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Antimicrobials in the balance: prudence and the precautionary principle
  1. N. Craven, BSc, BVSc, PhD, MRCVS
  1. The Vine Farm, The Street, Northbourne, Kent CT14 0LG
  1. e-mail: neilcraven142{at}btinternet.com

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With the European Commission looking at the veterinary use of antimicrobials, Neil Craven argues that any decision must be based on relevant evidence, and that vets should be more involved in the debate

THE development of resistance to antimicrobials is a challenge long associated with all uses of antimicrobials in people and in animals and is currently viewed as a growing problem, potentially limiting the effectiveness of available therapeutic options. It is certainly an issue that is currently receiving considerable attention internationally at scientific, public health and political levels. But what are the facts? What are the real risks from veterinary use? What risk management/mitigation actions are appropriate? How, and by whom, and on what basis should future policy on antimicrobial use in veterinary and human medicine be determined? And what should be the voice and role of the veterinary profession in this debate?

The hazard is clear and intuitive: (a) as part of a natural adaptation to a changing environment, some microorganisms develop resistance on exposure to antimicrobials and, often depending on further exposure, the resistant population can expand and increase in prevalence by clonal expansion or through transmission of resistance genes to other microorganisms; (b) resistant organisms arising in animals may transfer to people; (c) humans acquiring antimicrobial-resistant bacteria from animal sources may themselves require treatment; and (d) the antimicrobial resistance pattern may limit the choice of effective treatments for the human patient to the extent that the patient's recovery to health is seriously compromised (ie, actual harm arises). Although the hazard is clearly recognised, the likelihood and extent to which this chain of events will result in harm to particular human patients (ie, the risk) is almost impossibly difficult to quantify. Absence of evidence is, of course, not evidence of absence of risk; but neither is it …

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