Antimicrobial ratings: the importance of importance

Debate about antimicrobial resistance (AMR) in animals and the impact on humans is often inappropriately focussed on the crude amount of antimicrobials used in animals without deference to issues of ‘intensity of use’, ‘quality of use’ and especially the class of agents being administered. In the latter case, tools for helping to manage how the use of specific antimicrobial agents impact on the risk and consequences of antimicrobial resistance in humans have been available for almost two decades. These consist of antimicrobial ratings systems, which formally define the importance of each individual agent in human health by assigning them to a position on a graduated scale of ‘importance’ comprising up to four categories of risk. Until recently, these published ratings have only had a modest impact on antimicrobial stewardship at the frontline of medical and veterinary practice, although they will undoubtedly have a substantial influence into the future. This article considers the evolution of the available ‘antimicrobial ratings systems’ applicable to Australian and international settings and their pivotal future‐role in the educating of animal managers, policy makers and prescribers. Faithful application of these rating systems at all levels of decision making to do with antimicrobial use is now seen as central to the protection of animals, humans and economies from the scourge of AMR.     

Short history of regulations and approved indications of antimicrobial drugs for food animals in the USA

We review historical availability and regulation, and recent indications of antimicrobial drugs for food animals in the USA. We summarize the timeline of introduction of individual antimicrobial drug classes from the 1930s to present, history of regulation of antimicrobial drugs from the 1930s to present and indications of antimicrobial drugs in 1996–2014 for food animals in the USA. The history of antimicrobial drug regulation demonstrates a historical precedent for harmonized regulations of antimicrobials ‘for human and other animals’ in the USA.     

Use and abuse of pyrethrins and synthetic pyrethroids in veterinary medicine

Pyrethrin and pyrethroid insecticides are widely used in veterinary medicine for agricultural and domestic purposes. Although pyrethrins and pyrethroids are generally regarded as safe to animals, there have been reports of systemic poisoning in veterinary species. This review summarises the use of pyrethrins and pyrethroids in companion and food producing animals, including their mechanism of action and toxicity. The toxicokinetics of pyrethrins and pyrethroids are described, including absorption, distribution, metabolism (including interactions with other compounds affecting drug metabolising enzymes) and excretion, leading to the application of toxicokinetic/toxicodynamic concepts. Specific cases of pyrethroid poisoning in laboratory animals (including age-related toxicity), fish, companion and large animals are considered, including the high incidence of feline pyrethroids toxicosis following the extra-label use of topical formulations.     

Conduct,Oversight, and Ethical Considerations of Clinical Trials in Companion Animals with Cancer: Report of a Workshop on Best Practice Recommendations

Development of effective and safe treatments for companion animals with cancer requires the collaboration of numerous animal health professionals and the full engagement of animal owners. Establishing ‘Best Practice Recommendations’ for clinical trials in veterinary oncology represents an important step toward meeting the goal of rigorous clinical trial design and conduct that is required to establish valid evidence. Likewise, optimizing patient welfare and owner education and advocacy is crucial to meet the unique ethical obligations to both owners and animals enrolled in these clinical trials and to ensure trust in the team conducting the research. To date, ‘Best Practice Recommendations’ for clinical trial conduct have not been reported for veterinary oncology. This document summarizes the consensus of a workshop held in November, 2014 to identify relevant ethical principles and to ensure responsible conduct of clinical research in companion animals with cancer. It is intended as a working document that will be updated as advances in science and ethical considerations require. To the extent possible, existing guidelines for the conduct and oversight of clinical trials in humans have been adapted for veterinary trials to avoid duplicative effort and to facilitate integration of clinical trials such that translational research with benefits for both companion animals and humans are encouraged.     

Modern veterinary vaccines and the Shaman's apprentice

This paper is an overview and assessment of new, commercially available veterinary vaccines placed in a historical context. The authors critically evaluate the current state of the field of veterinary vaccines in both food and companion animals and the promises for future vaccine development. The authors maintain that there is considerable variability in safety and sustained efficacy among veterinary vaccines, especially those developed for companion animals. It is proposed that establishment of an international vaccine advisory committee be supported which would function to apprise the veterinary profession of the current status of vaccines and their use.     

Stakeholder position paper: companion animal veterinarian

The total quantity of use in companion animals is generally believed to be relatively small in comparison with antimicrobial use in food animals. Use in companion animals is principally for treatment, whereas the greater proportion of use in food animals is for prophylaxis, metaphylaxis and growth promotion. Therefore, it is important to collect data on end use in companion animals so that overall estimates of use in companion animals can be generated and separated from estimates for food animals. However, data from antimicrobial use in companion animals are extremely limited and no serious attempts to collect such data have ever been made in the United States. The lack of usage data in is concomitant with the dearth of information on antimicrobial resistance in companion animals. Companion animals have been involved in the transmission to humans of, or become infected with, foodborne zoonotic bacteria such as Salmonella and Campylobacter. Companion animals are an integral part of the ecology of antimicrobial resistance through their contact with food animals and exposure to antimicrobials for disease treatment and through contact with humans and the environment. In the practice of companion animal medicine, antimicrobial use data are important for understanding the potential impact on companion animal heath posed by antimicrobial resistance transferred from food animals, humans and the environment, and the threat to humans and other companion animals posed by antimicrobial use in companion animals. Basic information on the patterns and quantities of antimicrobial use in combination with resistance surveillance data, could help companion animal veterinarians understand the potential for development, or evidence of, an antimicrobial resistance problem in their practices, the role of companion animals in the overall epidemiology of antimicrobial resistance, and for comparison with local, regional, or national data. The combination of data from either a sentinel site system of clinics or a use survey with national data from the pharmaceutical industry should provide sufficient data to credibly estimate the total volume and patterns of antimicrobial use in companion animal medicine. The time and effort for use monitoring or to complete a survey would likely become burdensome. Practice management software now utilized at most companion animal clinics could be used to generate antimicrobial use data as well as patient population data as surrogate for the true population at risk for patient encounters in a companion animal practice.     

Demographic survey of private veterinary practices in western Canada

A workforce survey of private veterinary practices in western Canada was conducted in 2020. Data were obtained on 526 practices (response rate = 39.5%) and 1445 individual veterinary practitioners. Overall, 68.4% of practitioners identified as female, with 4 times as many females as males comprising the youngest age cohorts (26 to 35 y) of the profession. The majority of practices (67.9%) were companion animal, followed by mixed animal (21.9%) and food animal (10.2%). Most females (77.2%) and males (57.8%) were engaged in companion animal practice, whereas 23.5% of males and 6.0% of females were food animal practitioners. During an average work week, practitioners devoted 77.4% of practice time to small animals, 15.1% to food animals, and 7.5% to equine animals. A greater proportion of males (75.2%) versus females (63.2%) worked on a full-time equivalent basis (P < 0.001). Whereas males were 1.7 times (95% CI = 1.3 to 2.3; P < 0.001) more likely to be practice owners than females, 54.5% of females were owners. Practice ownership was lower than in previous surveys, a trend that may have long-term implications with respect to the corporatization of the veterinary profession.     

Evaluation of Specific Infection Control Practices Used by Companion Animal Veterinarians in Community Veterinary Practices in Southern Ontario

This study evaluated specific infection control practices in community veterinary practices in southern Ontario. Environmental disinfection, management of infectious patients and antimicrobial use in clean surgical procedures were investigated. Community companion animal veterinary practices (n = 101) in Southern Ontario were recruited, and a questionnaire was administered to one veterinarian and one veterinary technician from each practice. The veterinarian questionnaire gathered data on clinic demographics, management of infectious patients, infectious diseases of concern, environmental disinfection and antimicrobial use in surgical procedures. The veterinary technician questionnaire gathered data on environmental disinfection. None of the veterinary practices had a formal infection control programme. Sixty‐five per cent (n = 66) of the veterinary practices did not have an isolation area and 61% (n = 40) of these practices did not employ any specific infection control measures for infectious cases. The products most frequently used for environmental disinfection were hydrogen peroxide based or quaternary ammonium compounds. Bleach was the agent most commonly used for environmental disinfection of infectious body fluids; however 60% of the veterinarians and 40% of the veterinary technicians did not identify a product for environmental disinfection of infectious body fluids. Twenty‐four per cent of the veterinarians reported using antimicrobials in animals undergoing elective sterilization surgeries and 60% reported using antimicrobials in other clean surgical procedures. There is a need for community veterinary practices to develop infection control programmes specific to their individual practice. In addition, veterinarians should discontinue the common use of antimicrobials for clean elective sterilization surgical procedures.     

Extended-spectrum beta-lactamases-producing gram-negative bacteria in companion animals: action is clearly warranted!

Extended-spectrum beta-lactamases (ESBL)-producing Gram-negative bacteria pose a serious threat to Public Health in human medicine as well as increasingly in the veterinary context worldwide. Several studies reported the transmission of zoonotic multidrug resistant bacteria between food-producing animals and humans, whilst the contribution of companion animals to this scenario is rather unknown. Within the last decades a change in the social role of companion animals has taken place, resulting in a very close contact between owners and their pets. As a consequence, humans may obtain antimicrobial resistant bacteria or the corresponding resistance genes not only from food-producing animals but also via close contact to their pets.This may give rise to bacterial infections with limited therapeutic options and an increased risk of treatment failure. As beta-lactams constitute one of the most important groups of antimicrobial agents in veterinary medicine, retaliatory actions in small animal and equine practices are urgently needed. This review addresses the increasing burden of extended-spectrum beta-lactam resistance among Enterobacteriaceae isolated from companion animals. It should emphasize the urgent need for the implementation of antibiotic stewardship as well as surveillance and monitoring programs of multi resistant bacteria in particular in view of new putative infection cycles between humans and their pets.     

Antimicrobial use in food and companion animals

The vast literature on antimicrobial drug use in animals has expanded considerably recently as the antimicrobial resistance (AMR) crisis in human medicine leads to questions about all usage of antimicrobial drugs, including long-term usage in intensively managed food animals for growth promotion and disease prevention. Attention is also increasingly focusing on antimicrobial use and on bacterial resistance in companion animals, which are in intimate contact with the human population. They may share resistant bacteria with their owners, amplify resistant bacteria acquired from their owners, and act as a reservoir for human infection. Considerable effort is being made to describe the basis of AMR in bacterial pathogens of animals. Documentation of many aspects of use of antimicrobials in animals is, however, generally less developed and only a few countries can describe quantities of drugs used in animals to kg levels annually. In recent years, many national veterinary associations have produced 'prudent use guidelines' to try to improve antimicrobial drug use and decrease resistance, but the impact of guidelines is unknown. Within the evolving global movement for 'antimicrobial stewardship', there is considerable scope to improve many aspects of antimicrobial use in animals, including infection control and reduction of use, with a view to reducing resistance and its spread, and to preserving antimicrobial drugs for the future.     

Antimicrobial stewardship in the dairy industry: responding to the threat of antimicrobial resistance

Dairy Australia is the national service body for the Australian dairy industry. Its role is to help farmers adapt to a changing operating environment and achieve a profitable, sustainable dairy industry. Although the use of antibiotics in Australian agriculture is relatively low in global terms, Dairy Australia recognises important drivers for continuous improvement in antimicrobial stewardship (AMS). Dairy Australia’s first strategic priority is to support profitable farms. This priority has driven the development of a range of on‐farm change management programs in the animal health and welfare fields to optimise the unit cost of production and dairy cattle welfare. Dairy Australia’s third strategic priority is to further develop a ‘trusted dairy industry’. Previous and current work under these two strategies position the dairy industry favourably with respect to confronting the challenge of antimicrobial resistance (AMR) and supporting sound AMS with the guiding principle of ‘as little as possible, as much as necessary’. However, given an incomplete but ongoing threat of AMR, more work is needed. Supported by Dairy Australia, the dairy industry has developed an antimicrobial use strategy aligning with the Australian Animal Sector National AMR Plan 2018.     

Antimicrobial stewardship in equine practice

Antimicrobial stewardship involves the judicious use of antimicrobials balanced against the requirement to treat the presenting clinical condition. The same mandate and principles as discussed in human medicine and other veterinary disciplines are relevant to equine practice. This brief review will focus on available resources for equine practitioners, emerging perspectives on antimicrobial use and stewardship, and opportunities for more effective antimicrobial use in equine practice. There is a need for improved client education, availability of faster and more accurate techniques for identification and sensitivity testing of bacterial pathogens, and the development of novel agents.     

A review of ophthalmic local and regional anesthesia in dogs and cats

Objective

Orbital and globe surgeries are commonly performed in companion animals and are considered to cause moderate to severe pain. Regional anesthesia techniques can provide complete sensory blockade, analgesia for painful procedures and improve surgical conditions. The purpose of this review is to summarize local and regional anesthesia techniques for ophthalmic surgery in dogs and cats with emphasis on veterinary publications in the past 12 years.

Antimicrobial labelling in Australia: a threat to antimicrobial stewardship?

Antimicrobial resistance is a public health emergency, placing veterinary antimicrobial use under growing scrutiny. Antimicrobial stewardship, through appropriate use of antimicrobials, is a response to this threat. The need for antimicrobial stewardship in Australian veterinary practices has had limited investigation. A 2016 survey undertaken to investigate antimicrobial usage patterns by Australian veterinarians found that antimicrobial dose rates were varied and often inappropriate. Doses of procaine penicillin in horses and cattle were often low, with 68% and 90% of respondents, respectively, reporting doses that were unlikely to result in plasma concentrations above minimum inhibitory concentrations for common equine and bovine pathogens. Frequency of penicillin administration was also often inappropriate. Gentamicin doses in horses were largely appropriate (89% of dose rates appropriate), but 9% of respondents reported twice daily dosing. Amoxycillin and amoxycillin‐clavulanate were administered at the appropriate doses, or above, to dogs and cats by 54% and 70% of respondents, respectively. Here, we explore the potential reasons for inappropriate antimicrobial dose regimens and report that antimicrobial labels often recommend incorrect dose rates and thus may be contributing to poor prescribing practices. Changes to legislation are needed to ensure that antimicrobial drug labels are regularly updated to reflect the dose needed to effectively and safely treat common veterinary pathogens. This will be especially true if changes in legislation restrict antimicrobial use by veterinarians to the uses and doses specified on the label, thus hampering the current momentum towards improved antimicrobial stewardship.     

Participatory Policy Making by Dairy Producers to Reduce Anti‐Microbial use on Farms

Pressures for more responsible use of anti‐microbial (AM) medicines in food animals are likely to increase from policymakers and the food industry, including retailers. To address this challenge, participatory approaches to welfare interventions and disease prevention may also be necessary alongside more conventional regulatory measures. This article describes the process of enabling groups of dairy producers to use a participatory policy making approach to develop an AM stewardship policy. The policy includes measures agreed to by all producers for more responsible use of AMs, whilst maintaining or improving dairy herd health and welfare. This process provided a unique opportunity for collaboration and dialogue between producers, veterinarians, industry and researchers. Its participatory nature encouraged comprehensive learning for all involved. This integration of science with producers’ knowledge and experience led to credible and practical recommendations designed to deliver real and lasting change in AM use. The multidisciplinary nature of this research marks a significant contribution to embedding social science skills and approaches into the veterinary sphere. As an initial step in creating better understanding of how participatory approaches with farmers can be applied in a UK context and more widely, this work serves as a pilot for promoting more responsible use of veterinary medicines in other livestock species.     

Descriptive epidemiological study of the use of antimicrobial drugs by companion animal veterinarians in New Zealand

Abstract

AIM: To describe the patterns of use of antimicrobial drugs by veterinary surgeons treating commonly presented bacterial infections in companion animals in New Zealand.

METHODS: A postal survey of 800 randomly selected companion animal veterinarians practicing in New Zealand was conducted between August and December 2008. Data were collected regarding the antimicrobials prescribed for recent cases of skin, ear and urinary tract infections; the use of culture and susceptibility testing; and veterinarian characteristics such as proportion of time spent treating companion animals and recent attendance at continuing professional development (CPD) events. Potential associations within the data were explored using extended mosaic plots and multivariable regression models.

RESULTS:Completed surveys from 393 respondents were available for analysis, providing data on systemic antimicrobial drug use for 1,799 cases of presumptive bacterial infections. The most frequently prescribed drugs were amoxicillin-clavulanic acid (864 cases, 48%), cephalexin (558, 31%), and fluoroquinolones (198, 11%). Of 359 cases of canine superficial pyoderma, 157 (44%) were treated with amoxicillin-clavulanic acid and 155 (43%) were treated with cephalexin with median reported treatment durations of 7 and 10 days, for these two drugs respectively. Culture and susceptibility tests had been used in 376 of 1,984 (19%) of all reported cases and 160 (43%) of these were suspected urinary tract infections. Practitioners that spent 100% of their time treating companion animals and who had attended a CPD course related to companion animals within the 12 months prior to completing the survey were more likely to submit a sample for culture and susceptibility testing and to prescribe longer courses of antimicrobials for the treatment of canine pyoderma than practitioners who spent less than 100% of their time treating companion animals and had not attended a CPD course in the last 12 months.

CONCLUSIONS: Broad-spectrum drugs considered by the World Health Organisation to be critically important for human health, such as fluoroquinolones and amoxicillin-clavulanic acid, are amongst the most frequently prescribed antimicrobials in companion animal medicine, and these drugs are often prescribed without submitting a sample for culture and susceptibility testing.

CLINICAL RELEVANCE: Many cases of superficial pyoderma were treated for less than the recommended duration of 21 days, which may contribute to a higher rate of recurrent pyoderma and the development of drug resistance within the causal bacteria. Veterinarians should be aware that the use of fluoroquinolones, in particular, should be based upon the results of a culture and susceptibility test.