Joining to fight antimicrobial resistance
The AVMA, alongside the Canadian Veterinary Medical Association (CVMA) and the Federation of Veterinarians of Europe (FVE), released a joint statement aiming to ensure veterinary oversight of antimicrobial use, mitigation of antimicrobial resistance, and the continuing availability of critical medications for both animal and human health.
In a message by the AVMA president, he says, “This joint statement is an important step in recognizing ways we can work together to prevent resistance and ensure that antimicrobials continue to be used judiciously in animals.” The joint statement parallel new updates of antimicrobial resources and new tools released by the AVMA to help members be active antimicrobial stewards.
This is not the first joint effort by the AVMA, CVMA, and FVE and in 2009, the CDC created the Transatlantic Task force on Antimicrobial Resistance (TATFAR), which aims to improve appropriate therapeutic use of antimicrobial drugs, prevent drug-resistant infections, and develop strategies for new antimicrobial drugs. What is importantly emphasized through these joint statements are the continued push for further collaboration to combat these important global issues.
What does the joint statement say?
The joint statement released a series of recommendations considering many factors including other relevant stakeholder’s input and work conducted by OIE, WHO, FAO, CDC and others. The list is comprised of 14 recommendations ranging from regulatory systems for manufacturing and authorization of medicinal products, record keeping, and product availability, to the prosecution of illegal manufacturing and sale.
The statement also asks all members of the AVMA, CVMA, FVE and other organizations including non-professionals to engage actively and help gather data on antimicrobial use in animal health, and on the occurrence and spread of antimicrobial resistance.
It should be noted that all statements are recommendations. There is no discussion of any legal enforcement of these recommendations. Many countries vary in their regulation surrounding the manufacture, sale, and use of antimicrobials. In 2015 the OIE demonstrated that more than 110 countries do not yet have relevant legislation regarding the authorization, manufacture, distribution, sales and use of veterinary medicinal products, including antimicrobials.
Comparatively, the WHO in 2015 showed that sales of antimicrobials without authorization from a licensed health professional is widespread in many countries and many countries lack standard treatment guidelines for health care. This joint statement, therefore, really emphasises the importance of a holistic ‘One Health’ approach where members and others are active stewards in their countries to help monitor AMR.
A companion animal veterinarian's viewpoint
According to the CDC, an estimated 2 million people are sickened by antimicrobial resistant bacteria annually in the United States with an associated 23,000 deaths due to antimicrobial resistant bacteria. These bacteria are capable of spreading person to person or between animals and people, with resistant organisms also found in the environment, including water, soil, and air.
Companion animal practitioners are seeing more multi-drug resistant (MDR) bacterial infections in patients, according to the AVMA’s Task Force on Antimicrobial Stewardship in Companion Animal Practice. The Taskforce also concluded that although many veterinarians are aware of increasing MDRs, they do not feel equipped to take action.
Effective stewardship requires appropriate usage at a practitioner level as well as acceptance and compliance at a client level. Culture and sensitivity testing is costly, and owners' budgetary concerns can limit practitioner's ability to adhere to guidelines. Companion veterinarians also discussed concerns regarding compliance and adhering to treatment, as many antimicrobials may be difficult to give to patients.
In human medicine studies, client pressures and clinician habits are suggested to influence prescribing habits along with geographic location and settings. Self-reported survey data from veterinary hospitals reported an increase in antimicrobial use in dogs presented to referral centers. This demonstrates the importance of AMR in companion animal medicine.
In a survey by the AVMA, there was an overwhelming desire by companion animal veterinarians for more guidance on choosing appropriate antimicrobials and determining duration of use. Further investigation needs to focus on companion animal medicine, with greater awareness for their unique and similar difficulties.
Questions, comments, feedback about today's Weekly Update? Please email Dr. Gus Brihn
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Gus Brihn
Gus completed his undergraduate degree at the U of M in Global Studies, and has spent much of his time abroad, including time in France and Namibia. Gus became interested in emergency medicine from becoming a Wilderness First Responder and NR-EMT. He completed his veterinary degree at the University of Glasgow in Scotland. Gus is interested in zoonotic disease outbreak investigation, prevention, and epidemiology. Outside of work, Gus enjoys rock climbing and doing Brazilian Jiu jitsu. He has an 11 year-old Staffordshire terrier mix breed dog named Sweet Pea.