The American Animal Hospital Association and the American Association of Feline Practitioners are committed to the following objectives as developed by the American Veterinary Medical Association's Steering Committee on Judicious Therapeutic Antimicrobial Use:
Support research efforts for development of a scientific knowledge base that provides the basis for judicious therapeutic antimicrobial use.
Support educational efforts that promote judicious therapeutic antimicrobial use.
Preserve therapeutic efficacy of antimicrobials.
Continue to develop antimicrobial monitoring systems to determine resistance patterns. Ensure current and future availability of veterinary antimicrobials.
Therapeutic antimicrobial use should be confined to appropriate clinical indications.
Therapeutic alternatives should be considered prior to antimicrobial therapy.This includes supportive care, such as correction of fluid and electrolyte abnormalities, maintaining acid-base balance, and ensuring adequate nutrition. Surgical intervention may be necessary in some cases. The use of antimicrobials to prevent infection can only be justified in cases where bacterial infection is likely to occur.
Culture and susceptibility results aid in the appropriate selection of antimicrobials.
Use narrow spectrum antimicrobials whenever appropriate.It is best to choose an antimicrobial with a narrow spectrum that is effective against the organism.
Antimicrobials considered important in treating refractory infections in human or veterinary medicine should be used in animals only after careful review and reasonable justification.
Treat for the shortest effective period possible in order to minimize therapeutic exposure to antimicrobials.
Judicious use of antimicrobials in animals requires the oversight of a veterinarian.Judicious use of antimicrobials and extra-label use of antimicrobials should meet all requirements of a valid veterinarian-client-patient relationship (VCPR - see glossary).
Extralabel antimicrobial therapy must be prescribed in accordance with all federal laws including the Animal Medicinal Drug Use Clarification Act amendments to the Food, Drug, and Cosmetic Act and its regulations.
Appropriate dose form is critical for reliable application of the drug as well as safety for the pet and owner.Oral medication, when prescribed for aggressive or potentially injurious patients that require restraint, is not appropriate or at the very least will not be reliably administered. Alternative administration techniques, such as hiding medication in treats may allow safe administration.
Veterinarians should work with those responsible for the care of animals to ensure the judicious use of antimicrobials.
Regimens for therapeutic antimicrobial use should be optimized using current pharmacological information and principles.The antimicrobial chosen should be effective against the organism and be able to penetrate the affected organ in a proper concentration to eliminate the offending organism.
When combination antimicrobial treatment is advantageous, avoid the use of drugs whose actions are antagonistic.For example, a drug that inhibits the growth of microbes, e.g. tetracycline, should not be combined with a drug whose efficacy is dependent on rapid bacterial growth, e.g. penicillin.
The routine prophylactic use of antimicrobials should never be used as a substitute for good animal health management.Sterile technique and proper tissue handling should eliminate the need for prophylactic antibiotics in ovariohysterectomies and most other sterile procedures.
Minimize environmental contamination with antimicrobials whenever possible.
Accurate records of treatment and outcome should be maintained to evaluate therapeutic regimes.
Recognize risk factors for infections in cats and dogs and prevent or correct them whenever possible. These include, but are not limited to:
Glossary* These terms are to be defined and utilized in the context of Judicious Therapeutic Use, with the intent of focusing on antimicrobials that may be of significance to human health. They are to be applied to the principles of Judicious Use outlined within the context of this document.
Antibiotic – a chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms.
Antimicrobial – an agent that kills microorganisms or suppresses their multiplication or growth.
Broad Spectrum Antimicrobial – a type of antimicrobial effective against a large number of bacterial genera; generally describes antimicrobials effective against both Gram-positive and Gram-negative bacteria.Narrow Spectrum Antimicrobial – a type of antimicrobial effective against a limited number of bacterial genera; often applied to an antimicrobial active against specific families of bacteria.
Antibiotic Resistance – a property of microorganisms that confers the ability to inactivate or elude antimicrobials or a mechanism that blocks the inhibitory or killing effects of antimicrobials.
Extralabel – extralabel use means actual or intended use of a drug under veterinary direction, in an animal in a manner that is not in accordance with the approved labeling. This includes, but is not limited to, use in species not listed in the labeling, use for indications (disease or other conditions) not listed in the labeling, use at dosage levels, frequencies, or routes of administration other than those stated in the labeling, and deviation from the labeled withdrawal time based on these different uses.
Immunization – the process of rendering a subject immune or of becoming immune, either by conventional vaccination or exposure.
Monitoring – monitoring includes periodic health surveillance of the population or individual animal examination.
Therapeutic – treatment, control, or prevention of disease.
Veterinarian/Client/Patient Relationship (VCPR) – A VCPR exists when all of the following conditions have been met:
Veterinary Feed Directive (VFD) Drug – The VFD category of medicated feeds was created by the Animal Drug Availability Act of 1996 to provide an alternative to prescription status for certain therapeutic animal pharmaceuticals for use in feed. Any animal feed bearing or containing a VFD drug shall be fed to animals only by or upon a lawful VFD issued by a licensed veterinarian in the course of the veterinarian's professional practice.