California Medical Association Policy
Passed March, 2001

Countering Bacterial Resistance from Antimicrobial Overuse

AUTHORS: George Susens, MD and Steve Heilig, MPH

WHEREAS, Antibiotics remain perhaps the single most widely useful and important medical advance of the modern era, but their effective use is increasingly threatened by bacterial resistance, including multiple resistance in an increasing number of common and serious pathogens; and

WHEREAS, prestigious medical and public health authorities such as the CDC, IOM, FDA, WHO, APHA, and many others cited bacterial resistance as an increasingly serious and costly medical and public health threat in need of much greater attention and action, including more education, surveillance, and regulation; and

WHEREAS, the spread of bacterial resistance arises not only from unnecessary clinical use in human medicine, an issue the CMA has begun to address, but also from massive use in animal agriculture, with increasing evidence that resistance developed in animals is spreading to human pathogens; and

WHEREAS, an estimated sixteen million pounds of antimicrobials, or 80% of all such usage in agriculture, are used subtherapeutically as growth promoters, as pesticides, or prophylactically, all low-level constant uses likely to promote the development of resistance, and this use is allowed commercially and often without veterinary supervision; and

WHEREAS, the Food and Drug Administration has recently proposed to prohibit the agricultural use of at least two commonly-used fluoroquinolone antibiotic and estimates that at least 5,000 Americans are harmed annually due to use of these drugs, but will need much support to enforce this and future such public health restrictions; now be it

RESOLVED, the CMA commends the CMA Foundation for its AWARE program to counter antibiotic resistance in clinical practice and urges continued and further activity in this area, with expansion to a AMA national program; and be it further

RESOLVED, that the CMA opposes the use of antimicrobials used in human medicine at less than therapeutic levels in agriculture, or as pesticides or growth promoters, and urges that these uses be phased out by regulation; and be it further

RESOLVED, that the CMA urges that all agricultural use of antibiotics be limited to that authorized under veterinary prescription and supervision; and be it further

RESOLVED, that the CMA urges that increased surveillance of antimicrobial use and resistance be funded and instituted as recommended by the Institute of Medicine and American Society of Microbiology; and be it further

RESOLVED, that these recommendations be forwarded to the AMA for consideration, adoption, and action at their 2001 annual meeting.