Dear Members of the Maryland General Assembly:
As healthcare professionals and organizations, we urge you to support legislation that reins in the overuse of medically important antibiotics in animal agriculture to help ensure that the antibiotics that we rely on to treat our patients continue to work.
Antibiotic resistant bacteria are on the rise, and antibiotic overuse in both humans and animals contributes to the problem. The World Health Organization states, “A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.”
Stronger antibiotic stewardship in hospitals is important, but alone is insufficient to address this urgent threat. In the U.S., around 70% of all the antibiotics of human importance – including penicillins, tetracyclines, cephalosporins – are sold not to treat humans, but for use in livestock production.[2,3] And much of those antibiotics are given routinely to food animals that are not sick, to speed up growth or to compensate for crowding, stress and sometimes less than hygienic conditions. This use is allowed by the Food and Drug Administration (FDA) through a loophole in its policies.
We see every day how critical antibiotic stewardship is for our patients and communities. The Centers for Disease Control and Prevention (CDC) reports about 2 million Americans are stricken with antibiotic-resistant infections each year, with at least 23,000 deaths; the toll is rising. This epidemic is beginning to cripple the effectiveness of some of our most important tools in medicine, seriously undermining our ability to manage infections in patients undergoing chemotherapy, dialysis, organ transplants, and other surgeries.
As of 2008, several hospital emergency departments in Maryland – including three on the Eastern Shore – were seeing increased numbers of patients with methicillin resistant Staphylococcus aureus (MRSA), according to Maryland’s Department of Health and Mental Hygiene. Increased hospital stays and lost work days all contribute to the $55-70 billion annual cost of these antibiotic-resistant infections nationwide.
The routine use of antibiotics in livestock provides the selection pressure that helps create and allow resistant bacteria to flourish. They can then disperse from the farm through the air, water, soil, farm workers, or on the meat itself.
Says the American Academy of Pediatrics: “Because of the link between antibiotic use in food-producing animals and the occurrence of antibiotic-resistant infections in humans, antibiotic agents should be used in food-producing animals only to treat and control infectious diseases and not to promote growth or to prevent disease routinely.”
We want to ensure that Maryland’s medical professionals in the future will be able to fight infections with antibiotics that work. We urge you to support legislation that halts the routine use of medically important antibiotics in livestock and poultry production.
Robert Lawrence, MD (Professor, Johns Hopkins Bloomberg School of Public Health*)
Anthony So, MD, MPA (Robert S. Lawrence Professor, Johns Hopkins Bloomberg School of Public Health*)
Barbara Sattler, DrPH, RN (Alliance of Nurses for Healthy Environments)
Jerome Paulson, MD, MPA (Pediatrician and Emeritus Professor, George Washington University*)
Theoklis Zaoutis, MD (Pediatrician and Chief of Infectious Diseases, Children’s Hospital of Philadelphia*)
Richard Jackson, MD (Pediatrician/Professor, UCLA*; Former Director of CDC’s National Center for Environmental Health)
Robert Sprinkle, MD, PhD (Pediatrician and Professor, University of Maryland School of Public Policy*)
Robyn Gilden PhD, RN (Assistant Professor and Director, University of Maryland School of Nursing*)
Cynthia Bearer, MD, PhD (Chief, Division of Neonatology; Associate Chair of Pediatric Research, Department of Pediatrics; Editor-in-Chief, Pediatric Research, University of Maryland School of Medicine*)
Kerri Thom, MD (Associate Professor, University of Maryland School of Medicine*)
Pat McLaine, DrPH, MPH, RN (University of Maryland School of Nursing*)
Katie Huffling, MS, RN, CNM (Registered Nurse and Director of Programs Alliance of Nurses for Healthy Environments)
Susan Chaitovitz, MD, FAAP (President, Maryland Chapter of the American Academy of Pediatrics)
Michael Ichniowski, MD (Maryland Chapter of the American Academy of Pediatrics, Environmental Health Committee Chairperson)
Reshma Ramachandran, MD, MPP (Johns Hopkins Bloomberg of Public Health*)
Robert K Musil, PhD, MPH (President and CEO, Rachel Carson Council)
Devon Payne-Sturges, MPH, DrPH (Assistant Professor, University of Maryland School of Public Health*)
Michael Gee, MD (Family Physician)
Bobbie-Jo Phelps, RN (Registered Nurse)
David Wallinga, MD, MPA (Steering Committee, Keep Antibiotics Working; Senior Health Officer, Natural Resources Defense Council)
Yolanda Whyte, MD (Pediatrican)
Emily Heil, PharmD (Infectious Disease Clinical Pharmacy Specialist, University of Maryland Medical Center*)
Wayne Campbell, MD (Chief, Infectious Diseases, MedStar Union Memorial Hospital*)
Maureen Connors, PharmD, MPH (MedStar Union Memorial Hospital*)
Brittany Copeland, PharmD, BCPS (Clinical Pharmacist, Antimicrobial Stewardship, Suburban Hospital – Johns Hopkins Medicine*)
Janelle Caruano, PharmD (Pharmacist)
Jean Lee, PharmD, BCPS, AQ-ID (Infectious Disease pharmacist, Sinai Hospital of Baltimore*)
Ifeanyi Egbunike, PharmD (Clinical Pharmacy Coordinator, UMMC-Midtown Campus*)
Elizabeth Cichetti, PharmD (Clinical Pharmacist, Saint Agnes Hospital*)
Nicholas Peters, PharmD, BCPS (Critical Care Clinical Pharmacist, Suburban Hospital*)
Justin Graves, MS, RN (Sustainability Manager, University of Maryland Medical Center*)
Emily Smith, CRNP
Jennifer Bui, PharmD (Clinical Pharmacist, Upper Chesapeake Medical Center*)
Tracy Freeman, MD
Kelly Collins, RN, CCRN (University of Maryland Medical Center*)
Julie M. Zito, PhD (Professor of Pharmacy & Psychiatry, University of Maryland, School of Pharmacy*)
Robin Kaufman, CRNP, Nurse Practitioner Association of Maryland
Keisha Bates, BS (Nursing Student)
Maryland Nurses Association (MNA)
American Medical Student Association (AMSA)
Maria Brown, MD, EdM (Pediatrician)
Karin Russ, RN, MS (Course Director, Public Health, University of Maryland*)
Nurse Practitioner Association of Maryland (NPAM)
Beverly Lang, MScN, RN, ANP, BC (Executive Director, NPAM)
Julie Stanik-Hutt, PhD, CRNP, FAAN (Associate Professor (retired), Johns Hopkins University School of Nursing*)
Veronica Gutchell, CRNP (Nurse Practitioner, University of Maryland School of Nursing*)
Michael Donnenberg, MD (Professor of Medicine, Infectious Diseases, University of Maryland School of Medicine*)
Kate Scott, RN, MPH (Clinical Instructor, Maryland Nurses Association*)
Laurie Yancey, RN, MSN, ACNP (Nurse Practitioner)
* Affiliations for identification purposes only and do not represent the positions of any organizations.
 World Health Organization, Antimicrobial Resistance: Global Report on Surveillance, 2014, forward,http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1 (accessed February 23, 2015).
 U.S. Department of Health and Human Services, Food and Drug Administration, Center for Veterinary Medicine, 2011 Summary Report of Antimicrobials Sold or Distributed for Use in Food-Producing Animals, 2011, www.fda.gov/downloads/ForIndustry/UserFees/AnimalDrugUserFeeActADUFA/UCM338170.pdf (accessed February 23, 2015).
 Jerome A. Paulson, Theoklis E. Zaoutis. 2015. Nontherapeutic Use of Antimicrobial Agents in Animal Agriculture: Implications for Pediatrics. Pediatrics DOI: 10.1542/peds.2015-3630 Pediatrics; originally published online November 16, 2015.
 G. Khachatourians, “Agricultural Use of Antibiotics and the Evolution and Transfer of Antibiotic- Resistant Bacteria,” Canadian Medical Association Journal 159 (1998): 1129-1136. T. Jukes, “The Present Status and Background of Antibiotics in the Feeding of Domestic Animals,” Annals of the New York Academy of Sciences 182 (1971): 362-379.
 Natural Resources Defense Council. FDA’s efforts fail to end misuse of livestock antibiotics (fact sheet). http://www.nrdc.org/food/subway/files/fda-guidance-213.pdf. (accessed December 23, 2015),
 Centers for Disease Control and Prevention (CDC), Antibiotic Resistance Threats in the United States, 2013, http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf (accessed February 23, 2015).
 “MRSA Revisited,” Critical Link, Maryland Department of Health and Mental Hygiene, Vol. 12, No. 7; July 2008,http://dhmh.maryland.gov/laboratories/docs/july08critlink.pdf (accessed February 23, 2015).
 Executive Office of the President. President’s Council of Advisors on Science and Technology,
Report To The President On Combating Antibiotic Resistance. 2014, p. 3, http://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_carb_report_sept2014.pdf (accessed February 23, 2015).
 Chang, Q. et al, “Antibiotics in agriculture and the risk to human health: how worried should we be?” Evolutionary applications, 2014, pp. 1-8.