Preventing antimicrobial resistance – an issue long discussed in human health circles – is receiving a groundbreaking, updated perspective thanks to recommendations put forth by a group led by veterinarians from Colorado State University.
The American College of Veterinary Internal Medicine appointed eight specialists to critically review antimicrobial drug use in veterinary medicine. The group developed a unique document to address moral and ethical issues about drug use in veterinary medicine and provide veterinarians with detailed strategies for appropriate antimicrobial drug use. The document is published in the recent edition of the Journal of Veterinary Internal Medicine.
"The ACVIM showed great foresight and leadership in sponsoring this initiative," said Dr. Paul Morley, veterinarian at Colorado State University and chair of the committee. "I hope that other veterinary organizations and the larger medical community will review and build upon this effort."
As part of their professional oath, veterinarians swear to protect their patients in addition to protecting the well-being of the public and society, according to Morley. That pledge inadvertently places veterinarians in a difficult ethical situation: Antibiotics used to treat animal patients may alleviate suffering and may prevent the spread of illness, yet the use of antibiotics also may promote resistance, an occurrence that is counter to promoting societal well-being. This, Morley said, presents a difficult challenge for veterinarians.
"It might seem relatively simple to place equal emphasis on all of these needs and obligations in a veterinarian’s daily life," Morley said. "Yet, veterinarians may be forced to prioritize one of these obligations over another when making day-to-day decisions about antimicrobial drug use. We strongly believe that veterinarians need to use antimicrobial drugs to treat and prevent infectious diseases in animals. At the same time, we also believe – just as strongly – that veterinarians are obligated to balance this against the well-being and health of people."
Balancing those needs and obligations is not simple, Morley said. And the consequences of losing the beneficial effect of antibiotics in treating animals and humans with bacteria with ever-growing antimicrobial resistance could place public health in jeopardy.
"We hope that veterinarians and veterinary organizations look at this effort and adopt the recommendations presented," Morley said. "Veterinarians clearly recognize the importance of addressing antimicrobial resistance and the need for the veterinary profession to contribute to efforts aimed at maintaining the usefulness of antimicrobial drugs in animals and humans. Our committee believes that veterinarians are obligated to balance the well-being of animals under their care with the protection of other animals and public health – and often that obligation includes prescribing antimicrobial treatments. However, up until this point, the guidelines available to veterinarians to help them prudently prescribe these drugs have lacked specificity."
The bulk of the recommendations, which are published in their entirety in the recent Journal of Veterinary Internal Medicine, are voluntary. However, the special committee does recommend that laws be revised so that antimicrobial drugs used to treat animals will be restricted for use by a veterinarian or on their explicit order, such as via a prescription.
"This is not a new issue," said Josie Traub-Dargatz, veterinarian at Colorado State and member of the ACVIM committee. "It’s difficult to justify restricting the availability of these drugs for humans to prescription only, while allowing the same drugs to be purchased and administered to animals without approval of a veterinarian. This committee recommends that regulatory agencies promote dispensing these drugs via a prescription-only system, including restricting sales of drugs that are currently available to owners to treat their animals without a prescription. This action is intended to help ensure that the most appropriate drug is chosen for each treatment and used in the most appropriate dose and duration of treatment."
In developing this consensus statement, the committee studied the veterinary profession’s role in limiting bacteria’s developing resistance to antimicrobial drugs, as well as how medical strategies that are believed to increase or decrease the incidence of resistance relate to production, disease prevention and therapeutic practices used for animals. This led to making recommendations that veterinarians develop standardized antimicrobial drug use recommendations tailored for use in their practices, and the development of formal infection control plans for all veterinary facilities, such as animal hospitals or clinics, as an important step in decreasing the use of antimicrobial drugs by decreasing the risks of infections in animals within these facilities.
"It is important to realize that infection control plans are relevant for all types of animal operations – those for small or large animals, ranging from rural agricultural facilities, pleasure operations and even households with only a few pets," Morley said.
Morley is an associate professor and director of biosecurity at the Animal Medical Center at Colorado State University. Traub-Dargatz is a professor at Colorado State and an expert in controlling equine infectious diseases. Both are on the board of directors of the Animal Population Health Institute, an official center at Colorado State dedicated to investigating and promoting animal health issues important to veterinarians and animal producers around the world.
For the complete recommendations put forth by this group, visit the Journal of Veterinary Internal Medicine at www.acvim.org.