Our daily dose of antibiotics

As dairy farmers inject antibiotics in their livestock, chances are high that these are passed on to humans through milk, finds Delhi-based non-profit Centre for Science and Environment

By Rajeshwari Sinha, Divya Khatter, Amit Khurana
Published: Wednesday 17 June 2020

Most farmers CSE spoke to did not know they must wait after an antibiotic is given to an animal before its milk is soldKhairati lal Chokra, a dairy farmer at Fatehabad in Haryana, injects heavy doses of antibiotics to treat his sick cows and buffaloes. He repeats it every two to three days for a week. Saurabh Shrivastav, another dairy farmer of Jhansi in Uttar Pradesh, injects antibiotics for three conse-cutive days. They do this to treat their cattle whose mammary gla-nds have swollen due to an infection.

The milk emits a strange odour and changes colour. “At times it turns curdy or has blood in it,” says Shrivastav. Selling milk is their livelihood and they have to keep their cattle healthy. Chokra has 20 cows and buffaloes and Shrivastav has 92 of them. 

In 2018, when Food Safety and Standards Authority of India (FSSAI) tested milk samples from organised and unorganised sectors across the country, it found 77 of them had antibiotic residues beyond permissible limits. But the food regulator did not disclose the antibiotics that were detected or names of the brands tested.

Delhi-based non-profit Centre for Science and Environment (CSE) filed a Right to Information application, but did not receive clear answers despite several follow-ups and an appeal.

To understand the reasons for antibiotic misuse and its presence in milk, CSE spoke to a wide range of stakeholders across the country, including farmers of high milk-producing states — Punjab, Haryana, Uttar Pradesh, Rajasthan, Karnataka and Tamil Nadu. 

Burden of disease 

The biggest irritant for farmers is mastitis, a common disease in cattle. The animals contract it due to poor farming and milking hygiene. If an animal sits on an unclean floor immediately after being milked, microorganisms enter its body through the udder and cause the disease.

Mastitis can also occur if the milker’s hygiene is compromised or unclean milking equipment is used. The disease is most common in high milk-yielding exotic breeds or crossbreds. 

Farmers prefer to treat the animals themselves as it saves them the trouble of taking them to hospital. “Government doctors are mostly not available. Compounders come to the farm, but have little knowledge of either the disease or its treatment,” says Pruthvi Gowda, owner of Kaushik dairy farm in Karnataka.

He discusses the problem with other farmers on WhatsApp and speaks to doctors over phone. Private doctors charge very high fees. Medicines are easily available over the counter, without doctor’s prescription. 

Department of Animal Husbandry (DAHD) Farmer Manual recommends use of only penicillin, gentamicin, streptomycin and enro-floxacin on animals. Shrivastav, however, uses ceftiofur, amoxicillin, cloxacillin and ceftriaxone-sulbactam. Chokra uses ceftizoxime or ceftriaxone-tazobactum.

The anti-biotics are injected in the  animal’s muscle or vein. At times, these are injected directly into the mammary glands.

“Most farmers give the injections without knowing which antibiotic should be given and in what dose. As a result, they end up underdosing or overdosing the ani-mal,” says Jitender Pundhir, a veterinary officer at National Dairy Research Institute, Karnal. Many doctors give medicines without dia-gnosis. “If an antibiotic is ineffective, it is simply changed,” he adds.

Sandeep Kumar, who rears five dairy animals in Farwain Kala village, Sirsa, Haryana, says, “Once an animal gets mastitis, the chances of it getting fully cured are very low. It often gets an infection.” Some big farmers practise “dry cow therapy” to prevent mastitis.

When an animal is not lactating, long-acting antibiotics are injected inside its milking glands to prevent the disease. “This procedure is routinely performed on each animal in my farm,” says Naresh Jain, a dairy farmer of Sonipat, Haryana. 

Dairy cattle also contract bacterial diseases like haemorrhagic septicemia, black quarter, brucellosis, and viral ailments like foot and mouth disease. The government has vaccines for these but some farmers are unwilling to use them.

“I rely more on privately procured vaccines than free government vaccination servi-ces as I am unsure of their cold chain,” says Shrivastav. Mastitis has no vaccine. With over 100 microorganisms causing the dise-ase, finding its vaccine is difficult. The National Dairy Development Board has a Mastitis Control Populari-sation Project in place. 

As farmers overuse antibiotics, it makes the healthy milk that we drink unhealthy. 

Truth about our milk 

India is the world’s largest milk producer. It produced a massive 187.7 million tonnes in 2018-19. While urban areas consume 52 per cent of the total milk, rural regions use the rest. The unorganised sector, comprising milkmen and contractors, cater to 60 per cent of the milk in urban areas. But how good is the milk that we consume? 

There are times when milk comes from sick animals under heavy antibiotic treatment. Most farmers cse spoke to did not know about withdrawal period — this is the time after the last day an antibiotic is administered and before the milk is sold. Farmers must not sell milk cattle during this period as it can increase cha-nces of antibiotic residues in milk.

“I sell milk irrespective of the ongoing antibiotic treatment,” says Subhash Chandila, who owns 12 Murrah buffaloes in Badoli village of Faridabad, Haryana. Jitender Yadav, who has a dairy in Noida, wonders how farmers would sustain themselves if they do not earn for the 7-15 days of treatment and withdrawal period.

Mohan Tyagi of Dhaulpur in Uttar Pradesh admits he has sold such milk to Parag, the state coope-rative’s brand. Arjun Jat, too, used to milk the animals during treatment. But Saras, Raj-asthan’s cooperative brand, whom he sold milk to, asked not to do so. 

Consuming milk drawn during withdrawal period can lead to resistance against antibiotics because the antibiotics exert selection pres-sure among the gut bacteria in humans. Studies show that boiling or pasteurisation milk may not completely eliminate antibiotics.

A 2019 Bangladesh Agricultural Uni-versity research found that even after boiling milk at 100 degree Celsius for 20 minutes, there was no change in the status of residual amoxicillin, oxytetracycline and ciprofloxacin.

No effect of pasteurisation on cloxacillin residues in milk was observed in a study led by West Bengal University of Animal and Fisheries Sciences in India.

Probing companies 

CSE reached out to milk federations and found that most dairy cooperatives only occasionally tested milk for antibiotic residues. The cooperatives serve 80 per cent of the consumers with packaged milk and retail products.

These follow a three-tier structure — dairy coop-erative societies in the villages, district-level milk unions and a state-level milk federation as the apex. Milk collected from farmers at a dairy cooperative society is stored in bulk coolers and trans-ported in tankers to the district-level processing plants. 

Historically, milk federations have focussed more on removing adulterants like urea, detergent and starch than on checking antibiotic presence.

Responding to an email, Shabnam Chopra, in-charge of quality assurance at Parag, claimed the company has not reported any case of antibiotic residue.

“We have upgraded our major dairy laboratories. These laboratories have been provided with antibiotic test-ing kits. Testing is done route-wise for incoming milk. Once in six months we get our milk and milk products checked for nutritional values, pathogens, antibiotic resi-dues and veterinary drug residues. Qualitative testing is used for antibiotics testing,” she wrote. 

Similarly, T Thirupathappa, who is the additional director of quality assurance at Karnataka Milk Federation, that markets milk under the brand name Nandini, told CSE, “Milk is tested for antibiotics once in six months. Testing is done at nabl-accredited lab as per ISO standards.” Similar frequency of testing was cited by officials at milk federations in Rajasthan, Punjab and Haryana which sell brands Saras, Verka and Vita respectively.

“Testing of antibiotics in milk which gets pooled cannot be done with the lab infrastructure that we have,” says representative of Gwalior Sahakari Dugdha Sangh who did not wish to be named. The body is affliliated to Madhya Pradesh State Cooperative Dairy Federation Ltd, that sells milk under the brand name Sanchi. “Testing requires high-end equipment from certified labs,” he said.

Some cooperatives, however, said they conduct frequent testing. Gujarat Cooperative Milk Marketing Federation Limited, which sells India’s largest and most popular brand, Amul, is an example.

“Milk from all tankers is tested for antibiotic residues on a daily basis though fssai recommends less frequent testing. A kit-based quantitative method is used to test about 700 samples each day at a rate Rs 1,000 per sample,” says Sameer Saxena, senior manager, quality assurance, Amul. It procures about 23 million litres of milk every day.

“No antibiotic is found in samples taken from tankers as milk gets pooled from multiple societies,” he said. However, when cse asked Amul to share the test reports, the company did not respond.

The Malabar Regional Coope-rative Milk Producers’ Union (MRCMPU), which operates under Kerala Cooperative Milk Marketing Federation, claimed to perform tests at three levels — daily from tanker samples, once in two months at society level, and also at individual farmer level for root cause investigation.

When asked what is done in case antibiotics are detected in tested samples, James KC, senior manager at MRCMPU, said: “We have a traceability mechanism in place to trace the farmer.”

“Our workers in villages know the probable source of contami-nation. If found guilty, the provider is warned. If he repeats, he is removed from the list of registered farmers,” says an official from plant operations division at Sanchi, indicating that tests are done only when doubts are raised. 

CSE also reached out to other leading brands like Mother Dairy and private brands such as Nestle and Gopaljee. Nestle claimed milk processessed and sold by them is tested by both qualitative and quantitative methods at nabl-accredited labs.

When lab test reports were requested, the representative called to say the company does not share them. Mother Dairy and Gopaljee did not respond at all. 

FSSAI has recently approved three kits for antibiotic detection and released Scheme of Testing and Inspection (STI) of milk for dairy processing. As per STI, antibiotics and veterinary drug residues will be monitored at two inspection points. But the frequency of inspection is quarterly, too low to check malpractices. 

How this affects us 

The biggest problem in the Indian dairy sector is that there are no standard treatment guidelines for livestock diseases. Veterinarians, therefore, cannot refer to a standard document and prescribe antibiotics. 

Farmers indiscriminately use  on animals antibiotics that are crucial for humans. According to the World Health Organization, critically important antimicrobials (CIAS) are the limited therapies to treat human infections caused by bacteria from non-human sources, of which some are categorised as highest priority critically important antimicrobials (HPCIAS).

Dairy farmers indiscriminately inject into cattle antibiotics that are critical for humans

* The Department of Animal Husbandry Farmers Manual recommends these for treatment of mastitis. Penicillin is also recommended for treatment of anthrax and black quater, and streptomycin for bovine tuberculosis 
^ While ceftiofur and enrofloxacin are used in animals, they could lead to development of cross-resistance in bacteria to other antibiotics belonging to the same class, which are otherwise critically important for use in humans
* The Department of Animal Husbandry Farmers Manual recommends these for treatment of mastitis.
Penicillin is also recommended for treatment of anthrax and black quater, and streptomycin for bovine tuberculosis

^ While ceftiofur and enrofloxacin are used in animals, they could lead to development of cross-resistance in bacteria to other antibiotics belonging to the same class, which are otherwise critically important for use in humans 

In India, bacterial resistance to third-generation cephalosporins is already high with Escherichia coli and Klebsiella pneumoniae showing more than 75 per cent resistance. Both these bacteria cause several common infections.

2018 data with National Centre for Disease Control’s National AMR Surveillance Network shows 86-93 per cent resistance of E coli to ampicillin and 82-87 per cent to cefotaxime. Similarly, resistance of K pneumoniae to cefotaxime was 81-89 per cent.

A study published in Scientific Reports in 2019 reported high levels of resistance in commensal E coli in a cohort of 125 children between one and three years in a rural area of Madhya Pradesh. Highest resistance was observed for ampicillin while for each child, more than 90 per cent resistance to cephalosporins was observed. 

It is disturbing how antibiotics are being passed on to environment. About 70 per cent of the antibiotics given to animals are excreted unmetabolised. As cow and buffalo dung are used as manure in agricultural farms, it can make soil bacteria resistant and environment a reservoir of antimicrobial resistance (AMR)-causing determinants.

Other than food, human exposure to resistant bacteria through direct handling of dairy animal waste or through environmental route can lead to drug-resistant infections. 

The way out

India’s bovine population is almost 300 million. Obviously, the scale of CIA use is gigantic. A well-defined roadmap to limit misuse of cia, and no use of HPCIA, is critical to reduce the huge burden of antibiotic resistance. DAHD should develop standard treatment guidelines to reduce the misuse of antibiotics.

The outreach of veterinary extension system should be strengthened. DAHD must also expand the vaccine coverage for diseases through its programmes. It should run awareness campaigns for farmers so that they follow withdrawal period before selling milk. Good farm management and hygiene should be promoted to prevent mastitis.

It is time the FSSAI set tolerance limits for antibiotics such as amoxicillin, ceftriaxone and gentamicin, which are used in dairy animals, and not listed by FSSAI. Antibiotics with no tolerance limits should not be allowed for use in them.

The regulator should help state food and drug administrations to strengthen routine antibiotic monitoring in milk and make the data public. fssai must also increase the frequency of testing milk as per STI and support states on its implementation. 

The Central Drugs Standard Control Organisation must regulate over-the-counter sale of antibiotics. It should work with state drug officials to ensure that no antibiotic is sold without prescription. 

The Indian Council of Agricultural Research should also develop low-cost diagnostics for early disease diagnosis and antibiotic residue monitoring at all levels be it farm, veterinary healthcare setting or milk collection centre. Considering the linkages of environmental spread of AMR with dairy farm waste, the Central Pollution Control Board, along with the state pollution control boards, should ensure that its guidelines for Environmental Management of Dairy Farms and Gaushalas are followed.

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