if a resistance already exists. If the exact species causing the infection is not known, antibiotic treatment should be held off unless faced with a life-or-death situation such as sepsis, flesh-eating disease, or the plague. (Last year, the Public Health Agency of Canada attempted to change this mentality by saying "sometimes no prescription is the right prescription.")
It is worse in agriculture. Reduced use of antibiotics has been promoted for well over a decade and yet the same practices are being used without much change. The reason comes down to the concept of prudence once again. Although the drugs can no longer be used for growth promotion, they can still be effective in preventing infections. They are a prudent way to keep herds and flocks safe. It does little to tackle resistance, however.
The best way to move forward is to declare antibiotics both in medicine and agriculture as the last resort for treatment. For humans, this might mean waiting a day or two for proper testing and a more concrete diagnosis. For example, a skin infection may be caused by a normal Staphylococcus aureus strain, for which antibiotics are effective. But it also may be caused by methicillin-resistant Staphylococcus aureus, better known as MRSA. If this bacterial strain is the cause, many treatments won't work and could worsen over time. The effort to sit and wait while the diagnostic technicians do their job is the best way to keep antibiotic resistance at bay and keep patients safe.
As for agriculture, unless an animal is sick, there is no need for an antibiotic especially for growth promotion. Even if there is no current link between an antibiotic in agriculture and the current ones used in medicine, this might change. Ferguson explicitly points out this in his report by calling for a periodic review of all antimicrobials to ensure they do not have any links to human medicine. Uncertainty aside, there are effective alternatives to antibiotics just waiting to be used. All they need is approval from Health Canada.
The Auditor-General's Report will no doubt spur the government into action and some of the recommendations will be met. But while the regulators figure out how to address a two-decades-old problem, you can play a part in the solution. If visiting the doctor with an illness, don't ask for or demand an antibiotic straight away. Instead, ask for a swab, urine or fecal test to confirm the source of the illness. If there is something there – and in many cases there isn't – the treatment will be more focused and have less chance of failure. As for agriculture, the best thing to do is seek out and purchase meats from animals raised without antibiotics. You can easily find them in supermarkets across Canada and they are usually packaged with very large print declaring the absence of antibiotics.
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Jason Tetro is a Toronto-based microbiologist with more than 25 years experience in research. The self-described germs relationship therapist strives to improve humanity's bond with the unseen world. His science bestseller, The Germ Code, is out now. You can follow him on Twitter at @JATetro