Awareness crucial in antibiotic use

In August 2017 an inventory on antibiotic use of different farms in West Java, Indonesia, was carried out by Wageningen Livestock Research as part of a joint broiler farm improvement project. General data about the farms and more specific data about antibiotic use of the farms was collected (Table 1). The average AB daily dosage found during the inventory was 133, which is extremely high.

Semi-closed housing

Surprisingly the average daily dosage for semi-closed was higher (160 vs. 116) than for open broiler houses (Figure 1). It was expected that AB use was lower for the semi-closed houses due to the improved circumstances for the broilers. Broilers in semi-closed houses don’t suffer heat stress and the biosecurity level is much better compared to open broiler houses. It was expected that this would result in an overall improved health status and lower mortality of the birds. It was hypothesised that other mechanisms play a role in this opposite effect of housing system on AB use. The reason for the high AB use in the semi-closed systems was probably caused by the routine use of antibiotics in daily management in companies and farms. The farmers are used to it, do not know how to do change management and antibiotics are used as an extra “insurance” to improve their production performance. A fact is that they are not aware of the threat using antibiotics to food security and human health. Therefore they will not stop using the AB products as embedded in their daily routine and broiler management protocols.

To decrease AB use, a change in awareness is crucial. To make farms realise that the current AB use is excessive and a huge risk for human health an awareness program is needed. Especially for farmers who are planning to start developing semi-close houses. This might lead to a higher food security and a smaller chance of antimicrobial resistance in humans. Eventually the Indonesian government has to implement regulation regarding AB use to control and further lower the AB use in the Indonesian broiler production sector.

Dutch approach

The level of antibiotic use of 133 DD/DY is extremely high compared to the Dutch actual use of AB (average 2016 = 10.5 DD/DY). Due to the Dutch policy to reduce antibiotic use in the Netherlands AB daily dosage decreased over 9 years with 65%. This was done by developing, signing, but moreover by implementing the covenant ‘Antibiotic resistance’. This covenant contains a plan of action, registration of AB use at farm level, awareness of individual farmers, relations with veterinary and poultry company and much stricter regulation.

In the Netherlands, antibiotic use on farm level is classified in 3 main areas:

1. Target area: between 0 and 15 DD/DY. In this area, no further actions are necessary.
2. Warning area: between 15 and 30 DD/DY. In this area, the AB use needs attention, maybe actions are necessary.
3. Action area: above 30 DD/DY. In this area direct actions are necessary to lower the AB use immediately.

In the Netherlands, antibiotics for animals are classified in 3 main groups:

1. The first group consists of AB which do not cause antibiotic resistance in humans. These products can be used in a treatment protocol of a farm.
2. The second group of antibiotics can only be used when there is a valid argument for using. These products can only be used in the treatment protocol by exception and with limited time.
3. The third group consists of AB products consisting of AB which are critical for human health care. They can only be used if there is no other alternative and cannot be used in a treatment protocol and only in individual cases/animals.

This all must be based on bacterial research.

Antibiotic products in Indonesia

13 different antibiotic products were used on the 15 visited farms. Per farm an average of 2.2 products were used, ranging from 1 product to 3 products maximum. The most used product contain Fluoroquinolones (80%), Tetracycline’s (80%) and Peptides (53%) as the active ingredients of the products. The Indonesian broiler sector and government do not have a proper regulating system on gathering information on AB use. If AB use in the Indonesian broiler production sector is analysed by the Dutch standard, it is concluded that 43% of the used products are in group one, 27% in group two and 30% in group 3 (Figure 2). It is very worrying to discover that 30% of total used products contains an ingredient which is classified in group 3 (Dutch system only 1.6%) and also is (over) used by putting it in the prevention treatment protocol for the whole farm.

Group 3 AB’s are antibiotics which are classified as crucial for public human health. These products are also used in human health care and resistance developed against these antibiotics must be avoided. For this reason they are highly registered and can only be used on individual animals if there is no other alternative, according to the Dutch system. Only one AB ingredient fits into the third group, which is the fluoroquinolone called Enrofloxacin.

Furthermore, the antibiotics which are classified as group 1 represent 43% of total AB use. These products are safe to use in a treatment plan and will not have any negative influences on residues and resistance in animals, their meat and humans. Group 2 represent 27% of total AB used on the visited farms and can only be used when the use can be substantiated. Exceptions of this group of AB in treatment protocols can only happen for a limited amount of time and at exception according to Dutch standards. In the Indonesian sector all these products are used in a treatment protocols, which is set up as a prevention measure before the start of the cycle. According to Dutch standards, the Indonesian sector overuses products which are dangerous for human health.

Antibiotic dosage

The dosage of antibiotics per day per kg of bodyweight was between 100 and 400 mg/kg/d. About 69% of the total products use a maximum dosage of 100mg, 15% use a dosage of 200mg/kg/d and 8% use a dosage of 375 and 400 mg/kg/d. In comparison with the Netherlands, these dosages are up to 10 times as high or even higher. This differs quite a lot per product and sometimes the difference is smaller. A good example is Doxyvet with a 25% active ingredient called Doxycycline. The dosage advised is 400 mg/kg/d, that means 100mg of active ingredient per kg per day. A similar Dutch product, also called Doxyvet, had an active ingredient of 23%, which is Doxycycline. The dosage advised is 54mg/kg/day, which means 12.4mg of active ingredient per day. The Indonesian dosage of this product is about 8 times higher than its Dutch equivalent, and the active ingredient is 2 percentage points lower than the Indonesian equivalent.

To make farms realise that the current AB use is excessive and a huge risk for human health an awareness program is needed. Photo: Rick van Emous

An example of a product with a similar dosage is Amoxitin. It has an active ingredient of 26%, 20% of which is amoxicillin. The dosage advice is 100 mg/kg/d, that means 20mg of active ingredient per kg per day. The comparable Dutch product is “Amoxicilline 15%”. With a 15% active ingredient and advice to use 116mg/kg/d results in 17.40mg of active ingredient per day. At the first sight the dosage seems to be higher, however, due to a lower active ingredient the dosage is slightly lower.

Awareness necessary

Besides an extremely high antibiotic use also the proportion of choice 3 antibiotics (important for human care) and antibiotic dosages are very high in West Java Indonesia. Together this is a really huge threat for chick and human health in the nearby future. Surprisingly, the use of antibiotics in semi-closed houses was almost 40% higher compared to open houses. The reason for the high AB use is probably caused by the routine use of antibiotics and the use of antibiotics as an extra “insurance” to improve their production performance. To decrease AB use, a change in awareness in the future is crucial with the focus on the enormous risk for human health. Eventually the Indonesian government has to implement regulation regarding AB use to control and further lower the AB use in the Indonesian broiler production sector.