Chain Reaction VI

The Chain Reaction VI report and scorecard ranks America’s top restaurant chains on their policies relating to antibiotic use in their beef supply chains. The overuse of antibiotics on industrial farms contributes to antibiotic-resistant bacteria, which can cause life-threatening infections in people. We need our life-saving medicines to work, and because fast food companies are some of the largest buyers of meat, they are uniquely positioned to address this public health crisis.

How top restaurants rate on reducing antibiotic use in their beef supply chains


The growth and spread of antibiotic-resistant bacteria is a global health crisis, threatening to create a future in which common infections could once again become life-threatening on a large scale. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) consider antibiotic-resistant bacteria among the top threats to global public health, and the CDC estimates that each year, at least 35,000 Americans die from resistant infections.[1] Another estimate suggests it could be seven times as many, accounting for more than 160,000 annual deaths.[2]

The overuse of antibiotics in livestock production significantly contributes to the spread of antibiotic resistant bacteria.[3] The more antibiotics are used, the more opportunities resistant bacteria have to multiply and spread. Approximately two-thirds of the medically-important antibiotics sold in the United States go to food animals.[4],[5],[6] Many meat producers routinely give the drugs to animals that are not sick to prevent diseases caused by factory farm production practices.[7] Despite the threat posed to public health, the U.S. lacks effective laws and policies to prevent the overuse of antibiotics in agriculture.

Fast food restaurants, as some of America’s largest meat buyers, can play an instrumental role in pushing meat producers to use antibiotics responsibly. In fact, previous editions of Chain Reaction have documented how the nation’s top restaurant chains have stepped up their commitments to source chicken from producers that raise animals without the routine use of antibiotics.[8] These corporate actions have helped move the chicken industry toward more responsible antibiotic use practices. According to an industry survey, almost all of U.S. broiler chickens in 2020 were raised without the routine use of medically important antibiotics as defined by the Food and Drug Administration.[9]

[1] U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC from here on), Antibiotic Resistance Threats in the United States, 2013,
[2] Journal of Infection Control and Hospital Epidemiology, New Estimate of Annual Deaths Caused by Treatment Resistant Infections Highlights Gaps in Research, Stewardship, Surveillance3 December 2018,–publications-new/articles/2018/new-estimate-of-annual-deaths-caused-by-treatment-resistant-infections-highlights-gaps-in-research-stewardship-surveillance/
[3] World Health Organization, World Health Organization (WHO) Guidelines on Use of Medically Important Antimicrobials in Food-producing Animals, 17January 2018,; CDC, Antibiotic Resistance from the Farm to the Table (infographic), 2013,
[4] U.S. Food and Drug Administration (hereinafter FDA), Center for Veterinary Medicine, 2016 Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals, December 2017, Data on 2015 sales of antibiotics for human medicine in the United States were obtained from Eili Klein of the Center for Disease Dynamics, Economics & Policy (CCDEP). Klein also provided data for years prior to 2015 in Kar, A., and Klein, E. “Animal Antibiotic Sales Finally Drop, but Much Work Remains,” Natural Resources Defense Council (hereinafter NRDC), December 2017, CDDEP also provided those figures for years preceding 2015; 2016 data are not yet available.
[5] Natural Resources Defense Council, Livestock Antibiotic Sales See Big Drop, but Remain High, 18 December 2018,
[6] “Medically-important antibiotics” or “antibiotics important to human medicine” refers to antibiotics that are the same as, or similar to, classes of drugs used in human medicine. For example, the antibiotic tylosin, used in livestock, is a member of the medically-important macrolide class of antibiotics. Throughout this report, we will use the term “antibiotics” and “medically-important” antibiotics interchangeably, unless otherwise noted.
[7] Timothy F. Landers et al. “A Review of Antibiotic Use in Food Animals: Perspective, Policy, and Potential,” U.S. National Library of Medicine National Institutes of Health ,127(1): 4–22, Jan-Feb 2012,; “prevent disease caused by factory farm production practices” refers to routine antibiotic use ostensibly to prevent disease in healthy animals, rather than safer, non-antibiotic animal management alternatives.
[8] Antibiotics Off the Menu, Scorecards, accessed at, 30 September 2018; Here and throughout, “meat raised without the routine use of antibiotics” refers both to meat raised entirely without antibiotics and meat raised without routine uses of antibiotics on animals that are not sick. Report authors support the use of antibiotics to treat sick animals.
[9] “Poultry Health Today, No-antibiotics-ever production slips, but US producers remain committed to reducing antibiotic use, 14 May 2021,

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