Antibiotics in Food Production – Towards Responsible Antibiotics Use

What can we do to reduce the use of antibiotics in the food industry while slowing down the development of antibiotic-resistant bacteria? And how can we encourage others in the industry to do the same? These were the questions that the Sustainability Manager of Axfood asked when she contacted Axfoundation back in 2013. It was the starting point of several initiatives and collaborations aimed at highlighting and informing on the issue, as well as encouraging actors to take action. The overall goal: To promote a prudent and responsible use of antibiotics in the food industry – in Sweden and internationally.

The Issue

Antibiotic overuse is a widespread problem in food production. There is a clear link between sub-standard animal husbandry and an extensive use of antibiotics. Sweden has shown that it is possible to reduce the use of antibiotics radically while still maintaining production. Compared with many countries, Sweden today has, on average, very low consumption. However, in several countries within the EU and in countries outside the EU, the problem is widespread. Antibiotics are in some countries, used not only when the animals are sick, but for preventive purposes to keep the animals healthy in a sub-standard environment. Antibiotics are in many cases also used purely for growth promotion purposes, a procedure that was banned in Sweden in 1986, and within the EU in 2006.

One of the biggest threats to global health

The more antibiotics that are used, the greater the risk is that the bacteria will develop resistance, resilience and immunity to the drug. The medicine simply does not work anymore. This leads to an increased spread of resistant bacteria, between humans, between animals, and between animals and humans, creating a global health issue. Both the World Health Organization (WHO) and the Public Health Agency of Swedish state that antibiotic resistance is one of the biggest threats to global health. Currently, at least 1.2 million people die each year due to diseases related to drug-resistant bacteria. In 2050, the number is estimated to increase dramatically to 10 million people if actions are not taken to counteract the development.

Did you know…

Misunderstandings often arise when it comes to antibiotics in food production. This can involve everything from traces of drugs in food to crop cultivation. Here are four things that are good to know.

Antimicrobial resistance (AMR) and antibiotic resistance: Antimicrobial resistance (AMR) is a collective term for the ability of microorganisms (such as bacteria, viruses, or parasites) to resist treatment with drugs, pesticides, and more. Antibiotic resistance is included in the collective term AMR.

The antibiotic residues in food are so small that they are not a health risk for humans: Within the EU, there are strict rules regarding the allowed amount of antibiotic residues in food. The rules also state that animals treated with antibiotics, for example, cannot be slaughtered immediately.

The risk of humans getting infected with antibiotic-resistant bacteria through food is considered low: Instead, there is a greater risk that farmers get directly infected by their own animals and then spread the resistant bacteria to other people. The spread of resistant bacteria occurs between animals, between humans, and between humans and animals.

Antibiotics are also used in crop cultivation: This primarily occurs in fruit cultivation to protect trees from bacterial diseases. The use is still relatively small compared to the livestock sector, but it means that antibiotics are applied directly to the external environment.

Our Solution

To reverse the trend of increased antibiotic resistance, increased responsibility needs to be taken in all sectors that use antibiotics. As the largest use of antibiotics today is in animal husbandry, all actors in the food chain have a responsibility to minimize the spread of antibiotic resistance. Effective efforts that reach all levels require collaboration. Therefore, Axfoundation, together with companies, academia, authorities and industry associations, and civil society organizations, has in several initiatives worked to highlight the issue and encourage more actors to take action.

All actors in the food chain have a responsibility to minimize the spread of antibiotic resistance in animal husbandry. Photo: iStock

All actors in the food chain have a responsibility to minimize the spread of antibiotic resistance in animal husbandry. Photo: iStock

Our Work

Since the start in 2013, Axfoundation has been driving change through a series of practical initiatives related to responsible antibiotic use in food production.

The Antibiotic Criteria

The Antibiotic Criteria is a tool for the food industry to set and follow up on requirements from suppliers of meat, dairy products, and seafood regarding antibiotic use and animal welfare. There are 8 criteria in the Antibiotic Criteria list, addressing both direct antibiotic use and preventive interventions that can lead to reduced antibiotic use. For each criterion, there are associated questions to use for supplier dialogue and follow-ups.

Criteria for reduced, direct antibiotic use

  1. Antibiotics must not be used for growth promotion purposes.
  2. Antibiotics must only be used following the prescription by the veterinarian and must be approved for use in animal livestock in accordance with Codex.
  3. There must be detailed documentation of all the use of antibiotics, including via feed and water. The responsible veterinarian must regularly review and sign the documentation. Data on the use of antibiotics should be available on request from the actors in the supply chain.
  4. If recurrent antibiotics are used for all, or the majority of, an age-specific category of animals, the reasons for this must be documented, an investigation must be carried out by a veterinarian and an action program to counteract the health problems must be developed and applied. The goal is to phase out recurring use.
  5. Colistin, fluoroquinolones and third- or fourth-generation cephalosporins – antibiotics that are particularly important for human care, must only be used when a veterinarian deems that no other treatment options are effective.
  6. Criteria for preventive, indirect interventions that can lead to reduced antibiotic use

  7. For active work with reduced antibiotic use in the herd/facility, a plan with routines for preventive health care and reduced spread of infection must exist and be followed. The plan shall focus on strategic preventive animal health management, including infection control and animal welfare (see full document for what the plan must include).
  8. Animals must not be mutilated because of inadequate animal husbandry.
  9. Animals must be kept in a way that gives them space to move freely and be able to rest in a way that is suitable for them.

Download the Antibiotic Criteria 2.0 and associated questionnaire


actors and key experts were involved in developing the criteria 2.0 as it launched in 2020.


strengthened criteria are the result of the broad collaboration.


companies within retail and food service use the Antibiotic Criteria v.1.0. Axfoundation is now aiming for even more actors to adopt version 2.0.

Animals must be kept in a way that gives them space to move freely and be able to rest in a way that is suitable for them. Photo: iStock

Animals must be kept in a way that gives them space to move freely and be able to rest in a way that is suitable for them. Photo: iStock

The Antibiotic Platform – From Farm to Fork

A collaboration between The Royal Swedish Academy of Agriculture and Forestry (KSLA) and Axfoundation where stakeholders across sectors join forces to accelerate efforts against antibiotic resistance.

Learn more

Updates on Antibiotics (in Swedish)

Axfoundation sends out a bi-weekly update on antibiotics, trade, and animal husbandry, with the latest news and events curated by veterinarian and antibiotic expert Jenny Lundström.

Read more and subscribe


The work that Axfoundation has carried out during several years has inspired several other important initiatives to decrease the use of antibiotics.

  • New procurement criteria for responsible use of antimicrobial agents in food production: The network Health Care Without Harm – Europe, with thousands of hospitals and other healthcare facilities as members, has developed a set of procurement criteria to encourage responsible use of antimicrobial agents in food production and thereby contribute to reduced resistance development. The procurement criteria can be adapted to the needs of individual healthcare institutions. Based on many years of experience in working on the antibiotic issue, particularly through the development of antibiotic criteria for retail and food service, Axfoundation has been involved in and supported HCWH in their development efforts.
  • Web-based training in partnership with the Swedish University of Agricultural Sciences: Axfoundation has supported the development of the Swedish University of Agricultural Sciences’s free Massive Open Online Course (MOOC ) on effective livestock production with low use of antibiotics. The training is primarily aimed at livestock keepers and professionals working in the livestock production sector in low-income countries and emerging economies.
  • The Antibiotic Platform – from farm to fork: The platform is an initiative of Axfoundation and the Royal Swedish Academy of Agriculture and Forestry. The aim of the platform is to gather a wide range of actors across sectors, to quicken the pace of work against Antimicrobial Resistance (AMR) and antibiotic resistance, in Sweden, but also internationally. Within the framework of the ‘One-Health’ perspective, the platform focuses on the use of antibiotics in animal production.
  • Antibiotics within the EU: Åsa Domeij, sustainability manager at Axfood, the antibiotic expert Christina Greko at the National Veterinary Institute, Örjan Brinkman, chairman of the European Consumer Organisation (BEUC), Carolina Sachs Axfoundation’s secretary general at the time, and Mattias Espert, pig farmer and vice chairman of Grisföretagarna (The association of Swedish Pig Farmers) and others were present when the antibiotic issue was raised at a seminar in the European Parliament in September 2016. The seminar was arranged in collaboration with Alde, Alliance for Liberals and Democrats European Group and Fredrik Federley from the Centre Party.
  • EAT Initiative: Axfoundation has together with EAT Initiative carried out several seminars and talks focused on antibiotic resistance and food within the framework of Stockholm Food Forum.
  • ReAct: The criteria have inspired the expert organization ReAct, who conducts global advocacy regarding antibiotic resistance. ReAct has developed a toolbox for people and Axfoundation has contributed to a further development of the Toolbox so that it now also includes animal welfare, environment and agriculture. The WHO has endorsed ReAct’s Toolbox, and it is used across the globe by people working to address antibiotic resistance.
  • Köttguiden (The Meat Guide): Axfoundation’s Antibiotic Criteria form the basis for the selection criteria in WWF’s guide for consumers.
The spread of resistant bacteria occurs between animals, between humans, and between humans and animals. Photo: iStock

The spread of resistant bacteria occurs between animals, between humans, and between humans and animals. Photo: iStock

The Antibiotic Criteria

The first version of the Antibiotic Criteria was developed through an inclusive process during 2013-2014. They were first tested within food retailer Axfood and whole-saler Martin & Servera and then launched widely during 2014. The members of the Swedish Food Retailers Federation – Axfood, Bergendahls, Coop, ICA, Lidl, IKEA Foods and Livsmedelshandlarna – adopted a common policy to decrease the use of antibiotics in food production in 2016. The policy was based on the first four criteria in Axfoundation’s Antibiotic Criteria 1.0, and only applied to the companies’ private labels. Since then, the members of Swedish Food Retailers Federation have also strived to influence their suppliers of other brands to follow these criteria.

During 2019-2020, Axfoundation updated the Antibiotic Criteria to adapt to new legislation, changes in consumer behavior and, to further encourage a positive development in animal food production. During the course of the process, companies, academia, authorities and industry associations and civil society organizations collaborated to find common ground on the issue. This process also led to the Swedish Food Retailers Federation adopting a new common policy in 2020, based on the first 6 of the 8 updated criteria.

The Antibiotic Criteria 2.0

Axfoundation’s criteria 2.0 go beyond legislation and were strengthened in, primarily, four key areas:

  • Limiting the use of antibiotics especially important for human health care.
  • Clarified animal welfare criteria regarding animals in cages and mutilation of animals. The list has also been developed with criteria relating to routines for preventive animal welfare work.
  • Improved questionnaire that companies can use in dialogue with their suppliers, including clearer recommendations for follow-up.
  • Seafood is now included and both the criteria and the questionnaire are adapted.

Today, Axfoundation works to spread the Antibiotic Criteria 2.0 among Swedish food retailers and food service, to national and international bodies and to authorities to achieve transformative change.

Download the Antibiotic Criteria 2.0 and associated questionnaire

Recognized Efforts

In 2021, Axfoundation’s Antibiotic Criteria 2.0 for reduced antibiotic use in food production was awarded Venture of the Year (Årets Insats) by the Sustainable Brand Index, Europe’s largest independent brand study focused on sustainability. An important ingredient, according to the jury, was the broad industry collaboration that led to the voluntary list of criteria for antibiotics and animal husbandry that food companies can set for suppliers when purchasing meat, dairy products and seafood.

In June 2021, Axfoundation, through its work with the Antibiotic Criteria 2.0, was selected from more than 500 nominees to participate in the Food Systems Game Changers Lab and Solutions Accelerator program. The jury examined the nominated solutions based on potential impact, feasibility, sustainability and transformative capacity. Food Systems Game Changers Lab is designed by EAT, Thought for Food, the Rockefeller Foundation and other partners that support the UN Food Systems Summit 2021.


The Antibiotic Criteria 2.0 was developed by Axfoundation in collaboration with a group of experts comprising Max Troell from the Beijer Institute / Stockholm Resilience Center, Jenny Lundström from Friska Djur (Healthy Animals) and Frida Lundmark-Hedman from the Swedish University of Agricultural Sciences. In addition, a broad reference group actively participated in the development, with representatives from the food industry, civil society, academia and government; Axfood, Coop, Findus, Gård & Djurhälsan, ICA, Lidl, The Swedish Food Federation, The Federation of Swedish Farmers (LRF), Martin & Servera, SIWI, The National Veterinary Institute, (SVA), Swedish Food Retailers Federation, The National Agency for Public Procurement, Vi Konsumenter), World Animal Protection, WWF in Sweden.

The Antibiotic Platform is jointly operated by Axfoundation and KSLA. Both organizations contribute based on their respective missions, utilizing their capacity and expertise. We warmly welcome all interested parties to participate in the platform’s activities.

Updates on Antibiotics is a collaboration between Axfoundation and veterinarian and antibiotic expert Jenny Lundström. Every other week, she sends out a curated overview of the latest news in antibiotics, animal welfare, and trade (currently in Swedish).


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