Are you sick of chicken?

Antibiotics in poultry make Nepalis resistant to drugs that fight infections

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The next time you dig into a plate of chicken curry and rice or order momos, you may want to first find out what the birds are fed in the poultry farm where the meat came from.

Broiler poultry is fast replacing free-ranging chicken in markets across Nepal, meaning birds bred in crowded pens have to be fed antibiotics so they don't get infections and grow faster.

Half of broiler chicken meat and eggs in Nepal are estimated to have antibiotic residue. This means people who consume them slowly develop a resistance to antibiotics, and will not respond to treatment of bacterial infections.

An epidemic of anti-microbial resistance is sweeping the world, and scientists say one of the main reasons is the ingestion of antibiotics from poultry products, dairy milk, pork and aquaculture fish.

Common illnesses are turning into potential killers, and surgery can sometimes be fatal because of ‘superbugs’ that are immune to most antibiotics. Kathmandu hospitals all have patients who are not responding to antibiotic treatment for typhoid, tuberculosis, pneumonia, or common infected wounds.

“Two-third of antibiotics globally is used on animals, and chicken are often fed last resort antibiotics. It may not be a good idea to eat poultry products,” advises Buddha Basnyat, physician at Patan Hospital.

Numerous studies in Nepal have shown that antibiotic residue in poultry is finding its way into the human food chain. Poultry farmers use antibiotics not just when their chicken fall sick, but for prevention and also as a growth promoter.

“We know it for a fact that farmers are using antibiotics in poultry as prophylactics to prevent diseases,” explains Sameer Mani Dixit of the Centre for Molecular Dynamics Nepal. “We might be getting healthy chicken, but at the cost of resistance that has major public health consequences.”

However, the use of antibiotics in poultry farms is going down in Nepal because of a recent law against antibiotic additives in chicken feed, and farmers are now generally more careful about hygiene. Even so, chicken consumption in Nepal has grown several fold in the last decade as living standards rise. Nepalis consume up to 5kg per capita of chicken meat per year, higher than annual consumption per person in India and Bangladesh combined.

A study this year by the Institute of Agriculture and Animal Sciences showed that 94% of the E coli bacteria in broiler chicken in Chitwan showed resistance to up to four types of antibiotics. Not only is antimicrobial residue in meat making people resistant to the drugs, but the chicken themselves are contaminated with harmful bugs that are resistant. (See chart, below)

Another study published in the International Journal of Applied Sciences and Biotechnology last year showed high tetracyclin and penicillin residue in 22% of meat samples in Kavre and Kailali districts. Another research by the Institute of Agriculture and Animal Science, Rampur, showed that 40% of chicken samples in Gorkha, Parsa, Chitwan and Kathmandu had penicillin residue, while 35% had tetracycline traces, and there were aminoglycosides in 17.5% of the samples.

An earlier study by the Department of Food Technology and Quality Control found that nearly 70% of chicken meat sold in Kathmandu Valley still had ampicillin residue -- with about 17% having concentrations above the permissible threshold.

Although Nepal now has a law against antibiotic additives in feed, the ban is not effective because of the open border with India. A recent expose by the UK-based Bureau of Investigative Journalism titled ‘A Game of Chicken: How Indian Poultry Farming is Creating Global Superbugs’ revealed lax controls, and a looming superbug epidemic in hospitals across India.

High bacterial disease burden, overuse of human antibiotics, and no regulation on use of antimicrobials in poultry and livestock means India is sitting on a time bomb, scientists say. And right next door, with no border controls, is Nepal.

The British company Venky exported nearly a thousand tons of the ‘last hope’ antibiotic colistin branded ‘Colis V’ to India and Nepal in 2016 for use in poultry, according to customs data. WHO has recommended that colistin be restricted in animals because it is one of the few drugs that can still treat infections in humans. Two Indian companies also manufacture colistin as antibiotics and growth promoters.

The report quoted Timothy Walsh, professor of Medical Microbiology at Cardiff University as saying: “Colistin is the last line of defence. It is the only drug we have to treat critically ill patients resistant to carbapenems. Giving it to chickens as feed is crazy.”

Carbapenems are last resort antibotics used to fight infections in the bladder, lungs and blood in humans, but more than half of infected patients in India are already resistant to carbapenems and need colistin to get better. Drug resistant infections kill an estimated 58,000 babies in India every year. In Nepal, there is evidence that colistin resistance is spreading among humans (see graph, below).

Although European countries have restricted antibiotic use in animal feed, the United States is still using it indiscriminately even though the Atlanta-based Centre for Disease Control and Prevention and WHO have warned about the proven link between antibiotics in animals and antibiotic-resistant infections in humans.

From 2008 to 2016, Nepal’s import of veterinary drugs is estimated to have doubled as poultry farms proliferate to meet demand. An estimated Rs300 million worth of veterinary antibiotics were imported last year, records show. Nepal meets only 15% of its poultry and livestock antibiotic requirement from domestic pharmaceutical companies. Experts say the government controls on antibiotic additives in animal feed will not work as long as it is allowed in India.

“The trend of antibiotic residue in poultry and resistance in humans won’t stop unless there is a better mechanism to regulate and monitor quality control and sales of drugs,” says Varun Sharma at the Department of Livestock. "Our only hope is to make sure that antibiotics which still work last longer, by regulating their use."

There is also a need to make poultry farmers aware of the dangers. Many have a misconception that antibiotics prevent infections and promote growth, when it should be given only for treatment. However, Til Chandra Bhattarai of Pancha Ratna Group of Poultry Industries in Chitwan says it is impossible to run a modern poultry business without antibiotics because of the widespread danger of avian infections.

Tika Rai, who runs a poultry farm in Nuwakot that supplies meat to Kathmandu markets, agrees. He urges the government to help with alternatives like probiotics as growth promoters and biosecurity.

“These drugs are a major cost in the business, but we cannot stop using antibiotics. We would lose all our investment if the birds die,” Rai told us.

Farmers are also said to be violating the withdrawal period which requires birds fed antibiotics to be quarantined for a period before being sold. Over-the-counter sales of antibiotics, over-prescription and self-administration in poultry farms all contribute to spreading drug-resistance in humans.

WHO calls antibiotic resistance the biggest threat to global health. It warns that South Asia is 'the epicentre' of the drug resistance crisis, and an epidemic of superbugs in India would engulf Nepal as well.

Many Nepalis already have multi-drug resistant tuberculosis and pneumonia that do not respond to treatment, because of earlier misuse of antibiotics, and from eating chicken raised on antibiotic-laced feed.

Says Sarada Thapaliya, Dean of Veterinary Science and Fisheries in Chitwan: “The restrictive and judicious use of antibiotics in animal feed is the best available solution for now.”

Banning antibiotics in food animals

The link between anti-microbial resistance in humans and antibiotic use in poultry and livestock is now scientifically proven, and countries around the world have banned their use as growth promoters. Many countries still allow limited use to control poultry epidemics, but enforce a window period after the drugs are administered so the meat does not have drug residue when consumed.

Sweden was the first country to stop animal antibiotic use as growth promoters, in 1986. In 2006, the EU banned all antibiotics used to make animals grow faster. In 2017, the US also restricted antibiotics as feed supplement.

In the Asia Pacific region, antibiotic use in poultry feed is projected to rise by 129%, by 2030, with India and China leading the way because of higher living standards. Bangladesh law in 2010 criminalises antibiotic use as growth promoter in animal feed.

Read also:

Antibiotic resistance, Buddha Basnyat and Hellen Gelband

"Patients are impatient", Sonia Awale

Counter-attack of microbes, Sameer M Dixit, Buddha Basnyat and Paras Pokhrel

Source: Department of Food Technology and Quality Control, Antibiotic resistance pattern and virulence genes content in avian pathogenic Escherichia coli (APEC) from broiler chickens in Chitwan, Nepal, Multi-drug resistance and extended spectrum beta lactamase producing Gram negative bacteria from chicken meat in Bharatpur Metropolitan, Nepal, Prevalence and Antibioic Resistance Profile of Salmonella from Livestock and Poultry Raw Meat, Nepal, Assessment of Antibiotic Residues in the Marketed Meat of Kailali and Kavre of Nepal, Detection of antibiotic residues in marketed broiler meat of Gorkha, Parsa, Chitwan and Kathmandu district

Readers write:

Rajeeb Lal Satyal‏

Not scary anymore. It comes in package as a part of being Nepali and a lot more. We become vegetarian for the same reason. But Vegetarians are also not free. Every vegetable we eat has pesticide. That's why, unlike in old days, we look for vegetables with insects instead.