Antibiotics are powerful tools for fighting and preventing infections in human and animal health. However, widespread overuse of antibiotics has resulted in an alarming increase in antibiotic-resistant infections. The Centers for Disease Control and Prevention calls antibiotic resistance one of our most serious health threats that causes at least 2 million illnesses in Americans each year, with 23,000 deaths. “Antibiotic stewardship” is the process of improving how antibiotics are used.
How do antibiotics enter the environment?
Most antibiotics used to treat infections caused by bacteria or other pharmaceuticals enter our natural environment after use in human and animal health. For example, when:
- A person or animal is given an antibiotic, not all of the medication is used up inside the body. Some antibiotic, either in its original form or slightly changed, is released in urine and/or stool.
- Unused antibiotics are thrown into landfills or flushed down drains or toilets.
- Antibiotics in manure and other waste-based fertilizers run off crop and grazing fields into waterways.
- Antibiotic-containing waste from our pets ends up in landfills and in neighborhood sewer runoff.
- Antibiotics applied to fruit trees as treatment for bacterial infections run off fields runoff into waterways.
- Some industrial processes, like ethanol production, generate antibiotic-containing waste products that might contribute to environmental contamination.
How can environmental antibiotics contribute to resistance?
This is what we know.
- In any setting (natural, hospital, or within our bodies), bacteria in the presence of an antibiotic will try to change to survive. These changes can lead to antibiotic resistance — the ability of bacteria to withstand antibiotic effects.
- Bacteria can also pass on the ability to resist antibiotic effects by sharing the genetic instructions (resistance genes) with other bacteria in water and soil.
This is what we need to learn.
- Do antibiotics, antibiotic-resistant bacteria, and resistance genes in the environment put people and animals directly at risk for resistant infections?
- Do environmental sources of antibiotics, resistant bacteria, and resistance genes make the fight against antibiotic resistance more difficult?
Antibiotics and resistance genes in Minnesota environments
- The Minnesota Pollution Control Agency (MPCA) and University of Minnesota researchers have detected antibiotics commonly used in healthcare and animal health at low levels in lakes, rivers, and streams throughout Minnesota, and the U.S. Geological Survey has found antibiotics in groundwater in non-agricultural and urban areas. 1–6 Groundwater is used for drinking by many people, especially in rural areas
In Minnesota, antibiotics are present in our water at levels below those considered concerning for human health. (Minnesota Department of Health. 2015. Pharmaceutical Water Screening Values Rpt. http://www.health.state.mn.us/divs/eh/risk/guidance/dwec/pharmwaterrept.pdf)
University of Minnesota researchers have developed methods to measure antibiotic resistance genes in the environment. Work is ongoing to understand the diversity, source, and impact of these genes on health and the resistance problem.
What you can do to keep antibiotics out of our water
- Decrease the need for antibiotics by avoiding infections. Wash your hands properly, cover your cough, and get recommended vaccines.
- Do not ask for antibiotics if your healthcare provider, dentist, or veterinarian thinks they are unnecessary.
- When you are prescribed antibiotics, take them exactly as directed.
- Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Antibiotics treat specific infections. Taking the wrong medicine might make things worse.
- Do not save antibiotics for your next illness. Properly dispose of any leftover medication once the prescribed course of treatment is completed. Information on proper disposal of medication can be found at the MPCA's Managing unwanted medications webpage.
About the Minnesota One Health Antibiotic Stewardship collaborative
A “One Health” approach recognizes connection among the health of humans, animals, and the environment. The Minnesota One Health Antibiotic Stewardship Strategic Plan was launched in July 2016. Since that time, progress to meet strategic plan goals has been made by the One Health Antibiotic Stewardship Collaborative, working under the vision statement, “Minnesota leaders in human, animal, and environmental health will work together to raise awareness and change behaviors to preserve antibiotics and treat infections effectively.”
Find out more at www.health.state.mn.us/onehealthabx
More information about the studies
- Minnesota Pollution Control Agency (MPCA). 2017. Pharmaceuticals and Chemicals of Concern in Rivers: Occurrence and Biological Effects. https://www.pca.state.mn.us/sites/default/files/tdr-g1-20.pdf
- Minnesota Pollution Control Agency (MPCA). 2015. Pharmaceuticals, Personal Care Products, and Endocrine Active Chemical Monitoring in Lakes and Rivers: 2013. https://www.pca.state.mn.us/sites/default/files/tdr-g1-18.pdf
- Minnesota Pollution Control Agency (MPCA). 2013. Pharmaceuticals and Personal Care Products in Minnesota’s Rivers and Streams: 2010. https://www.pca.state.mn.us/sites/default/files/tdr-g1-17.pdf
- Elliott et al. 2014. Pharmaceutical Compounds in Shallow Groundwater in Non-Agricultural Areas of Minnesota – Study Design, Methods, and Data. U.S. Geological Survey Data Series 878. https://pubs.usgs.gov/ds/0878/pdf/ds878.pdf
- Erickson et al. 2014. Contaminants of emerging concern in ambient groundwater in urbanized areas of Minnesota 2009-12. U.S. Geological Survey Scientific Investigations Report 2014–5096. https://pubs.usgs.gov/sir/2014/5096/pdf/sir2014-5096.pdf
- Sedimentary record of antibiotic accumulation in Minnesota Lakes. Science of the Total Environment
- Minnesota Department of Health. 2015. Pharmaceutical Water Screening Values Report. http://www.health.state.mn.us/divs/eh/risk/guidance/dwec/pharmwaterrept.pdf