Main

Hollis A, Ahmed Z. N Engl J Med 2013; 369: 2474–2476

Has a dentist fallen short if, as a precaution, they prescribe antibiotics on a Friday afternoon for a patient with a symptomatic tooth when surgical drainage appears to be sub-optimal? The stark reality is that '51 tons of antibiotics are consumed daily in the United States alone' of which 80% of antibiotics are used in agriculture and aquaculture. They are fed to pigs as growth promoters, to salmon in net-cages, and even combined with marine paint to inhibit the formation of barnacles. It has long been argued by industry that there is no evidence that such use harms humans, particularly because much is used at subtherapeutic levels. Yet 'bacteria are not particular about whether they colonize a milk cow or a human, and they easily exchange genes conferring resistance.' The authors of this 'Perspective' favour the introduction of a usage fee for the non-human application of antibiotics, akin to a 'stumpage' fee. The outright banning of growth promoters in Europe has resulted in an increase of their use for 'therapeutic reasons'.