Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 10, Number 6—June 2004

Antibiotics in Animal Feed and Spread of Resistant Campylobacter from Poultry to Humans

Article Metrics
citations of this article
EID Journal Metrics on Scopus
Nicole M. Iovine* and Martin J. Blaser*†Comments to Author 
Author affiliations: Antibiotics in Animal Feed; *New York University School of Medicine, New York, New York, USA; †and New York Harbor Department of Veterans Affairs Medical Center, New York, New York, USA

Cite This Article


Thumbnail of Acquisition of fluoroquinolone (FQ)-resistant Campylobacter from poultry. Campylobacter species are part of the normal enteric flora of poultry and are not resistant to fluoroquinolones, unless these have been added to the poultry feed in subtherapeutic doses. These antimicrobial-exposed poultry become colonized with resistant Campylobacter strains but remain healthy. During the slaughter and processing of the poultry, meat can become contaminated with Campylobacter in fecal materia

Figure. Acquisition of fluoroquinolone (FQ)-resistant Campylobacter from poultry. Campylobacter species are part of the normal enteric flora of poultry and are not resistant to fluoroquinolones, unless these have been added to the...

Contamination of food with potentially dangerous human pathogens has been recognized since the time of Pasteur (1) and is well-documented in the modern era (2), but the development of antimicrobial agents has helped limit the consequences of such infections. Concomitantly, the widespread use of antimicrobial agents has also led to the emergence of antimicrobial drug–resistant organisms (3,4). Gupta et al. demonstrate the increasing prevalence in the United States of ciprofloxacin-resistant Campylobacter species isolated from humans and poultry from 1990 to 1997, and their studies implicate the prophylactic treatment of poultry with fluoroquinolones in this emerging problem (5). Their report indicates that the source of fluoroquinolone-resistant Campylobacter infections was consuming poultry colonized with resistant strains (Figure), rather than selection for Campylobacter resistance in the human gut after clinical fluoroquinolone use to treat the diarrheal illness (5). This work provides further evidence that fluoroquinolone use in poultry promotes the emergence of resistant Campylobacter strains that subsequently infect humans (6). That persons infected with these fluoroquinolone-resistant strains had 3 additional days of illness and were more likely to be hospitalized demonstrates the harm caused by such resistant stains (5).

Since campylobacters are normal enteric flora in many avian species, poultry represents a model system to test the hypothesis that prophylactic and growth-promoting use of antimicrobial agents in food animals selects for the emergence of antimicrobial drug–resistant organisms. In one study, chickens that were naturally colonized with fluoroquinolone-susceptible Campylobacter strains began to excrete resistant strains after 2 days of doses of enrofloxacin (7), which is commonly used for prophylaxis in the poultry industry. A single point mutation in gyrA encoding the bacterial DNA gyrase was sufficient to confer high-level resistance (7,8). This small genetic change apparently has a low "fitness cost" to the organism, as evidenced by fluoroquinolone-resistant strains' rapidly replacing susceptible Campylobacter in treated chickens (7). Developing an animal reservoir of fluoroquinolone-resistant Campylobacter has been the major factor behind transmission of quinolone resistance to humans (8,9).

In contrast, among poultry treated therapeutically with enrofloxacin, no resistance was observed in the 13 C. jejuni isolates tested (9). Similarly, after the prophylactic and growth-promoting uses of macrolides in swine were banned in Denmark, the prevalence of macrolide-resistant C. coli declined (10). Thus, the major determinant of developing resistance appears to be use of subtherapeutic antimicrobial doses. The antimicrobial drug ban in Denmark did not decrease the amount of meat produced by the poultry and pig production industries, which removed a major concern (10). Evidence suggests that restricting fluoroquinolone use to therapeutic indications only in food animals could decrease rates of fluoroquinolone-resistant Campylobacter, and the Danish experience with macrolide restriction proves that such limitations need not harm the husbandry of food animals.

The increased likelihood of foreign travel in persons infected with ciprofloxacin-resistant strains (5) illustrates the global threat posed by resistant strains. Appreciating such realities favors concerted efforts to limit use of fluoroquinolones (and other antimicrobial drugs) to therapy only in food animals. This view was supported by a recent (March 2004) landmark decision by Federal Drug Administration Administrative Law Judge Daniel J. Davidson, withdrawing approval for the new animal drug application to use enrofloxacin for prophylaxis or growth-promotion in poultry (11). This decision was the first occasion that a previously approved antimicrobial agent was removed from the U.S. veterinary market because of concerns about antimicrobial drug resistance. With this decision as precedent, we should follow the examples set in Europe and ban use of all antimicrobial agents in food animals, except when necessary for therapy of ill animals.

Dr. Iovine is a fellow in the Division of Infectious Disease and a post-doctoral fellow in the Department of Microbiology at New York University. She studies the interactions between human enteric pathogens and innate host immunity.

Dr. Blaser is the Frederick H. King professor and chair of the Department of Medicine, and professor of microbiology at New York University. He has been studying Campylobacter infections since 1977.



  1. Pasteur  L. On spontaneous generation. In: Sorbonne scientific soiree. 1864 Apr 7; Paris.
  2. Blaser  MJ. How safe is our food? Lessons from an outbreak of salmonellosis. N Engl J Med. 1996;334:13245. DOIPubMedGoogle Scholar
  3. Conly  J. Antimicrobial resistance in Canada. CMAJ. 2002;167:88591.PubMedGoogle Scholar
  4. Shea  KM. Antibiotic resistance: what is the impact of agricultural uses of antibiotics on children's health? Pediatrics. 2003;112:2538.PubMedGoogle Scholar
  5. Gupta  A, Nelson  J, Barrett  T, Tauxe  R, Rossiter  S, Friedman  C, Antimicrobial resistance among Campylobacter strains, United States, 1997–2001. Emerg Infect Dis. 2004;10:11029.PubMedGoogle Scholar
  6. Smith  KE, Besser  JM, Hedberg  CW, Leano  FT, Bender  JB, Wicklund  JH, Quinolone-resistant Campylobacter jejuni infections in Minnesota, 1992–1998. Investigation team. N Engl J Med. 1999;340:152532. DOIPubMedGoogle Scholar
  7. Luo  N, Sahin  O, Lin  J, Michel  LO, Zhang  Q. In vivo selection of Campylobacter isolates with high levels of fluoroquinolone resistance associated with gyrA mutations and the function of the CmeABC efflux pump. Antimicrob Agents Chemother. 2003;47:3904. DOIPubMedGoogle Scholar
  8. Hooper  DC. Emerging mechanisms of fluoroquinolone resistance. Emerg Infect Dis. 2001;7:33741. DOIPubMedGoogle Scholar
  9. Threlfall  EJ, Ward  LR, Frost  JA, Willshaw  GA. Spread of resistance from food animals to man—the UK experience. Acta Vet Scand Suppl. 2000;93:638.PubMedGoogle Scholar
  10. Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, foods and humans in Denmark. Copenhagen: Danish Zoonosis Center, Danish Veterinary Institute; 2003.
  11. Davidson  DJ. In the matter of enrofloxacin for poultry: withdrawal of approval of Bayer Corporation's new animal drug application 1 (NADA) 140-828 (Baytril). In: FDA Docket No. 00N-1571; 2004.




Cite This Article

DOI: 10.3201/eid1006.040403

Table of Contents – Volume 10, Number 6—June 2004

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.



Please use the form below to submit correspondence to the authors or contact them at the following address:

Martin J. Blaser, Department of Medicine, NYU School of Medicine, 550 First Avenue, OBV-606, New York, NY 10016, USA; fax: 212-263-3969

Send To

10000 character(s) remaining.


Page created: February 22, 2011
Page updated: February 22, 2011
Page reviewed: February 22, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.