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Preserving a precious resource

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THE BVA’s new poster on responsible use of antimicrobials in veterinary practice, a copy of which is enclosed with this issue of The Veterinary Record, is timely. First, its production coincides with European Antibiotic Awareness Day (November 18), an annual event aimed at raising awareness of the threat to public health of antibiotic resistance and the need to use antibiotics responsibly. Secondly, and perhaps more importantly, it comes at a time when concern about antimicrobial resistance, and the way in which antimicrobials are used, is increasing.

It is more than 10 years now since an influential report from the House of Lords Science and Technology Committee highlighted concerns about antimicrobial resistance, emphasising the importance of antimicrobials in treating disease in people and animals and the need for such products to be used prudently to preserve their efficacy. Other reports produced around that time included one from the Advisory Committee on the Microbiological Safety of Food, discussing veterinary antimicrobial use in relation to food safety and the development of resistance to products used in human medicine, and reports from the World Health Organization which, although largely concerned with the use of antimicrobials in humans, made specific recommendations aimed at reducing the risk to human health of antimicrobial use in food animals.

The European Commission responded to such concerns by introducing an EU-wide ban on the use of antibiotics as growth promoters in animal feed. The ban was phased in gradually and took full effect from January 1, 2006. In the UK, government initiatives included the publication by the Department of Health in 2000 of a ‘UK antimicrobial strategy and action plan’. This identified surveillance, infection control and the prudent use of antimicrobials in humans and animals as ‘key elements’ in attempts to control antimicrobial resistance, and emphasised the need for a coordinated approach. Defra, for its part, produced a strategy for developing and implementing a programme of surveillance for antimicrobial resistance in animals; this was published in 2004 and updated last year (VR, August 23, 2008, vol 163, p 227).

Since this flurry of activity in the first half of the decade, political interest in antimicrobial resistance seems to have waned slightly, although the problem itself has not gone away. There has recently been a resurgence in interest, as evidenced, perhaps, by a call from the UK’s Chief Medical Officer earlier this year for a ban on the use of quinolones and cephalosporins in animals (VR, April 11, 2009, vol 164, p 444). European Antibiotic Awareness Day, now in its second year, itself reflects this renewed interest; although the main focus of the day is on the use of antibiotics in humans, it is clearly also relevant to the veterinary profession (VR, November 8, 2008, vol 163, p 551).

The BVA’s new poster on responsible antimicrobial use (which is also available for download from www.bva.co.uk) updates and replaces the Association’s previous guidance on this issue and should find a place on every practice notice board. Backed up by more detailed information on the BVA website, it outlines an eight-point plan for the responsible use of antimicrobials in veterinary practice, covering issues such as working with clients to avoid antimicrobial use, sensitivity testing and antimicrobial choice, minimising prophylactic and perioperative use, and record keeping. It emphasises that any suspected treatment failure should be reported through the Veterinary Medicines Directorate’s Suspected Adverse Reaction Surveillance Scheme, as any such failure could be the first indication that resistance is developing. It also includes specific advice in relation to fluoroquinolones and third and fourth generation cephalosporins. It makes the point that antimicrobials are essential for the treatment and prevention of infections and zoonotic diseases in both animals and humans, and that responsible use means using as little as possible but as much as necessary.

Antimicrobials are a precious resource that needs to be preserved. The prospect of new classes of antibiotic being developed in the near future is remote, so it is important to ensure that the products available are used appropriately. The debate must not be allowed to degenerate, as it nearly did a few years ago, into arguments about whether medical or veterinary use contributes more to the development and spread of resistance; antimicrobials are needed, and must be used responsibly, in both fields. Cooperation and mutual understanding are important here. The aim, in animals and humans, must be to ensure that antimicrobials are used only when necessary and to best effect, so that their efficacy is maintained as far as possible and that they remain available for use where really needed.

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