Contents

• COMMITTEE TO STUDY THE HUMAN HEALTH EFFECTS OF SUBTHERAPEUTIC ANTIBIOTIC USE IN ANIMAL FEEDS
• ADVISORY PANEL ON ANTIBIOTICS IN ANIMAL FEEDS BOARD ON AGRICULTURE AND RENEWABLE RESOURCES COMMISSION ON NATURAL RESOURCES
• PREFACE
• SUMMARY
• Chapter 1. The Use of Antimicrobial Agents
  • Nature of the Selection Pressure Imposed by Antimicrobials
  • Mechanisms and Transfer of Resistance
  • The Use of Antimicrobials in Human Medicine
  • The Use of Antimicrobials in Agriculture
  • Definition of Human Health Hazard
• Chapter 2. Measuring Effect on Human Health From the Subtherapeutic Use of Antimicrobials in Animal Feeds
  • Epidemiological Studies
  • What Is The Ideal Study?
  • Feasibility Of A Comprehensive Study
  • Alternatives To A Comprehensive Study And Their Deficiencies
• Chapter 3. Critical Review Of The Epidemiological Literature
  • Investigations of Epidemics
  • Population Surveys
  • Experimental Studies
  • Case Reports
  • Subtherapeutic Use In Humans
  • Expertence With Regulations In Other Countries
  • Conclusions Drawn From The Literature
• Chapter 4. Study Possibilities
  • Study 1 The Effects Of Subtherapeutic And Therapeutic Doses Of Antimicrobials On The Prevalence Of R⁺ Enteric Organisms In Animals
  • Observational Study
  • Study 2 Studies Of Vegetarians And Nonvegetarians
  • Study 3 Studies Of Abattoir Workers, Their Families, And Neighborhood Controls
  • Rationale For Conducting Studies Of Morbidity And Mortality In Humans
  • Study 4 Comparison Of Controls With Subjects With Urinary Tract Infection
• Chapter 5. Conclusions And Recommendations
  • Conclusions
  • Recommendations
• REFERENCES
• CONSULTANTS' PAPERS THE APPENDIXES
  • Appendix A The Clinical Use of Antimicrobials and the Development of Resistance
  • Appendix B Possible Human Health Effects of Subtherapeutic Antimicrobial Use as Pesticides
  • Appendix C Genetics of Antimicrobial Resistance
  • Appendix D Impact Of Antimicrobials On The Microbial Ecology Of The Gut
  • Appendix E Antimicrobial Residues And Resistant Organisms: Their Occurrence, Significance, and Stability
  • Appendix F Zoonotic Aspects of Subtherapeutic Antimicrobials in Feed
  • Appendix G Transmission of Food-Borne Diseases Implications of The Subtherapeutic Use Of Antimicrobials
  • Appendix H Food Contamination
  • Appendix I Infectious Disease: Effect of Antimicrobials on Bacterial Populations
  • Appendix J Immunological Consequences of Antimicrobials in Animal Feeds
  • Appendix K Antibiotics In Animal Feeds

The work on which this report is based was performed pursuant to Contract No. 282-78-0163, T. O. 8, with the Food and Drug Administration.

NOTICE

The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the Councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.