A forthcoming symposium brings together medical and veterinary professionals to discuss the problem of antimicrobial resistance. Lord Trees talks to Ayshe Ismail about the thinking behind it.
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ANTIMICROBIAL resistance has been given a lot of attention in both human and veterinary medicine but, as veterinary peer Lord Trees points out, the two professions tend to work independently.
Lord Trees, a past president of the RCVS and veterinary editor-in-chief of Veterinary Record, has helped to initiate a joint symposium, which will be held next week, where veterinary and medical professionals will discuss the use of antibiotics in human and animal health. The symposium, ‘Antimicrobial resistance in human and veterinary medicine – one medicine, one problem’ will bring together the Royal College of Veterinary Surgeons, the Royal College of Pathologists and the Royal College of Physicians in association with the Health Protection Agency and will include speakers with medical and veterinary backgrounds from the UK and elsewhere in Europe.
Speaking to Veterinary Record ahead of the symposium, Lord Trees said that he was keen to bring together medical and veterinary scientists and practitioners to consider the subject ‘partly in the spirit of one medicine, one health’. He explained that the symposium aims to produce a rational evidence base that both parties can use to ‘accurately describe where the problem of antimicrobial resistance comes from and how and to what extent antimicrobial resistance is transferred between human and animal populations’.
Acknowledging that the issue of antimicrobial resistance generates a ‘considerable amount of heat at times’ – which has led to political reactions, including calls for veterinary use of certain products to be banned – Lord Trees said that he hopes that the organisations will reach a measure of agreement, which can be used to ‘inform the debate and might help politicians make some sensible decisions’.
Although much of the political activity surrounding antibiotics use is in Europe, Lord Trees suggested that the major threat ‘may well be from abroad’ due to the ‘massive use of antibiotics in Asia and the Far East, in both animal species and in humans, and in most cases with a good deal less regulation’.⇓
‘When one looks at the quantity of the misuse, and the size of the populations concerned, of humans and animals, in Asia and the Far East, coupled with the speed and ease of global travel, then whatever we do in our little island may have limited effectiveness in controlling the spread of the problem,’ he suggested. Nevertheless he emphasised that it is essential that everyone uses antimicrobials responsibly.
Lord Trees believes that both the medical and veterinary professions have a large but equal role to play in the control of antimicrobial resistance and said that there is a need to understand the use and possible abuse of antibiotics on both sides. He said that ‘one of the problems is, to some extent, client pressure,’ which can occur in both human and veterinary practice and requires that doctors and vets educate patients and owners on the best use of antibiotics.
Lord Trees noted that the veterinary profession is anxious to defend its right to use its professional judgement when administering drugs, as and when necessary, to safeguard animal welfare. At the same time, he said vets have to safeguard the privileges they have by demonstrating that they are using the drugs they are allowed to prescribe responsibly. He said that the BVA and the Responsible Use of Medicines in Agriculture (RUMA) Alliance had ‘done a very good job to promulgate the message to use antibiotics as minimally as possible, only when necessary, and then to only use the most appropriate antibiotics in an appropriate dosage regime’.
Defending the right to treat
Another matter he hopes will be discussed is the difference between metaphylactic and prophylactic use of drugs. While prophylactic use is difficult to justify, metaphylaxis, he said, is a different issue. In metaphylaxis, members of a herd, which have been in close contact with an animal that has been diagnosed with a specific infection, and consequently have a high risk of also becoming infected, are medicated. Lord Trees said that in this case the veterinary profession would strongly defend its right to medicate members of the herd to prevent disease, and it was important that the two uses were clearly differentiated.
In terms of research, Lord Trees believes more needs to be done to establish where the threats are and the flow of antimicrobial resistance, using the increasing number of tools available for tracing infections, including molecular analysis as well as modern epidemiological methods.
▪The ‘Antimicrobial resistance in human and veterinary medicine – one medicine, one problem’ symposium will be held at the Royal College of Physicians, in London, on October 2. More information is available on the RCVS website (www.rcvs.org.uk/news-and-events/upcoming-events/joint-symposium-on-antimicrobial-resistance/).
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