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December 2005

Antimicrobial Resistance: Why Should Veterinarians Be Concerned?

1. Development of antimicrobial resistance in animal pathogens may compromise the effectiveness of antimicrobial therapy for animal diseases. Antimicrobials are needed for the relief of pain and suffering in animals caused by bacterial diseases. Many animal diseases cannot be prevented, controlled or treated by changes in management or husbandry practices alone, or with supportive therapy, and therefore require antimicrobial therapy.
2. Antimicrobial resistance in animals can result in transfer of resistant bacteria (human pathogens or commensals) or genetic determinants to humans through the food supply, by direct animal and human contact, or indirectly through the environment. Although the scientific evidence regarding the level of risk to and impact on human health is limited and conflicting, public health agencies and consumer organizations are recommending that the use of antimicrobials in food animals be restricted or otherwise managed, especially the use of antimicrobials considered important in human medicine.

What has the AVMA done to address the issue of antimicrobial resistance?

The American Veterinary Medical Association recognizes the potential seriousness of antimicrobial resistance and shares the concerns of the public health and medical professions regarding the problems experienced by those professionals in dealing with resistant human pathogens. Subsets of resistant human pathogens are zoonotic pathogens that may have developed resistance in animals, as a result of the use of antimicrobials in animals, and been transferred to humans through undercooked meat, animal contact, or other environmental pathways. The AVMA acknowledges that the use of antimicrobials by veterinarians for therapy (treatment, prevention or control of disease) can cause the emergence of resistance. Therefore, the AVMA started a series of actions, beginning in earnest in 1998, to lessen the potential risk. Specifically, the AVMA has accomplished the following:

1. Established the Steering Committee on Antimicrobial Resistance to provide the expertise necessary, including public health and human infectious disease experts, to advise and guide the Association. The Committee was charged to develop guidelines for judicious therapeutic antimicrobial use by veterinarians and to create educational materials and methods to inform the profession about antimicrobial resistance and judicious use. The Steering Committee was also tasked to work with the Food and Drug Administration to craft a framework for evaluating and assuring the human safety of the effects of antimicrobials used in food animals. After completion of these tasks, other AVMA councils and committees were charged to continue investigate and recommend AVMA action and policy on this topic and the Steering Committee was discontinued.
2. Developed the AVMA Judicious Therapeutic Use of Antimicrobials General Principles. These Principles served as the basis for species-specific guidelines that were written by experts and then approved by the AVMA. Guidelines have been completed for veterinarians treating cattle, poultry, swine, equine, cats, dogs, and food fish.
3. With the assistance of the American Association of Swine Veterinarians, American Association of Bovine Practitioners, and American Association of Avian Pathologists, wrote four educational booklets: Judicious Use of Antimicrobials for Swine Veterinarians, Judicious Use of Antimicrobials for Beef Cattle Veterinarians, Judicious Use of Antimicrobials for Dairy Cattle Veterinarians, and Judicious Use of Antimicrobials for Poultry Veterinarians. A booklet is also being developed for food fish veterinarians. The FDA provided financial support for development, printing, and distribution of the booklets. The booklets were direct mailed to food animal veterinarians and extra copies were given to AAAP, AABP, and AASV. Veterinary schools and colleges have also been given copies.
4. Wrote the script for an educational video explaining the judicious use principles. The FDA produced the video and distributed it to veterinary schools and colleges, and to veterinary organizations.
5. With other organizations, funded the initial development of the Veterinary Antimicrobial Decision Support System (VADS). The other supportive organizations are the AABP, AASV, Academy of Veterinary Consultants, National Cattlemen's Beef Association, National Pork Producers Council, and US Pharmacopiea. After the first three years, the FDA has continued funding of VADS. The objective of VADS, which is under development, is to provide veterinarians with a source of easily accessible, peer-reviewed information, including public health considerations, regarding the therapy of important animal diseases to help veterinarians make wise therapeutic decisions.
6. With the assistance of the American Association of Veterinary Laboratory Diagnosticians, initiated a pilot project to develop an animal pathogen resistance monitoring program. The project provided a one-time quantitative description of antimicrobial susceptibility of animal pathogens that will be used as part of the Veterinary Antimicrobial Decision Support System. The project also created a network of laboratories that could be funded to provide on-going surveillance to detect the development of resistance in animal pathogens.
7. Maintained a dialogue with the FDA Center for Veterinary Medicine, the Centers for Disease Control and Prevention, and other entities to provide a veterinary perspective on antimicrobial resistance and proposed actions responding to antimicrobial resistance.
8. The AVMA actively assisted in the development of the FDA's Guidance for Industry #152, "Evaluating the Safety of Antimicrobial New Animal Drugs with Regard to Their Microbiological Effects on Bacteria of Human Health Concern".
9. The Association has also reviewed and provided advice on the FDA risk assessments on the use for therapy and growth promotion of virginiamycin, and the use of enrofloxacin to treat specified poultry diseases.
10. The AVMA continues to advocate for improved surveillance systems and lobbies for adequate U.S. Congressional funding of the National Antimicrobial Resistance Monitoring System (NARMS). In addition, the AVMA has served on two expert review panels to evaluate NARMS.
11. The AVMA also continues to advocate for implementation of the Federal Interagency Action Plan to Combat Antimicrobial Resistance. Seven of the top thirteen priority and 30 of the total 84 action items address the potential risks from the use of antimicrobials in animals.
12. The AVMA has established a position of non-support of proposed Federal legislation that would withdraw approvals of certain antimicrobials based on the way they are used instead of using science-based, case-by-case risk assessments.
13. The AVMA assisted in the development by the World Organization for Animal Health (OIE) of a list of veterinary critically important antimicrobial drugs. The list will be used, in conjunction with a counterpart list of critically important human antimicrobials, to guide potential risk management activities of the WHO, OIE and member countries.
14. The AVMA consistently and continuously advocates for needed scientific research, improved surveillance programs, and application of risk analysis to assess the risks, communicate the risk levels to the public, and appropriately manage the risks commensurate with their demonstrated importance.

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