By Katie Burns
"Veterinarians should be involved in the decision-making process for the use of antimicrobials in animals regardless of the distribution channels through which the antimicrobials were obtained," according to a resolution that the AVMA Executive Board has introduced for consideration by the House of Delegates as Resolution 2 for the 2010 regular annual session of the HOD.
The statement originated from discussions of the AVMA Antimicrobial Use Task Force. The multidisciplinary members of the AUTF met during the past year to clarify veterinarians' role and level of involvement in therapeutic and production uses of antimicrobials in food animals—encompassing drugs available by prescription, over the counter, and via veterinary feed directive—in light of the issue of antimicrobial resistance.
The board also introduced another resolution, Resolution 3, which states that the AVMA should "be at the forefront of discussions that may impact drug availability, such as regulatory changes in veterinary oversight especially pertaining to antimicrobial use."
The board did not submit the resolutions by the deadline, but the HOD can vote to consider them during its July 29-30 regular annual session.
The current discussion of AVMA policy on antimicrobial use began last July during the 2009 regular annual session of the HOD. Delegates deliberated then on a resolution that would revise the policy on "Judicious Therapeutic Use of Antimicrobials" by removing "when under the direction of a veterinarian" from the following statement: "Judicious use of antimicrobials, when under the direction of a veterinarian, should meet all requirements of a veterinarian-client-patient relationship."
The HOD voted to refer the resolution to the board with recommendations that the board form an entity to address veterinarians' role in antimicrobial use and provide the entity's recommendation to the HOD by the 2010 regular annual session. The board subsequently formed the AUTF, and in June, the task force delivered a summary of its discussions to the board.
Meeting June 10-12, the board recommended that this July the HOD disapprove last year's resolution on antimicrobial use and introduced the two new resolutions on antimicrobial use.
The AUTF found that "the issues surrounding antimicrobial use in veterinary medicine are multifaceted, involving highly complex information as well as a multitude of scientific unknowns," according to an executive summary of the discussions of the task force.
Following discussion of the use of antimicrobials for growth promotion or feed efficiency, members of the AUTF came to consensus on the following points:
- Veterinarians should be involved in the use of antimicrobials. Veterinarians should strive to improve their relationships with producers and clients as well as explore ways to better educate and communicate information on antimicrobial use.
- Although [it was] discussed and suggested by some members, there was no recommendation for additional veterinary supervision or oversight of antimicrobial use by those responsible for animal care. It was agreed that "oversight" could imply and engender additional regulation and responsibility without improving actual overall stewardship of antimicrobial use. Certain antimicrobials have no potential to impact human resistance patterns and therefore should not require additional veterinary oversight. Additionally, these products should be allowed to be used according to their labeled indications (including growth promotion and feed efficiency).
- It has been theorized that antimicrobials labeled for growth promotion or feed efficiency prevent subclinical disease and allow the animal to reach its full growth potential. Many agreed that in principle (with logistic barriers aside) drugs in this group that have been shown to have therapeutic efficacy (disease treatment, control, or prevention) should be reassessed and, if appropriate, relabeled accordingly. It was acknowledged that for disease prevention, the specific disease being prevented may not be easily identified from among the many that are probable, and the mechanism by which antimicrobials promote growth could remain unknown. There was also the understanding that over-the-counter availability is not necessarily equivalent to a lack of veterinary oversight.
- Investigation of over-the-counter antimicrobials that potentially have a demonstrable human health risk is warranted and could be evaluated by a risk assessment.
- Demonstration of significant human health risk associated with over-the-counter availability of antimicrobials should trigger a requirement for additional veterinary supervision.
The AUTF could not reach a consensus on the level of veterinary involvement necessary in the use of antimicrobials. The task force discussed four processes that might enhance veterinary oversight: availability of antimicrobials by prescription only, a certification requirement for producer access to antimicrobials, prioritization of antimicrobials by importance to human health, and electronic communication to supplement on-farm visits by veterinarians.
The current AVMA policy on "Judicious Therapeutic Use of Antimicrobials" indicates that "Veterinarians should work with those responsible for the care of animals to use antimicrobials judiciously regardless of the distribution system through which the antimicrobial was obtained."
Resolution 2, "The Role of the Veterinarian in Animal Antimicrobial Use," would create a separate policy indicating more broadly that veterinarians should take part in the decision-making process for use of antimicrobials in animals.
Pending legislative and regulatory initiatives could lead to additional legal restrictions on antimicrobial use in veterinary medicine, according to the background to Resolution 3, "Veterinary Foresight and Expertise in Antimicrobial Discussions."
"If discussions by others are underway to change the way animal antimicrobials are used which will potentially result in additional regulation or decreased drug availability, it is imperative that the profession actively seek opportunities to lead the discussions, providing its members' expertise, whether or not the Association has current policy on the matter under discussion," according to the background to the resolution.
The resolution states that, regarding drug availability and antimicrobial use, the AVMA should take the following steps:
- Proactively engage stakeholders and aggressively pursue opportunities to participate in and, where appropriate, lead those discussions.
- Make certain that decisions are informed by science.
- Ensure that risks and benefits to both humans and animals are given due consideration.
- Strive to minimize the potential for unintended negative consequences and maximize potential benefits.
- Incorporate members' expertise to effectively advocate for the veterinary profession, the animals in its care, and the public whose health veterinarians safeguard.
The resolutions and accompanying background are available here.