AVMA defines stewardship, judicious use

Antimicrobial policy aimed at and beyond veterinary profession
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AVMA leaders hope changes in how veterinarians prescribe and administer antimicrobials can prolong the effectiveness of those drugs in the medical professions.

In January, the AVMA House of Delegates enacted a policy that defines antimicrobial stewardship by veterinarians individually and as a profession, and principles of antimicrobial use. The Association plans to promote those definitions to veterinarians and use the definitions to help reach agreements on how antimicrobial drugs should be used.

Dr. Rena Carlson-Lammers, a member of the AVMA Board of Directors and Board liaison to the AVMA Committee on Antimicrobials, said during House deliberations that enacting the policy is an important development toward the committee's goals of working with counterparts in human medicine and regulatory agencies, among others, to determine how antimicrobials should be used. The Board had recommended that the delegates enact the policy. Dr. Carlson-Lammers is the Board member representing Alaska, Idaho, Montana, Oregon, Washington, and Wyoming.

The policy states that veterinarians, as individuals and a profession, can preserve the effectiveness and availability of antimicrobial drugs by implementing oversight and making responsible decisions. It also describes considerations for veterinarians and practices developing stewardship plans.

The policy is available at http://jav.ma/AVMAstewardship.

The AVMA House of Delegates, shown during deliberations at its regular winter session in January in Chicago (Photo by R. Scott Nolen)

Dr. Neil Moss, delegate from Utah, said on the House floor that the policy is a call to action. He also asked for an explanation of how the AVMA would provide the information to clinical practitioners so that they could use it to improve antimicrobial use.

Dr. Michael Whitehair, chair of the AVMA Board of Directors, said AVMA staff and leaders, including the delegates themselves, would work to distribute the document.

After the House vote, the AVMA sent information on the action to U.S.-based organizations in veterinary medicine, national veterinary associations in other countries, international associations, the Food and Drug Administration, the Department of Agriculture, the Centers for Disease Control and Prevention, the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations, and Pew Charitable Trusts. The Association also notified members through the AVMA@Work blog on the AVMA website.

Dr. Michael Costin, assistant director of the AVMA Division of Animal and Public Health, said the Committee on Antimicrobials will discuss other ideas for distributing the information.

A unanimous House vote enacted the policy.

After the meeting, Dr. Carlson-Lammers said that, by defining stewardship and judicious use, the AVMA will ensure that organizations understand one another during discussions. Much of the policy's language was adapted from CDC publications.

The AVMA's antimicrobial committee plans to work with the FDA and USDA as those entities develop regulations that guide daily antimicrobial use, Dr. Carlson-Lammers said. And the AVMA will lobby for regulations and laws that preserve veterinarians' ability to administer or prescribe needed antimicrobials.

The AVMA wants evidence-based decisions that include animal welfare considerations, Dr. Carlson-Lammers said. They should account for animal and societal needs across animal species.

Veterinarians need to be leaders on antimicrobial stewardship and judicious use, she said. They are the people best educated and prepared to act on animal health and welfare and should be the leading voice.

Dr. Moss noted the House has considered previous proposals that would have called on veterinarians to change their use of antimicrobials. Three years earlier, for example, delegates voted against two proposals to endorse guidelines of the International Society for Companion Animal Infectious Diseases on antimicrobial use for treatment of superficial pyoderma in dogs and urinary tract disease in dogs and cats.

Dr. Moss said delegates found those proposals to be too prescriptive for AVMA policy. But he began applying the principles in his own practice by performing more diagnostic testing, using smaller amounts of antimicrobials, and decreasing the use of drugs in the most important antimicrobial classes.

Veterinarians, like physicians, are under pressure to prescribe antimicrobials, Dr. Moss said. He said he has explained the protections the changes have for clients and their cats, and he has received little resistance.

Dr. Whitehair said the policy shows veterinarians' commitment to patients, clients, and the public, and it creates opportunities to share the insights of an expert panel. He said that AVMA leaders also can say that the moment the delegates voted to enact the policy is when the veterinary profession progressed as advocates for preserving antimicrobial effectiveness.

He said he is enthusiastic about the potential changes yet somber in the face of challenges of antimicrobial resistance and the possibility that veterinary practices—along with those of other professions—contributed to drug resistance.

Dr. Whitehair expressed confidence veterinarians will use the guidance to take action. He and fellow livestock veterinarians already recognize that changes in management practices, husbandry, nutrition, and animal environments can reduce antimicrobial administration.

The policy helps show a "commitment to making sure we're good guardians of the antimicrobials that we use in our practice," he said. But it will be insufficient if it is put on a shelf rather than shared.

Related JAVMA content:

Creation of antimicrobials committee among Board acts (Aug. 15, 2016)

WHO seeks end to antibiotic use without disease (Jan. 1, 2018)

Adjusting to reduced drug access, use (May 1, 2016)