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NOVEMBER 1999

AVMA Develops Judicious Antimicrobial Use Guidelines
Prudent Practices in the Cross Hairs
by Shannon Linderoth
Posted with permission of the Dairy Producer

The public policy microscope has focused its sights on how and when your animal receives antimicrobial therapy. With heightened awareness stemming from antibiotic resistances concerns, regulators have counted their cross-section slides of the industry and are scrutinizing treatment and product-use-practices under increased magnification.

This attention to on-farm antimicrobial treatment and its impact on human health has been developing for years -- almost since antimicrobials first hit the market. However, it's only since 1997 that the World Health Organization (WHO) recommended the use of antibiotics in animals, particularly for enhancing growth, be reduced. Studies have not found conclusive evidence of human health hazards, but the risk hypothesis offered by experts has been important enough to warrant further action.

By its June 1998 meeting, WHO concluded that "further research and data gathering are essential" to fill in gaps in our understanding of antibiotic resistance. The U.S. Food and Drug Administration and the Center for Disease Control have signed on to this position, and further U.S. antimicrobial regulation and drug monitoring is in development.

In light of these concerns, the American Veterinary Medical Association's steering committee on judicious therapeutic antimicrobial use has developed a set of principles for farmers and veterinarians to follow. Their purpose is to help insure current and future availability of veterinary antimicrobials, as well as preserve therapeutic efficacy of these products. In addition, the AVMA is developing educational efforts that promote these judicious-use guidelines, as well as promoting an information database on the use of antimicrobials.

The move to minimize resistance and protect animal and human health has also been undertaken by AVMS's European counterparts.

According to recent report in Feedstuffs, Comissa, a Brussels, Belgium-based group representing the worldwide animal health industry, the World Wide Veterinary Association and the International Federation of Agricultural Producers has finalized what they are calling global basic principals for the prudent use of antibiotics in animals. The basic format and content of these guidelines are similar to those of the AVMS, but the guidelines also cover antibiotic growth promoters, which AVMA does not.

Attention to on-farm antimicrobial treatment and its impact on human health has been developing for years -- almost since antimicrobials first hit the market.

The AVMA judicious-use principle, which goes above and beyond producer quality assurance programs, are as follows:

The AVMA Judicious-Use Principle

Preventive strategies, such as appropriate husbandry and hygiene, routine health monitoring and immunization should be emphasized.

Other therapeutic options should be considered prior to antimicrobial therapy.

Judicious use of antimicrobials, when under the direction of veterinarian, should meet all requirements of a valid veterinarian client relationship.

Prescription antimicrobials must meet the requirement of a valid veterinarian-client patient relationship.

Extralabel antimicrobial therapy must be prescribed only in accordance with the Animal Medicinal Drug Use Clarification Act amendments to the Food, Drug and Cosmetic Act and its regulations.

Veterinarians should work with those responsible for the care of animals to use anticmicrobials judiciously regardless of the distribution system through which the anticmicrobials were obtained.

Regimens for therapeutic antimicrobial use whould be optimized using current pharmacological information and principles.

Antimicrobials considered important in treating refractory infections in human or veterinary medicine should be used in animals only after careful review and reasonable justification. Consider using other antimicrobials for initial therapy. (In this context, this principle takes into account development of resistance or cross-resistance to important antimicrobials.)

Use narrow-spectrum antimicrobials whenever appropriate.

Utilize culture and susceptibility results to aid in the selection of antimicrobials when clinically relevant.

Therapeutic exposure to antimicrobials should be minimized by treating only for as long as needed for the desired clinical response.

Limit therapeutic antimicrobial treatment to ill or at-risk animals, treating the fewest animals indicated.

Accurate records of treatment and outcome should be used to evaluate the therapeutic regimens.

These guidelines, as previously reported, are being further developed to address the needs of individual animal species. Check with your local veterinarian for the list. The guidelines shown here are currently independent of the Framework Document developed by the FDA's Center for Veterinary Medicine. The outcome of the action should be available by May 1999.