Antimicrobial Use and Stewardship

CDFA-AUS  •  1220 N Street, Sacramento, CA 95814  •  916-576-0300

Antimicrobial Stewardship

The emergence of bacteria that are resistant to antimicrobials is a serious threat to animal health, human health, and the planet.1-4 Physicians, veterinarians, livestock owners, companion animal owners, and the general public all contribute in the One Health effort to fight against the development of antibiotic resistance by incorporating antimicrobial stewardship into their day-to-day activities.

Antimicrobial Stewardship Plans aim to optimize patient health and improve antimicrobial drug use in order to preserve the efficacy and ensure the availability of antimicrobials for years to come. 5-11

The comprehensive antimicrobial stewardship approach in veterinary medicine includes reducing the need for antimicrobial drugs by implementing livestock management practices that aid in the prevention of infectious disease in addition to using antimicrobial drugs selectively and responsibly to optimize animal health and minimize the risk for developing antimicrobial resistance. 9-11 The following five principles are the foundation to a successful antimicrobial stewardship plan. Based on these principles, the CDFA Antimicrobial Use & Stewardship program is working in collaboration with university and cooperative extension experts to provide scientifically-based guidelines for veterinarians and livestock owners.

Program notes are provided to update the reader on the progress the AUS program has made on the guidelines* that will inform measures to mitigate antimicrobial resistance. Notes are current as of publication.

Californians will lead the nation in efforts to reduce antimicrobial resistance by effectively uniting the animal management expertise of livestock owners and personnel responsible for animal care with the scientific knowledge and professional training of veterinarians. Establishing a veterinarian-client-patient relationship (VCPR) is an essential first step in the development of an Antimicrobial Stewardship Plan.1,3,4,9,12-19

Program Note: Guidelines on VCPR Practice Models have been developed for interactions with youth agriculture groups and additional models are forthcoming.
VCPR Example – Agent Authorization This document is not required for youth agriculture participation, or to establish or maintain a VCPR. The intent of the document is to inspire creative solutions within the context of the definition of a VCPR in California. A VCPR is validated by the communications and actions between the veterinarian and the client.
Nominate Veterinary Shortage Areas Help guide CDFA’s efforts to nominate veterinary shortage areas for USDA’s Veterinary Medicine Loan Repayment Program (VMLRP). The program helps qualified veterinarians offset a significant portion of the debt incurred in pursuit of their veterinary medicine degrees in return for their service in certain high-priority veterinary shortage situations.
A collaborative effort between the individual livestock owner and the veterinarian to design a well-rounded animal health program will most effectively address the unique challenges faced by each operation, farm, or ranch. Animal health programs should be science-based, practical, and respect the owner’s resources and values.12 These programs cover fundamental areas such as low-stress animal handling, facility design, land management, sanitation, biosecurity, transportation, feeding and nutritional recommendations, animal genetics, and protocols to aid in the prevention of specific diseases based on a risk assessment and on the efficacy of available animal health products.4,12,14-16,18,19 Thoughtful design and implementation of animal health programs should greatly limit the need for antimicrobial therapy while reducing economic losses and promoting animal health and wellbeing.4,7,10,12

Program Note: Best management practices and syndrome-specific antimicrobial stewardship guidelines will be developed for each livestock production type after information is gathered from California livestock owners in order to recommend effective, practical, and scientifically-based practices.
To establish the need for an antimicrobial drug, judicious use necessitates a thorough evaluation and diagnosis of disease or infection, careful assessment of the benefit, efficacy, legality** and safety of an antimicrobial therapeutic regimen, and consideration of the use of effective and practical non-antibiotic treatment alternatives.1,12-17 Livestock owners and personnel responsible for animal care should follow instructions to ensure proper storage and careful administration of the medications, maintain necessary records, and to carry out the designated withdrawal interval for eggs, milk, or meat food products from treated animals.1,10,13-20

** Laws regarding drug use in livestock are established in order to ensure meat, poultry, dairy and eggs are safe for our families to eat and protect animal and human health. Please go to the Federal & State Policy page for more details on current laws.
Guidelines for Judicious Use of Antimicrobials in Livestock These guidelines are intended to aid livestock owners and their employees responsible for animal care in responsible antibiotic use under the guidance of a veterinarian in compliance with state and federal laws.
Guidelines for Veterinarians: Judicious Use of Antimicrobials in Livestock These guidelines are intended to serve as an adjunct to professional judgement. They are based on current scientific principles and state and federal laws regarding medically important antimicrobial drug use in livestock.
Responsible Antibiotic Use This printer-friendly infographic of AUS’ Guidelines for Judicious Use of Antimicrobials in Livestock (see full text in documents above) is intended to help veterinarians, livestock owners, and their employees understand their roles and the necessary actions taken to preserve the effectiveness of antibiotics, also referred to as antibiotic stewardship.

Printing Tip: For best printing results, adjust your Printer Properties to:
Orientation: Landscape and Scale: Shrink to Fit.
Veterinarians and livestock owners work together to develop a record keeping system that serves the needs of the individual operation.1,10,12-19 Records should include an accurate drug inventory, production performance records, livestock health records that include treatment outcomes, and results of diagnostic tests, such as culture, necropsy, and antimicrobial susceptibility testing as necessary to provide a complete picture of on-farm animal health management. Knowledge of this information will aid in monitoring the value of the animal health program and the application and outcome of treatment protocols, as well as trends in antimicrobial resistance. Routine evaluation of records is critical to the continuous improvement of animal health programs and treatment protocols.1,5-8,16-19 Veterinarians and livestock owners are encouraged to contribute to the information gathered by the CDFA Antimicrobial Use & Stewardship program. Participation in these surveys and studies will improve our understanding of the role of strategic antimicrobial use in the fight against antimicrobial resistance.

Program Note: For information on data gathering efforts please go to the Surveys & Studies page.
Continuing Education for Judicious Use of Medically Important Antimicrobial Drugs (MIADs)
This link will redirect you to the Veterinary Medical Board's Continuing Education page. California veterinarians looking to fulfill their CE requirement in judicious use of MIADs may find resources here.
Opportunities for dairy antimicrobial stewardship continuing education:

Partnering for Antimicrobial Stewardship: A Conference for Farmers and Veterinarians in the West***
This free, one-day, interactive, multimedia conference will take place on April 17, 2020 in Portland, Oregon with interactive “Go-To-Meeting” locations in Lynden (WA); Modesto, Tulare, Orland (CA); and Twin Falls (ID). This shared venture by AUS and Washington State University will bring together dairy veterinarians and their producers to discuss on-farm antimicrobial stewardship measures. Up to 6 hours of continuing education for veterinarians will be provided from speakers with practical expertise in dairy antimicrobial stewardship. More information is available at: https://vetextension.wsu.edu/dairy-antimicrobial-stewardship/.
***Funding for this conference was made possible, in part, by the Food and Drug Administration through grant 1 R13 FD006696-01. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does any mention of trade names, commercial practices, or organization imply endorsement by the United States Government.

Please contact us with any questions or requests for Continuing Education speakers related to large animal antimicrobial stewardship. Email cdfa_aus@CDFA.ca.gov or reach out by phone at (916) 576-0300.

Printer Friendly Version: Principles of Antimicrobial Stewardship.

References

  1. Joint FAO/WHO Codex Alimentarius Commission, World Health Organization, Food and Agriculture Organization of the United Nations. Animal food production. 1st ed. Rome, 2008.
  2. FDA. Guidance for Industry #152. Evaluating the Safety of Antimicrobial New Animal Drugs with Regard to Their Microbiological Effects on Bacteria of Human Health Concern. https://www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/GuidanceforIndustry/UCM0
    52519.pdf
    , 2003.
  3. FDA. Guidance for Industry #209. The Judicious Use of Medically Important Antimicrobial Drugs in Food-Producing Animals. https://www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/GuidanceforIndustry/UCM
    216936.pdf
    , 2012.
  4. Weese JS, Giguère S, Guardabassi L, et al. ACVIM Consensus Statement on Therapeutic Antimicrobial Use in Animals and Antimicrobial Resistance. Journal of Veterinary Internal Medicine 2015;29:487-498.
  5. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2016;62:e51-77.
  6. Stenehjem E, Hyun DY, Septimus E, et al. Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2017;65:691-696.
  7. Libertin CR, Watson SH, Tillett WL, et al. Dramatic effects of a new antimicrobial stewardship program in a rural community hospital. American Journal of Infection Control 2017;45:979-982.
  8. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. 2015. https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.html Accessed March 19, 2018.
  9. AVMA. Antimicrobial Stewardship Definition and Core Principles. 2018. https://www.avma.org/KB/Policies/Pages/Antimicrobial-Stewardship-Definition-and-Core-Principles.aspx Accessed March 19, 2018.
  10. AABP. Key Elements for Implementing Antimicrobial Stewardship Plans in Bovine Veterinary Practices Working with Beef and Dairy Operations. 2017. http://aabp.org/resources/AABP_Guidelines/AntimicrobialStewardship-7.27.17.pdf
  11. Manning ML, Septimus EJ, Ashley ESD, et al. Antimicrobial stewardship and infection prevention—leveraging the synergy: A position paper update. American Journal of Infection Control 2018;46:364-368.
  12. Morley PS, Apley MD, Besser TE, et al. Antimicrobial Drug Use in Veterinary Medicine. Journal of Veterinary Internal Medicine 2005;19:617-629.
  13. AVMA. Judicious Therapeutic Use of Antimicrobials. 2018. https://www.avma.org/KB/Policies/Pages/Judicious-Therapeutic-Use-of-Antimicrobials.aspx Accessed March 19, 2018.
  14. AVMA. AABP/AVMA Judicious Therapeutic Use of Antimicrobials in Cattle. 2018. https://www.avma.org/KB/Policies/Pages/AABP-Prudent-Drug-Usage-Guidelines-for-Cattle.aspx Accessed March 19, 2018.
  15. AVMA. American Association of Swine Veterinarians Basic Guidelines of Judicious Therapeutic Use of Antimicrobials in Pork Production. 2018. https://www.avma.org/KB/Policies/Pages/AASV-Basic-Guidelines-of-Judicious-Therapeutic-Use-of-Antimicrobials-in-Pork-Production.aspx Accessed March 19, 2019.
  16. AVMA. AAAP-AVMA Guidelines for Judicious Therapeutic Use of Antimicrobials in Poultry. 2018. https://www.avma.org/KB/Policies/Pages/AAAP-Guidelines-to-Judicious-Therapeutic-Use-of-Antimicrobials-in-Poultry.aspx Accessed March 19, 2018.
  17. Guidelines A. Prudent Antimicrobial Use Guidelines for Cattle. 2013. http://aabp.org/resources/aabp_guidelines/AABP_Prudent_Antimicrobial_Use_Guidelines-2013.pdf
  18. BQA. Antibiotic Stewardship for Beef Producers https://www.bqa.org/Media/BQA/Docs/bqa_antibiotics_final.pdf Accessed March 19, 2018.
  19. Board NP. Pork Industry Guide to Responsible Antibiotic Use. 2016. https://d3fns0a45gcg1a.cloudfront.net/sites/all/files/documents/PQAPlus/V3.0/BinderMaterial/Tab%204/1%20AntibioticsBooklet.pdf Accessed March 19, 2018.
  20. FDA. Animal Medicinal Drug Use Clarification Act. 21 FCR 530. USA: https://www.ecfr.gov/cgi-bin/text-idx?SID=054808d261de27898e02fb175b7c9ff9&node=21:6.0.1.1.16&rgn=div5, 1994.