Judicious therapeutic use of antimicrobials

Position statement

Antimicrobial stewardship refers to the actions veterinarians take individually and as a profession to preserve the effectiveness and availability of antimicrobial drugs through conscientious oversight and responsible medical decisionmaking while safeguarding animal, public, and environmental health. Management and prevention strategies should be employed to minimize the need for antimicrobial drugs. Judicious therapeutic use of antimicrobials is a core principle of the broader goal of antimicrobial stewardship. In accordance with the FDA, therapeutic uses are associated with the prevention, control, and treatment of specific diseases that are necessary for assuring the health of animals.

Judicious use principles

Maintain veterinary oversight by establishing a veterinarian-client-patient relationship (VCPR), the basis for interaction among veterinarians, their clients, and their patients, regardless of the distribution system through which the antimicrobial was obtained.
Identify barriers to appropriate antimicrobial prescribing and usage.
Use an evidence-based approach for making a diagnosis and determining whether an antimicrobial drug is indicated.
- Investigate the problem to understand the population or individual level risk factors.
- Perform diagnostic testing to confirm the likelihood that an infectious pathogen is present and causing or likely to cause disease.
- Avoid antimicrobial therapy for uncomplicated viral infections, self-limiting bacterial infections, and non-bacterial inflammatory conditions.
Make an informed selection of an appropriate antimicrobial drug and regimen.
- Determine whether the purpose of therapy is for prevention, control, or treatment.
- Target antimicrobial therapy to ill or at-risk animals when possible and discern if individual treatment of ill or at-risk animals is sufficient to improve the overall group morbidity, mortality, and herd wellbeing; or if herd or group therapy is needed to control clinical outcome properly.
- Perform culture and antimicrobial susceptibility testing when indicated and feasible, to guide the selection of antimicrobials.
- Use current pharmacological science, principles, regulatory guidance and contextual understanding of resistance in the animal population of concern.
- Determine duration of therapy by evaluating scientific and clinical evidence, where available, to obtain the desired health outcome while minimizing selection for antimicrobial resistance, as allowed by law.
- Follow scientifically based withdrawal periods to prevent violative residues in foods of animal origin.
Refer to relevant veterinary medical guidelines for judicious therapeutic use.
Assess outcomes of antimicrobial use.
- Maintain accurate records of therapy and outcome.
Ensure proper handling of antimicrobials.
- Avoid environmental contamination with antimicrobials whenever possible including proper disposal according to guidelines and local, state, or federal law.
- Adhere to and promote proper storage and handling according to the label.

Glossary

*These terms are defined and utilized in this text as applied to the principles of Judicious Use outlined within this document.

Antibiotic—a chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Often used interchangeably with “antimicrobial agent.”

Antimicrobial—an agent that kills microorganisms or suppresses their multiplication or growth. Often used interchangeably with “antibiotic.”

Antimicrobial resistance—a property of microorganisms that confers the ability to inactivate or elude antimicrobials or a mechanism that blocks the inhibitory or killing effects of antimicrobials.

Therapy/Therapeutic—prevention, control and treatment of disease.

Antimicrobial prevention of disease (synonym: prophylaxis)

Prevention is the administration of an antimicrobial to an individual animal to mitigate the risk for acquiring disease or infection that is anticipated based on history, clinical judgment, or epidemiological knowledge.
On a population basis, prevention is the administration of an antimicrobial to a group of animals, none of which have evidence of disease or infection, when transmission of existing undiagnosed infections, or the introduction of pathogens, is anticipated based on history, clinical judgment or epidemiological knowledge.

Antimicrobial control of disease (synonym: metaphylaxis)

Control is the administration of an antimicrobial to an individual animal with a subclinical infection to reduce the risk of the infection becoming clinically apparent, spreading to other tissues or organs, or being transmitted to other individuals.
On a population basis, control is the use of antimicrobials to reduce the incidence of infectious disease in a group of animals that already has some individuals with evidence of infectious disease or evidence of infection.

Antimicrobial treatment of disease

Treatment is the administration of an antimicrobial as a remedy for an individual animal with evidence of infectious disease.
On a population basis, treatment is the administration of an antimicrobial to those animals within the group with evidence of infectious disease.