Colistin is commonly mixed in chicken’s drinking water

The Ministry of Agriculture (MoA) of Indonesia through the Directorate General of Livestock and Animal Health Services (DGLAHS) issued regulation No 09160/PK.350/F/12/2019 on December 13, 2019 to prohibit the use of the antibiotic colistin (also known as polymyxin E) in animals. This is a very important step to reduce the occurrence of antimicrobial resistance (AMR).

The World Health Organization (WHO) has developed and launched a tool to help global, regional and national decision-making on which antibiotics to use and when. The tool indexes the most effective antibiotics into three groups – ACCESS, WATCH, RESERVE (AWaRe for short). Evidence shows that to optimize use of antibiotics and reduce resistance, countries should increase the proportion of ACCESS antibiotics to correspond to at least 60% of total national consumption. The “Access” group is the first choice for the healthcare system; the “Watch” group may be used for the most common and severe infections; and the “Reserve” group should only be used as the last resort when other antibiotic groups fail to control a bacterial infection. Colistin is listed as an antibiotic of last-resort.

Despite this, the results of a 2017-18 survey of 877 boiler farmers in Lampung, West Java, Central Java, East Java, South Sulawesi and West Kalimantan provinces, conducted by MoA and the Food and Agriculture Organization (FAO) of the United Nations, indicate that many poultry farmers still use colistin, not only for therapeutic treatment of flocks but also for disease prevention. These survey results have been used to make policy recommendations to the MoA related to antimicrobial usage (AMU) in the livestock sector, including the overuse of antibiotics in animals.

This is a “soft” announcement that the government of Indonesia will ban the use of colistin in the livestock sector in July 2020. In the future, no one will be permitted to produce and trade colistin in the veterinary medicines market,” said drh. Fadjar Sumping Tjatur Rasa, Director of Animal Health at the Ministry of Agriculture, in Jakarta, on 13 December 2019.

Meanwhile, the Head of the Sub-Directorate of Veterinary Medicine Control, DGLAHS-MoA Ni Made Ria Isriyanthi stated that this decision had been extensively discussed with stakeholders on 5 December 2019. Meeting participants discussed and evaluated Minister of Agriculture Regulation No. 14/2017 regarding the classification of animal medicines. The meeting participants represented the MoA, Ministry of Health (MoH), the Veterinary Medicines Commission, the DGLAHS Animal Health Experts Commission, FAO, WHO, the Indonesian Association of Veterinary Medicine Producers (ASOHI), and the Indonesian Feed Mills Association (GPMT).

Dr Ria informed the meeting that the Government plan to gradually ban the use of colistin on farms had been supported by FAO. She presented examples of countries that had previously banned or restricted the use of colistin on farms such as the European Union, the United States, Brazil, India, Malaysia, and China.

James McGrane, Team Leader of the FAO Emergency Centre for Transboundary Animal Disease (ECTAD) strongly supports the DGLAHS efforts to reduce colistin use and said that this is an important decision. FAO, with funding from USAID, continues to support the government in implementing AMU regulations to reduce the global threat of AMR to human and animal health. A similar opinion was conveyed by Benyamin Sihombing (WHO) who stressed that this decision will increase Indonesia’s standing worldwide as a country fully committed to controlling AMR.

The MoH, representing the human health sector expressed their appreciation to the MoA in addressing the AMR threat by controlling the use of antimicrobials in the livestock sector. “In human health, colistin is only used if laboratory test results indicate that a patient needs this antibiotic as medication and its prescription needs special permission”, said Dr. Anis Karuniawati, of the MoH Antimicrobial Resistance Control Committee (KPRA).

Responding to the plan to ban colistin in 2020, ASOHI and GPMT stated that they would be willing to comply with the regulation once established. “We will support all regulations coming from the Government. However, we ask for a “grace” or transition period to manage antimicrobial products containing colistin that are already circulating in the market,” said drh. Irawati Fari, Chairman of ASOHI.