Joint AVMA-FVE-CVMA statement on responsible and judicious use of antimicrobials

Comment on this policy

Note: This statement has been adopted jointly by the AVMA, Federation of Veterinarians of Europe, and Canadian Veterinary Medical Association.

Responsible and judicious use of antimicrobials is in the best interests of animal health and welfare, human health, and the environment. Strategies to preserve antimicrobial effectiveness and availability must be well coordinated in a One Health approach to mitigate antimicrobial resistance and encompass everyone involved in the use of antimicrobials.

Antimicrobials are essential for therapy of infectious diseases in animals. Lawfully allowed uses maintain animal health and welfare and support food safety. Veterinarians, being well-educated health professionals and accountable through regulation, are expected to be good stewards of antimicrobials to preserve their effectiveness and accessibility. Antimicrobial stewardship includes the implementation of preventive strategies, such as appropriate husbandry practices; management, vaccination, and biosecurity programs; and appropriate nutrition, as well as judicious antimicrobial use. The use of alternatives to antimicrobials should also be considered.

Once a determination is made that use of antimicrobials is indicated, the veterinarian should balance expected therapeutic outcomes for the specific patient(s) with potential risks to public health, animal health, and the environment by:

selecting antimicrobials for suspected target organisms based on integration of medical history, clinical signs, physical examination findings, diagnostic test results, laboratory data including antimicrobial susceptibility testing using approved standards when appropriate,¹ and expected clinical outcomes based on the best published evidence, existing formularia and the experience of the veterinarian;
ensuring appropriate dose, route of administration, and duration of treatment in compliance with all legal requirements to achieve the desired clinical response;
restricting antimicrobial use to ill or at-risk animals and administering antimicrobials to the fewest animals possible; and
maintaining medical records² and evaluating outcomes.

Continued availability of effective antimicrobials for veterinary use is a critical component for a safe food supply and optimal animal health and welfare, and therefore of importance to all One Health stakeholders. To that end:

Regulatory proposals and actions should be specific, transparent, and based on scientific risk analysis.
Antimicrobial resistance risk analyses should evaluate the risks and benefits to animal health and welfare in connection with the risks and benefits to human health, using a holistic One Health approach.
In the context of One Health, animal and human healthcare professionals should work collaboratively to ensure responsible and judicious use of antimicrobials.

Every time a human or animal healthcare professional makes a decision whether or not to recommend antimicrobial therapy, there is an opportunity to educate the patient or client on antimicrobial stewardship, including proper administration protocols, compliance with treatment regimens, appropriate disposal of unused medicines, and prevention best practices.

Veterinarians should advocate for increased research and innovation to enhance the development of alternatives to antimicrobials and bring to market effective, rapid, and affordable diagnostics to improve understanding of new and existing methods to prevent and medically manage microbial infections with an aim at reducing our dependence on antimicrobials.

¹Clinical Laboratory Standards Institute, CLSI. Performance Standards for Antimicrobial Disk and Dilution Susceptibility Tests for Bacteria Isolated From Animals; Approved Standard—Fourth Edition. CLSI document VET01-A4. Wayne, PA: Clinical and Laboratory Standards Institute; 2013; and Performance Standards for Antimicrobial Disk and Dilution Susceptibility Tests for Bacteria Isolated From Animals; Third Informational Supplement. CLSI document VET08. Wayne, PA: Clinical and Laboratory Standards Institute; 2015.
²AVMA, CVMA and FVE Joint Statement on Continuous Monitoring of Antimicrobial Use and Antimicrobial Resistance, November 2018 (accessed December 5, 2019 at www.avma.org/policies/joint-avma-fve-cvma-statement-continuous-monitoring-antimicrobial-use-and-antimicrobial and www.fve.org/publications/joint-avma-fve-cvma-statement-on-continuous-monitoring-of-antimicrobial-use-and-antimicrobial-resistance/)