D.V.M., A.C.PV.
Zeeland, MI
U.S.A.
The last several years have seen an increasing public awareness of and concern over the use of antimicrobials in food animal production. This awareness goes along with the concerns over animal welfare, environmental issues, and food safety. Food animal production continues to be scrutinized from many different fronts, not the least of which is state and federal legislatures. The purpose of this article is to emphasize the antibiotic issue and to provide information to the producers on the judicious use of antibiotics, so that we will be able to continue to use these very important and necessary tools in the future.
The concern about antibiotic use in animals is that by using them in animals, bacteria will become resistant, and that these bacteria may then infect people, which consequently will lead to these antimicrobials being ineffective for human treatment.
The first thing to understand is that whenever antimicrobials are used, both in animals or people, resistant bacteria will develop.
The debate becomes whether or not antimicrobial use in food animals, particularly growth enhancing antimicrobials, leads to resistance in bacteria, which put humans at risk. Discussion about the details of this risk is beyond the scope of this paper, but there are strong opinions on both sides, which will ensure that issue will not go away anytime soon. Therefore, as producers, we need to be doing all we can by using all approved drugs wisely and correctly.
Some of the articles in the press or on television about the antimicrobial resistant "super bugs" that being found and how animal agriculture is responsible for much of this resistance. The media is more than happy to help sensationalize and fuel the debate. The Internet has many sites with which people or groups with various agendas tell their half-truths or misconceptions as fact. And many of these people or groups have other agendas and are using antimicrobial resistance as another way to move forward whatever it is they are trying to achieve.
Mostly it is an anti-agriculture, anti-corporate farming, anti-technology, anti-development, anti-free trade, and hiding behind the terms of environmentally friendly, healthier for you, etc. These groups are well funded and have people whose full time job it is to pursue their agenda and tell the producer and poultry company how to care for their animals.
And the consuming public is ignorant about what we do in animal agriculture and quickly believe all the false claims and misinformation. All this has put the animal agriculture and especially poultry production, on the defensive.
In response to this, the poultry industry needs to be proactive by adopting judicious use guidelines and principles to help keep these valuable tools available for use. The FDA in cooperation with the AVMA has put together Judicious Use Guidelines for the Poultry Producer and for the poultry veterinarian.
There are 15 Judicious Use Principles in the FDA guidelines, which are a guide for optimal use to maximize the therapeutic effectiveness and minimize the selection for resistant bacteria. They are generally easy to adhere to, and enforce the need that animals should receive prompt and effective treatment as deemed necessary by the prescribing or supervising veterinarian. These principles also recognize the need for a strong, three-way partnership between the producer, the veterinarian, and the poultry company. These guidelines are available from the FDA.
Principle #1
Preventative strategies, such as appropriate husbandry and hygiene, routine health monitoring, and immunizations, should be emphasized.
- Prevent disease as much as possible so no antimicrobial treatment is needed
- Emphasize Biosecurity, hygiene and disinfection, IPM procedures
- The poultry industry is a leader these areas, but the image is factory farms with a dependence on antibiotics.
Principle #2
Other therapeutic options should be considered prior to antimicrobial therapy.
- Treat symptomatically, give TLC.
- Consider using pre- and pro-biotics.
Principle #3
Judicious use of antimicrobials, when under the direction of a veterinarian, should meet all the requirements of a valid veterinarian-client-patient relationship.
- Prescription antimicrobials and any extra-label use require this.
- A valid V-C-P relationship exists when the following conditions are met:
- The veterinarian has assumed responsibility for clinical judgments and the client has agreed to follow veterinarian's instructions
- The veterinarian has sufficient knowledge of the animals to initiate treatment.
- The veterinarian is available for follow-up treatment.
Principle #4
Prescription, Veterinary Feed Directive, and extralabel use of antimicrobials must meet all the requirements of a valid veterinarian-client-patient relationship.
- Federal regulations mandate a valid VCPR for the dispensing and use of prescription and VFD drugs and for extralabel use of drugs.
Principle #5
Extralabel antimicrobial therapy must be prescribed only in accordance with the Animal Medicinal Drug Use Clarification Act amendments to the Food, Drug, and Cosmetic Act and its regulations.
- For food animals, extralabel drug use (ELDU) is not permitted if a drug exists that is labeled for the food animal species and contains the needed ingredients, is in the proper dosage form, is labeled for the indication, and is clinically effective.
- ELDU is permitted only by or under the supervision of a veterinarian.
ELDU is allowed only for FDA approved animal and human drugs.
ELDU is permitted for therapeutic purposes only.
ELDU is not permitted in feed.
ELDU is not permitted with certain drugs. An example is fluoroquinolones.
Principle #6
Veterinarians should work with those responsible for the care of animals to use antimicrobials judiciously regardless of the distribution system through which the antimicrobial was obtained.
- What this is saying is that even over the counter drug use should be done with the advice of a veterinarian.
Principle #7
Regimens for therapeutic antimicrobial use should be optimized using current pharmacological information and principles.
- This is important as the issue of antimicrobial resistance is often about bacteria OTHER than the ones we are treating for in poultry.
- This refers to the correct drug, dose, and duration of treatment.
- Veterinarian is most qualified to make these decisions.
- This will be the most effective use of your treatment dollar.
- Always follow label directions to be sure you are administering correctly and observe all label warnings.
Principle #8
Antimicrobials considered important in treating refractory infections in human or veterinary medicine should be used in animals only after careful review and reasonable justification. Consider using other antimicrobials for initial therapy.
- For poultry, this is for drugs like the fluoroquinolones. But the guidelines also acknowledge that fluoroquinolones are very important for treating colibacillosis.
Principle #9
Use narrow spectrum antimicrobials whenever possible.
- This is to minimize the development of resistance to non-target bacteria. This also will help keep the antibiotics used for animals effective.
Principle #10
Utilize culture and susceptibility results to aid in the selection of antimicrobials when clinically relevant.
- The poultry industry generally does a good job of this. In disease outbreaks treatment may need to be started, but culture and susceptibility tests should be done to be sure of the correct treatment regime.
Principle #11
Therapeutic antimicrobial use should be confined to appropriate clinical indications.
Inappropriate uses such as for uncomplicated viral infections should be avoided.
- This can be tough to do when a flock is sick. Involve the veterinarian to make the best possible clinical decision. Poultry companies should not medicate the grower.
Principle #12
Therapeutic exposure to antimicrobials should be minimized by treating only for as long as needed for the desired clinical response.
- Treat not only until symptoms subside, but also until the risk of recurring infection is gone. This requires knowledge of the type of infection you are treating, but also the pharmacokinetics of the antimicrobial being used. The veterinarian is the best resource to make this decision.
Principle #13
Limit therapeutic antimicrobial treatments to ill or at risk animals, treating the fewest animals indicated.
- The poultry industry comes under scrutiny on this one as it almost always treats an entire flock. Treatment of at risk animals is totally justified, however, long-term antimicrobial treatment to prevent disease requires clear medical justification.
Principle #14
Minimize environmental contamination with antimicrobials whenever possible.
- This is becoming an area of increased surveillance. Runoff from agricultural operations is being implicated for antimicrobial resistance in watersheds and in aquatic species, etc. Always check the label for any environmental warnings.
Principle #15
Accurate records of treatment outcome should be used to evaluate therapeutic regimes.
- This is just good management and important for a number of reasons including compliance and product residue avoidance. A good QA program would require these records.
These guidelines need to be adopted and a part of every farm management plan. The industry needs to take its antimicrobial use responsibility seriously.
The days of indiscriminate antimicrobial use are over. The quicker the industry follows these simple guidelines, the less restrictive the laws may be. If we don't follow the guidelines, and convince the government and public that we are in using antimicrobials wisely, these valuable tools will be taken away.
From Proceedings of the "Midwest Poultry Federation Convention", St. Paul, Minnesota, U.S.A.
