American Association of Equine Practitioners (AAEP) judicious use of antimicrobials guidelines

Note: The AVMA has endorsed these guidelines developed by the American Association of Equine Practitioners.

The promotion of the health and welfare of equines and their owners is the primary goal of members of the AAEP. Antimicrobials are a necessary tool to manage infectious diseases in equids, but adverse effects of antimicrobials and increasing development of multi-drug resistant organisms require the use of antimicrobials to be sparing and carefully considered. The following are general guidelines for the prudent therapeutic use of antimicrobials in equids:

The equine veterinarian's primary responsibility is to provide clients with the best information and care regarding the prevention and treatment of equid disease.
Antimicrobials should be used only within the confines of a valid veterinarian-client-patient relationship; this includes both dispensing and prescriptions.
Veterinarians should:
1. Participate in continuing education programs that include topics on therapeutics and emerging and/or development of antimicrobial resistance.
2. Determine when antimicrobials are indicated through laboratory assessment, clinical experience, physical examination, and relevant history.
3. Consider clinical evidence of the identification of the pathogen(s) associated with the disease. Culture and sensitivity should be performed when the identity of the organism or the antibiotic sensitivity pattern is unknown.
4. Select antimicrobials that are appropriate for the target organism and administered at a dosage and route that are likely to achieve effective concentrations in the target organ.
5. Make product choices and use regimens that are based on available laboratory and package insert information, additional data in the literature, and consideration of the pharmacokinetic and pharmacodynamic aspects of the antimicrobial drug; consult with a veterinary diagnostic microbiologist as appropriate.
6. Use products that have the narrowest spectrum of activity and known efficacy in vivo and/or in vitro against the pathogen causing the disease.
7. Utilize antimicrobials at an appropriate dosage for the condition treated for as short a period of time as reasonable.
8. Select antimicrobials of lesser importance for human medicine whenever possible.
9. Avoid selection of antimicrobials based primarily on convenience of use.
10. Utilize antimicrobials on an extra-label basis only within the provisions contained within AMDUCA regulations These regulations can be found at https://www.fda.gov/animal-veterinary/acts-rules-regulations/animal-medicinal-drug-use-clarification-act-1994-amduca
11. Avoid using combination antimicrobial therapy unless there is evidence for either an increase in efficacy or suppression of resistance development for the target organism.
12. Protect product integrity through proper handling, storage, and observation of the expiration date.
13. Follow appropriate disposal recommendations; do not discard antimicrobials via landfill or sewage routes.
14. When appropriate and feasible, use local therapy preferentially over systemic therapy.
15. Consider use of effective and practical non-antimicrobial treatment alternatives (excellent wound hygiene, antiseptic wound dressings, etc.).
Veterinarians should endeavor to ensure proper on-farm antimicrobial drug use.
1. Prescription or dispensed drug quantities should be limited such that stockpiling of antimicrobials on the farm is avoided.

The American College of Veterinary Internal Medicine has developed a very detailed and extensive consensus statement for antimicrobial drug use in veterinary medicine. To view this document visit https://onlinelibrary.wiley.com/doi/abs/10.1111/jvim.12562