JAC Advance Access originally published online on March 17, 2004
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Journal of Antimicrobial Chemotherapy (2004) 53, 886
© 2004 The British Society for Antimicrobial Chemotherapy
Correspondence |
Reply
Division of Laboratory Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia
Keywords: antibiotics, animal husbandry, resistance
Sir,
I was pleased to see the response from Phillips et al.1 to my leading article.2 It is now clear that their sentiments are to give the evidence a fair hearing, and this is to be applauded. I believe that the authors and I concur on many points about the current state of the evidence, and on a wish not to reach false conclusions. Much of the data are still open to interpretation, and some of the necessary experimental evidence is either missing or very difficult to generate. Hence their wish, I suspect, for the debate over the evidence to be continued and even broadened.
I take a different view. From the bacterial perspective, it matters little where the antibiotic exposure occurs. As we continue to observe, microbes and their resistance genes are eminently adaptable to a range of hosts and environments. Hence, if we continue to debate how readily resistance is transmitted between reservoirs, it diverts energy and resources away from getting better antibiotic use in all settings. We need to spend this energy and resources on finding effective interventions—of which there are precious few currently—rather than on studies to find out how frequently or infrequently resistance is transmitted. If we obtain good interventions that eliminate unnecessary use by medical practitioners, veterinarians and farmers without jeopardizing human or animal health, then reduced resistance rates will follow.
As I pointed out in my article, it is all too common for the evidence to be presented selectively. We should remained puzzled then as to why the authors specifically drew attention to the evidence on streptogramin resistance and virginiamycin usage in their response, and yet failed to note, either in their article or response, the emergence of significant rates of streptogramin resistance in human clinical isolates of pathogens such as Enterococcus faecium in Taiwan.3,4 This has occurred in the absence of availability of streptogramins for human use, but modest use of virginiamycin in animals. The true source of this resistance is not clear, but neither is it clear why all the available evidence was not presented in their article. For just this reason, I continue to advocate that we move on from debate about evidence of transmission to evidence of effective interventions.
Footnotes
* Tel: +61-8-8204-8873; Fax: +61-8-8204-6051; E-mail: turnidgej{at}wch.sa.gov.au 
References
1 . Phillips, I., Casewell, M., Cox, T. et al. (2004). Antibiotic use in animals. Journal of Antimicrobial Chemotherapy 53, DOI: 10.1093/jac/dkh149.
2
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Turnidge, J. (2004). Antibiotic use in animals—prejudices, perceptions and realities. Journal of Antimicrobial Chemotherapy 53, 26–7.
3
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Luh, K. T., Hsueh, P. R., Teng, L. J. et al. (2000). Quinupristin-dalfopristin among gram-positive bacteria in Taiwan. Antimicrobial Agents and Chemotherapy 44, 3374–80.
4 . Hsueh, P. R., Liu, C. Y. & Luh, K. T. (2002). Current status of antimicrobial resistance in Taiwan. Emerging Infectious Diseases 8, 132–7.[Web of Science][Medline]
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