With European Antibiotic Awareness Day (EAAD) this month (18th), the Veterinary Medicines Directorate (VMD) is encouraging veterinary surgeons to continue to take the issue of antibiotic resistance and the importance of prudent antibiotic use very seriously.
The directorate has issued a number of key messages on responsible use and prescribing; these are:
- Work with your clients to minimise the need to use antibiotics, for example through providing advice on keeping their animal(s) healthy, explaining to them why antibiotics may not be needed, and through the development of an effective health plan with farmers.
Diagnose before prescribing
- Conduct a thorough clinical examination and make a diagnosis if possible before prescribing antibiotics.
- Use antibiotics responsibly – the right medicine, at the right dose and at the right time. Wherever possible use antibiotics at an early stage, when clinical signs of disease are first diagnosed and become evident.
- Use a narrow spectrum antibiotic wherever possible.
- The product’s Summary of Product Characteristics (SPC) or product literature instructions and contraindications must be clearly understood and taken into account, especially when deciding on the dosage and duration of treatment. Follow the storage advice.
- Emphasise to clients the need to follow the antibiotic’s labelling instructions. In particular, stress to clients that the full course of antibiotics should be administered, even if the animal gets better quickly.
- Perform sensitivity testing on causal bacteria against antibiotics prior to treatment, where possible.
- If a treatment does not appear to work, perform further diagnostic tests and report the treatment failure using a yellow form (available from: www.vmd.defra.gov.uk), as a Suspected Lack of Efficacy, to the VMD. This is a valuable tool for veterinarians to be part of an alert system to bring an emerging resistance problem to the attention of interested parties.
- For farm animals the routine preventive use of antibiotics is not responsible use and should be avoided by addressing poor management and husbandry and the underlying causes of recurrent or chronic disease.
Public health initiative
EAAD was established in 2008 as an event to be held on 18th November each year. It is a Europe-wide public health initiative to raise awareness about the threat to public health of antibiotic resistance and the importance of prudent antibiotic use.
For a number of years this has been primarily led on the human health side; this year, however, the VMD, as the government lead on antimicrobial resistance (AMR) policy with respect to animal health, is working in close collaboration with a number of animal health and welfare organisations to promote key messages around the responsible use of antibiotics.
EAAD supports the recently published aims of the UK five-year antimicrobial resistance strategy 2013 to 2018, which focuses on antibiotics and sets out actions to slow down the development and spread of antimicrobial resistance.
The VMD will be publishing messages and other useful information to support the day on an EAAD webpage – www.vmd.defra.gov.uk.
“EAAD is another opportunity to continue to encourage the animal health sector to share ownership in the drive to minimise antimicrobial resistance through engaging and supporting the veterinary and farming bodies in taking forward sector-specific initiatives,” says the VMD.
Much work is already under way in the veterinary sector, it says: groups such as RUMA and BVA (nationally), and EPRUMA and FVE (internationally), have developed guidelines for the responsible use of antibiotics in food producing and companion animals.
The day is also a platform aimed at engaging animal owners and highlighting the concerns around antibiotic use.
The key messages are that antibiotics are losing their effectiveness at an increasing rate, that there are very few new antibiotics in the development pipeline so existing antibiotics must be protected, and that not all infections will need to be treated with antibiotics so do not expect them from your vet.
Earlier this year, The Heads of Medicines Agencies and the Federation of Veterinarians of Europe undertook a survey “to gain a better insight into the decision-making process of veterinary surgeons in Europe when prescribing antibiotics”.
The survey was completed by 3,017 practitioners with responses from 25 European countries, including the UK.
The responses indicated that:
- No single information source is universally considered critical, though training, published literature and experience were indicated as the most important.
- Factors which most strongly influence prescribing behaviour were recorded as sensitivity tests, own experience, the risk for antibiotic resistance developing and ease of administration.
- Most practitioners usually take into account responsible use warnings.
- Antibiotic sensitivity testing is usually performed where a treatment failure has occurred.
- Significant differences were observed in the frequency of sensitivity testing between the different types of practitioners and the different countries studied.
The responses indicate, says the FVE, that there is a need to improve sensitivity tests and services in this area, with the availability of rapid and cheaper testing being key factors.