News and Opinions  –  2019

Antibiotic footprint: change the way food is labelled?

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Reducing the misuse and overuse of antibiotics in food production is critical to any global attempts to prevent the emergence and spread of resistant bacteria. As consumers around the globe become more aware of the dangers of antimicrobial resistance meat producers and food retailers everywhere are rushing to label their products as "antibiotic-free" or as "raised without antibiotics". The trouble is though, these labels do not fully explain in accurate terms what exactly they mean.

Photo: Shutterstock.

For example, consumers may believe that meat labelled “antibiotic-free” comes from animals raised without the use of antibiotics. However, what many producers actually mean is they stopped using antibiotics on their animals a certain number of days before putting their meat for sale in the market.

Today antibiotic free really equals no antibiotic residues in product

At best what they are claiming really is that there are no antibiotic residues in the product anymore, which cannot be confirmed without testing. These labels also do not indicate what kind of antibiotics, including ones that are critically important to human health, were used on the animals before the withdrawal period set in.

It is precisely to help overcome the problem of such vague labelling that a leading Thai academic, collaborating with many global partners, working on antimicrobial resistance (AMR) issues has suggested the concept of “antibiotic footprint”, which requires full transparency in specifying both the type and amount of antibiotics used to produce the food systematically.

Concept similar to carbon footprint

Making a presentation on the theme at a workshop in Bangkok recently Dr Direk explained that the concept proposed was similar to the idea of a carbon footprint used to measure impact of energy consumption on global warming.

The workshop titled “Globalizing Food Campaigns: Sharing Strategies to Address Antimicrobial Resistance”, from 12-15 December 2018, was organized by ReAct North America together with ReAct Asia Pacific and the Drug Systems Monitoring and Development Center and attended by animal health professionals, civil society and health advocacy groups.

 Carbon and antibiotic footprint concepts
Carbon and antibiotic footprint concepts. By:

“Showing the total amount of antibiotics used to produce that portion of food, possibly comparing it with global targets – would empower consumers”

says Dr Direk Limmathurotsakul, Head of Microbiology at the Mahidol Oxford Tropical Medicine Research Unit (MORU), in Bangkok.

Like other countries in the region, Thailand too has developed intensive farming systems, leading to rising consumption of antibiotics for various purposes, including routine use for disease prevention. The lack of effective regulations, appropriate policies, and poor implementation of standards for antibiotic use, together with low levels of biosecurity, hygiene, and sanitation, have accelerated the emergence and dissemination of antibiotic resistance.

Survey on amount of antibiotics used by rural poultry farms in Thailand

To address the paucity of data on the amount of antibiotics used in Thailand’s food-animal production Dr Direk and his team of researchers carried out a survey of rural poultry farms in 2016. Using both quantitative and qualitative methods, they extrapolated data collected from eight farms in a single province, on the amount of antibiotics used annually for prophylaxis in the production of chicken. None of the farms reportedly used antibiotics as growth promoters and had a median capacity of 15,000 chickens.

Standard regimen included critically important antimicrobials

The regimen used by several of the farms, based on recommendations from the company supplying the broiler stock, included amoxicillin, colistin, doxycycline, oxytetracycline and tilmicosin. According to WHO, amoxicillin is a critically important antimicrobial, colistin is one of the highest priority critically important antimicrobials and doxycycline and oxytetacycline are highly important antimicrobials.

The mean total weight of antibiotics used per chicken was 303 mg, allocated daily for 31 days and typically mixed with drinking water and distributed via a pipe system. The last 10 days on the farm no antibiotics was given to the chicken, representing an attempt to eliminate antibiotics from the chicken meat reaching consumers.

This translated into around 101 mg of antibiotics per kilogram of chicken meat produced. In meat production (not exclusively chicken) within 30 European countries in 2015, antibiotic use per so-called population correction unit, i.e., per kg of biomass produced, varied from 2.9 mg in Norway to 434.2 mg in Cyprus.

“It is not just possible but critical to put such information on retail labels when the chicken from these farms is sold in the market”,

says Dr Direk.

This they say will allow consumers to choose meat produced with minimal use of antibiotics.

Develop global standards to measure antibiotic footprint of meat products?

Dr Direk’s team has recommended developing global standards to measure the “antibiotic footprint” of meat products, for display of all antibiotics used in the production process, through labels on the food products. However, more research is needed according to him to understand the impact of such detailed labelling of food products on consumer behavior, prices and overall consumption of antibiotics in the food-animal sector.

Sample label using antibiotic footprint concept. By:

Once developed further, another possible use of the concept, says Dr Direk, is as a strategic tool to calculate both individual and national antibiotic footprint and correlate it with overall levels of antimicrobial resistance and drug-resistant infections at the level of the community or country.

For further information visit:


Antimicrobial policy interventions in food animal production in South East Asia Flavie Goutard; BMJ. 2017;358:j3544

Critically important antimicrobials for human medicine – 5th revision. Geneva: World Health Organization; 2017.

Sales of veterinary antimicrobial agents in 30 European countries in 2015. Trends from 2010 to 2015. Seventh ESVAC report. London: European Medicines Agency; 2017.


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