Joint AVMA-FVE-CVMA statement on continuous monitoring of antimicrobial use and antimicrobial resistance

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

Considering that:

  1. The AVMA, CVMA and FVE developed a joint statement in 2011 on Responsible and Judicious Use of Antimicrobials1.
  2. The development of antimicrobials has contributed enormously to improving the health and welfare of people and animals throughout the world. However, any increase in antimicrobial resistance and spread of resistant bacteria poses a global threat to human and animal health.
  3. A "One Health" holistic approach through cooperation among stakeholders spanning human and animal health, food, agriculture, aquaculture and the environment, is vitally important to be able to best address the growing problem of antimicrobial resistance. This approach will promote and ensure the availability of effective antimicrobial treatments whilst minimizing resistance.
  4. Continuous availability of a range of effective antimicrobials is vital, and preservation of antimicrobial efficacy through a responsible and judicious use of antimicrobials is in the best interests of animal health and welfare, food safety, human health and the sustainability of our planet.
  5. The veterinary profession has a great deal to offer in relation to the management of animals through knowledge and practice of husbandry, biosecurity, nutrition, and immunology, in order to mitigate antimicrobial resistance. The profession plays a major role in raising awareness and informing people about the need and best practices for the preservation of the effectiveness of antimicrobials.
  6. Evaluations made by the World Organisation for Animal Health (OIE) in 2015 have shown that more than 110 countries do not yet have relevant legislation regarding the authorization, manufacture, distribution, sales and use of veterinary medicinal products, including antimicrobials. Consequently, these products circulate in an uncontrolled manner similar to ordinary goods, and counterfeit formulations are often available.
  7. The World Health Organisation (WHO) worldwide country situation analysis of 20152 showed that sale of antimicrobials without authorization from a licensed health professional is widespread in many countries. Furthermore, many countries lacked standard treatment guidelines for health care. Thus, the potential for overuse of antimicrobials by the public and the medical profession was high in at least some countries in all regions of the world, and few countries reported a system for monitoring use of antimicrobials.
  8. Associations have been demonstrated between development of antimicrobial resistance and both the use of antimicrobials in human and veterinary medicine and the international movement of people and domestic and wild animals3.
  9. It is important to keep the use of antimicrobials in all sectors (animal, human and environment) as low as possible without compromising animal and human health and welfare, environmental and public health, and food safety.
  10. Many actions have been taken to promote responsible use of antimicrobials, find alternatives for the use of antimicrobials, and decrease the amount of antimicrobials used.
  11. The Transatlantic Taskforce on Antimicrobial Resistance (TATFAR)4 has as one of its aims to develop robust surveillance systems for antimicrobial use and resistance, in order to ensure appropriate therapeutic use of antimicrobial drugs in human and veterinary medicine.
  12. The OIE is working on creating a global database on the use of antimicrobials in farmed animals, to be managed in parallel with its World Animal Health Information System (WAHIS).
  13. The AVMA, CVMA and FVE support the work being coordinated internationally (e.g. through the OIE, Food and Agriculture Organization of the United Nations (FAO), TATFAR, WHO and others) in order to address antimicrobial resistance development.
     

    Recommendations:

  14. All countries shall have a robust regulatory system in place in respect to the authorization and manufacture of human and veterinary medicinal products, including antimicrobials. In addition, a legislative system shall be in place to regulate the distribution and sales, including internet sales, of these same medicinal products.
  15. Illegal manufacture, distribution or sales of medicines shall be prosecuted.
  16. Medically or critically important antimicrobials, as defined by the relevant national health authority, or in its absence, the WHO, shall only be administered to animals with the oversight, in accordance with national legislation, of a licensed veterinarian.
  17. In order to evaluate the effectiveness of these actions, a robust global network of surveillance and monitoring systems for antimicrobial use and resistance development shall be established. Antimicrobial use shall be monitored both in the human and animal health sectors and any other sector in which antimicrobials are used. The levels of antimicrobial resistance shall be monitored in people, animals, food products and the environment.
  18. Easily available, effective, rapid and standardized diagnostic tests shall be available in order to carry out susceptibility testing. Results of these tests shall be made available to facilitate evidence-based decisions about antimicrobials. Development of national or regional level databases for collecting and sharing susceptibility data and metadata is encouraged. The use of modern techniques such as genomics, which trace the origin and circulation of bacterial strains, should be promoted as appropriate in accordance with available resources.
  19. Sufficient funding shall be available for further research and development of rapid and affordable diagnostic tests.
  20. In order to establish a truly One Health system and to be able to compare what is happening in the different sectors, harmonised standards for measuring, evaluating and interpreting data on antimicrobial use and resistance need to be developed. The AVMA, CVMA and FVE shall support the work of the OIE and European5, Canadian, and American agencies in this area.
  21. Veterinarians must retain access to effective antimicrobials for therapeutic purposes for animals suffering from a bacterial disease in order to safeguard animal health and welfare and public health; therefore, antimicrobials must not be unilaterally limited for use in humans only.
  22. Record keeping at the patient or practice level is essential for the evaluation of the success, and where necessary, modification, of antimicrobial treatments. In addition to the evaluation of individual cases, there is also a need to monitor the overall use of antimicrobials in animals, both in food producing animals as well as in companion animals. Veterinarians must keep appropriate medical records of all antimicrobial use and participate in official jurisdictional surveillance programs of antimicrobial resistance development and use as required. The collection of significant and informative data is essential to enhance the responsible use of antimicrobials and control misuse and minimize potential resistance development.
  23. The AVMA, CVMA and FVE shall call on all organizations working to address antimicrobial resistance at a global level (i.e., OIE, WHO, TATFAR, and others) to ensure that our organizations are always consulted.
  24. The AVMA, CVMA and FVE shall call upon their members, veterinary professional organisations, all veterinarians, veterinary technicians and animal keepers to actively engage and contribute to the collection of relevant data on antimicrobial use in animal health and on the occurrence and spread of antimicrobial resistance.
  25. The AVMA, CVMA and FVE shall call on decision makers to ensure that when trade standards are established and agreed to, these take into account the monitoring of antimicrobial use and resistance development and antimicrobial stewardship.
  26. The AVMA, CVMA and FVE shall collaborate in promoting responsible use of antimicrobials in animal production and animal care in all countries, and in particular, in the developing world.
  27. The AVMA, CVMA and FVE, shall continue to take a leadership role in promoting global antimicrobial stewardship.

Background information of partners concerned:

  1. The American Veterinary Medical Association (AVMA), the Canadian Veterinary Medical Association CVMA) and the Federation of Veterinarians of Europe (FVE) are three of the leading veterinary professional organisations in the World. Together they represent over 330 000 veterinarians in all disciplines of the veterinary profession;
  2. The mission of the AVMA is to lead the veterinary medical profession by advocating for its members and advancing the science and practice of veterinary medicine to improve animal and human health;
  3. The CVMA is the national voice for the veterinary profession dedicated to serving and representing the veterinarians of Canada. The Association is committed to excellence within the profession and to the well-being of animals. It promotes public awareness of the contribution of animals and veterinarians to society;
  4. The European Veterinary profession, embodied by FVE, strives to promote animal health, animal welfare and public health across Europe. Together with its members, FVE aims to support veterinarians in delivering their professional responsibilities at the best possible level, recognized and valued by society.

1https://www.avma.org/policies/joint-avma-fve-cvma-statement-responsible-and-judicious-use-antimicrobials
2http://apps.who.int/iris/bitstream/10665/163468/1/9789241564946_eng.pdf?ua=1
3Chantziaras I et al, Correlation between veterinary antimicrobial use and antimicrobial resistance in food-producing animals: a report on seven countries. J Antimicrob Chemother doi:10.1093/jac/dkt443
4http://www.cdc.gov/drugresistance/tatfar/index.html
5 JIACRA Report: http://ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-JIACRA-report.pdf

Additional Resources

Antimicrobial Use and Antimicrobial Resistance

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