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Abstract
Background We have previously reported, in a systematic review of 181 studies, that restriction of antibiotic use in food-producing animals is associated with a reduction in antibiotic-resistant bacterial isolates. While informative, that report did not concretely specify whether different types of restriction are associated with differential effectiveness in reducing resistance. We undertook a sub-analysis of the systematic review to address this question.
Methods We created a classification scheme of different approaches to antibiotic restriction: (1) complete restriction; (2) single antibiotic-class restriction; (3) single antibiotic restriction; (4) all non-therapeutic use restriction; (5) growth promoter and prophylaxis restriction; (6) growth promoter restriction and (7) other/undetermined. All studies in the original systematic review that were amenable to meta-analysis were included into this substudy and coded by intervention type. Meta-analyses were conducted using random effects models, stratified by intervention type.
Results A total of 127 studies were included. The most frequently studied intervention type was complete restriction (n=51), followed by restriction of non-therapeutic (n=33) and growth promoter (n=19) indications. None examined growth promoter and prophylaxis restrictions together. Three and seven studies examined single antibiotic-class and single antibiotic restrictions, respectively; these two intervention types were not significantly associated with reductions in antibiotic resistance. Though complete restrictions were associated with a 15% reduction in antibiotic resistance, less prohibitive approaches also demonstrated reduction in antibiotic resistance of 9%–30%.
Conclusion Broad interventions that restrict global antibiotic use appear to be more effective in reducing antibiotic resistance compared with restrictions that narrowly target one specific antibiotic or antibiotic class. Importantly, interventions that allow for therapeutic antibiotic use appear similarly effective compared with those that restrict all uses of antibiotics, suggesting that complete bans are not necessary. These findings directly inform the creation of specific policies to restrict antibiotic use in food-producing animals.
- systematic review
- public health
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Footnotes
Handling editor Peter MacGarr Rabinowitz
Contributors Each of the 12 authors meets the authorship requirements as established by the International Committee of Medical Journal Editors in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. All authors were involved in the design and development of the study. HG created the search strategy and conducted the literature search in electronic databases. DN conducted the grey literature search. KT and NC screened all studies for inclusion into the systematic review and performed all study quality assessments. SC, PR and HB provided input on studies where consensus could not be reached. KT, NC, DN, AP and NS performed data extraction. All authors contributed to data interpretation and data analysis. KT drafted the manuscript and all authors revised it critically for content. All authors have read and approved the manuscript. KT accepts full responsibility for the work and conduct of the study, had access to the data and controlled the decision to publish. The corresponding author (KT) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding This study was funded by World Health Organization.
Disclaimer The authors alone are responsible for the views expressed in this publication and do not necessarily represent the views, decisions, or policies of the World Health Organization.
Competing interests JK has an unrestricted grant as a principal investigator from Pfizer Canada to conduct an epidemiological study of invasive pneumococcal disease in humans, including impact of pneumococcal vaccines, and has a contract with GSK Canada as a local co-investigator a clinical trial of a maternal pertussis vaccine; no other relationships or activities that could appear to have influenced the submitted work. All other authors report no other relationships or activities that could appear to have influenced the submitted work.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.