Big Players like Mcdonald’s and Burger King received an F, while Shake Shack and BurgerFi each got an A.

A new report stamps most Burger chains in the United States a failing grade when it comes to their use of Beef produced with Antibiotics. Antibiotic overuse in livestock production is a massive public health problem because it can lead to the growth of antibiotic-resistant bacteria (“superbugs”) and antibiotic-resistant infections in people from contaminated meat. Antibiotics have been added to cattle feed and water to speed growth, prevent disease, and treat active infections.

The data, gathered by a number of organizations — U.S. PIRG Education Fund, Center for Food Safety, Consumer Reports, Natural Resources Defense Council, and Friends of the Earth — surveyed 25 burger chains via mail and email. This survey included questions about their antibiotic-use policy, how such policies are being implemented, and transparency (such as if they used a third-party audit to verify compliance). Seven chains responded. For those who didn’t voluntarily supply the information, the organizations carried out their own research using information from company websites, annual reports, and other public data.

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Which Burger Chains Failed and Which Passed?

Amongst the 25 chains, 23 earned F ratings, including McDonald’s, Burger King, Sonic, Whataburger, Culver’s, Five Guys, In-N-Out Burger, and Smashburger. They flunked “for lacking any announced policy to source beef raised without the routine use of antibiotics,” per the report.

Wendy’s fared slightly better than the rest, awarded a D-. The authors of the report say the home of the Frosty got a bump because it sources 15 percent of its beef from producers who cut the use of the antibiotic tylosin by 20 percent. Tylosin is particularly important, notes the report. In beef livestock, it treats liver abscesses that occur from grain feeding; in humans, this antibiotic is an important treatment for serious foodborne illness.

It was not all bad news. As Shake Shack and BurgerFi earned A ratings because they use beef raised without any antibiotics. Some smaller chains received honorable mentions for favorable antibiotic supplier practices (though they weren’t surveyed). Those include Epic Burger, Burger Lounge, and Elevation Burger.

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Why Fast Food Restaurants Are Changing How They Use Antibiotics in Beef

As the report mentions, fast food companies are important buyers of beef, meaning they can influence suppliers’ use of antibiotics. The goal, the authors outline, is for these companies to buy beef from producers who follow the 2017 World Health Organization Guidelines that say “medically important antibiotics should not be used unless animals are sick” and should not be used “for growth promotion and/or outline disease prevention purposes.”

“Medically important” antibiotics are those that are used in humans to treat disease. In 2016, McDonald’s announced that the chicken served in its U.S. restaurants was free of these medically important antibiotics. This new report could push them to do the same with beef. “As McDonald’s did with chicken, theirs and other quick-serve restaurants will need to see how they can meet consumer demand for cleaner foods — beef in particular, in this case,” says the New York City–based nutritionist Bonnie Taub-Dix, RDN, the creator of BetterThanDieting.com and author of Read It Before You Eat It: Taking You From Label to Table. 

In January 2017, the Food and Drug Administration enacted guidelines to curtail the use of medically important antibiotics in the feed of animals. Suppliers can no longer use antibiotics for animal growth; any antibiotics given have to be supervised by a licensed veterinarian who has decided an animal needs it for a medical reason, says Amy Knoblock-Hahn, PhD, MPH, RDN, of Whole Food Is Medicine in St. Louis. She wrote an August 2016 paper in the Journal of the Academy of Nutrition and Dietetics that notes these government guidelines “are a first step toward decreasing unnecessary administration of medically important antibiotics in animals.”

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The burger chain report highlights a key problem: These antibiotics are still being misused for routine disease prevention — just now under vet guidance.

While the threat of antibiotic-resistant bacteria is real, one common misconception is that your meat is filled with antibiotics. As Dr. Knoblock-Hahn says, “There are strict requirements regarding animal slaughter after medical administration of antibiotics. Animals are not allowed to be slaughtered for food until antibiotics have completely left the animal’s system. This helps ensure there are no antibiotic residues consumed by humans,” she says. In short: There’s no trace of antibiotic residue in your meat when you eat it.

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How to Limit or Avoid Exposing Yourself to Antibiotics in Beef

If you regularly eat beef, it can be tough to dodge the antibiotics issue. First, “there’s no formal approved definition of antibiotic-free,” Knoblock-Hahn says. The only way to ensure the meat hasn’t been raised with antibiotics is to choose organic, she says. (Should an animal on an organic farm need to be treated with antibiotics, it can no longer be labeled organic in the store.) You can also look for meat labeled “no antibiotics.” According to the FDA, producers must provide documentation that this is the case.

But labels on packages can be confusing, and even when they sound good, they may be misleading. The Environmental Working Group has a handy Label Decoder for meat, which lays out exactly what label lingo means. For instance, in order to receive the American Grassfed Association label, the Food Alliance Certified-Grassfed label, or the Global Animal Partnership label, the meat cannot have been produced using antibiotics.

One change you can make when it comes to meat: Eat less of it. “Increasing plant-based foods and decreasing animal-based foods is a nutrition behavior change everyone can benefit from,” Knoblock-Hahn says. “You don’t have to be 100 percent meat-free, but think of meat as a condiment used for some flavor rather than the main attraction.”

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