Team:Sheffield/episode6

A template page

AGRICULTURE

Dr Simon Rushton also highlighted the fact that human health is not the sole contributor to the problem; antibiotics are used in different spheres. Antibiotic usage is prevalent in agriculture as well as domestic veterinary care and these are also big contributors to the problem.

In order for our device to have maximal effect we started thinking about the potential use for it in agriculture and in domestic veterinary care.

This means potentially our device can apply to animals and hopefully address issue of misusing antibiotics in the non-human health sector. To find out if the sector actually needs our device, we went to speak to

We created a network of interactions between individuals in direct contact with antibiotics to better understand the platform of antibiotic use. This also helped us in our next step of determining whether the targets, aims and goals laid down by policy makers, researchers and managers were actually realistic and being met on the ground where individuals dealt with antibiotics on a daily basis.

Legend

  1. In yellow, individuals consuming antibiotics; in the UK patients can only get antibiotics through having a prescription although in other countries it is possible to get them without a prescription. Family pets, cattle and other farm animals also consume antibiotics at the discretion of vets.
  2. In orange, individuals that prescribe or ensure consumption of antibiotics. GPs and hospital doctors prescribe antibiotics to patients with advice from microbiologists whilst nurses ensure patients take the course. Vets also prescribe antibiotics and it is the responsibility of farmers and owners to give antibiotics to their animals.

  3. In red and dark red, individuals who are less directly affected by antibiotics but may influence an individual's consumption of them. As stated previously, microbiologists advice doctors on whether to prescribe antibiotics. Family and friends may encourage or discourage an individual to seek antibiotic treatment either though a physician or other means. Likewise, other animals may influence a farmer or owner’s decision to seek antibiotic treatment if they are seen to be ill and in need of antibiotics as can the opinions of friends, family and other individuals around them.

Professor Andrew Rycroft

Again, we would like to find out what the reality looks like. For the non-human health sector, we have interviewed Professor Andrew Rycroft at Royal Veterinary College.The professor confirms there is a culture of misuse of antibiotics in the non-human health sector as well.

On one hand, if we look at companion animals, such as dogs and cats, they received individual treatment, unlike livestock. Owners sometimes are willing to pay for expensive cares for them. In some cases, veterinary surgeons will prescribe antibiotics irrespective of what is wrong with the animals. Since they are considered as “harmless” and cheap, despite the lack of necessity, they will still be prescribed.

Secondly, farm animals, for example, pigs, cattles and poultry, are where antibiotics are most used on. Production of a farm gets affected when there is an infection outbreak, so antimicrobials are seen differently. The use of antibiotics is seen as a business decision as well as a decision for animal welfare. Vets sometimes give antibiotics not to individual animals but to the entire herd in boxes and bottles of antibiotics. There may be leftover. It increases the likelihood of misusing antibiotics because this means farms could be using without provision of a vet.

Professor Rycroft told us a few stories that highlight the culture of using antibiotics unnecessarily.

  1. The Professor was told one time that about what a farm manager did for what seemed to be an outbreak of an infectious disease. The first thing that the manager did was to give a 100 ml of penicillin-streptomycin mixture and other antimicrobials to the cattles that were not looking well. However, the antibiotics did not do any good because it was not a bacterial infection that causes the problem. This was a case of misusing antibiotics.
  2. Antibiotics are given by Vets on prescription. However, some vets might promote antibiotics because selling them would make profit. This even happens in the UK but not to the same extent it happens in Southern Europe. In the UK, as mentioned, vets may supply antibiotics in a quantity that is more than one course. This means there would be leftover and that farms would not need to contact a vet next time and themselves could decide when to use the drugs.
  3. Pneumonia is a respiratory disease that could kill pigs in 24 hours and could be highly contagious. To prevent it, in Cyprus, some farms will put pigs on antimicrobials from 7-10 days from age.

Finally, we would like to know what Prof. Rycroft think would make a good device.

What do you think about the idea of using this device on animal?

“Sounds perfectly good. It’s the kind of thing that the veterinary surgeons really are looking for. Pen-side tests that they want to be able to do the test to ask a question like a pregnancy test would give you the result.. But the reality for veterinary it’s got to be cheap. While for companion animals or even horses, you might spend easily hundreds of pounds on tests or treatments… Now farmer isn’t going to spend that even on a herd of cow.”

For the device to be practical for vets, would it need to be able to analyse multiple blood samples at once?

“Yes, if you have an outbreak of infectious disease,each animal should be representative but you would normally sample more than one. When we go on a farm and looking for diease, we might kill three animals and do the post mortems on them… so you want to sample more than one. And for some infectious diseases when you diagnose it with a blood test looking for antibody perhaps a viral infectious something like leptospirosis…, you might have to sample 12 animals. So for your blood sample yes you would probably want to sample several of them.

“So how rapidly would your blood test be expected to give a result?”

It would depend on our reporter system. We are hoping to bring down to quickly as 20 minutes. For GFP, hopefully less than an hour.

“That’d be marvellous. That’s the kind of diagnostic test that people are genuinely trying to use…”

What kind of a percentage would you say is an acceptable range of accuracy for a device like this?

“Anything above 80% sensitivity and specificity would be good.”

“In terms of a pen side test,currently our plan would be a small spectrophotometer that would probably be able to fit into the back of a car,particularly the back of a landover. And then having a smaller test that you will actually take to sample. Would that be alright in terms of portability for a vet going to farm?”

“Small devices in the back of a landover would be fine.As long as the test didn’t involve more than 2 or 3 steps would be fine. They don’t like it when it’s complicated and require following difficult instructions. That would tend to put them off. You need to be able to offer the test under 10 pounds. For the individual machine, wouldn’t be unreasonable to pay 3000 pounds for such a piece of equipment”

Practicality for vets

Result coming in under an hour.

Accuracy

Above 80%

Portability

Small devices and no more than 2-3 steps.

Cost

Each test should be under £10.

We aimed to integrate Prof. Rycroft expert opinions into our designing of the device. Nevertheless, as our findings showed a device that we proposed would have limitations in tackling the problem of antibiotic resistance as a whole. Recommendations and guidelines are not enough to enforce correct behaviors. There would be little global improvements in antibiotic resistance unless policy changes and attitude changes are taken place.