Antimicrobial Sales, Use and Stewardship

What is antimicrobial resistance (AMR)?

when organisms survive exposure to an antimicrobial product expected to kill them or inhibit their growth

What can AMR result in?

• increased frequency of treatment failures

• increased severity of infections - prolonged duration, increased hospitalisation and mortality

• loss of treatment options - human and animal health

What are the global risks of AMR?

1.27 million additional deaths per year

What’s important relating to antibiotic stewardship?

• keep antibiotics working in animals

• minimise risk of AMR transmission to humans

• disease prevention

• responsible antibiotic use

What should you consider when making a health plan for disease prevention?

• biosecurity

• infection control

• husbandry

• vaccination

What should be considering when using antibiotics responsibly?

• correct drug, dose and duration

• lowest clinically effective risk category

• only use when appropriate

Which bacteria are highest risk in terms of transfer of resistance from animals to humans?

• E.coli

• Salmonella spp.

• Campylobacter spp.

What is considered when Highest Priority Critically Important Antibiotics are categorised?

• need in human medicine

• risk of resistant bacteria/resistance genes spreading

• indications & availability of alternative antibiotics if resistance did occur

Which antibiotic groups are the most critical for human medicine?

• fluoroquinolones

• cephalosporins (3rd/4th gen)

• colistin

What are category B antibiotics?

RESTRICT

• critically important in human med and use in animals should be restricted to mitigate risk to public health

• only used when no category C/D antibiotics that could be clinically effective

• use based on antimicrobial susceptibility testing

What is the risk of resistance transfer in 3rd and 4th gen cephalosporins?

resistance often transferable (plasmid mediated)

What is the risk of resistance transfer in polymyxins (colistin)?

resistance gene can spread in plasmid

What is the risk of resistance transfer in quinolones/fluoroquinolones?

select for resistance in campylobacter spp. and salmonella spp.

What does the Red Tractor Farm Assurance scheme say about use of HP-CIA in cattle?

only used as last resort, alongside antibiotic sensitivity testing and/or diagnostic testing

What does the red tractor farm assurance scheme say about use of HP-CIAs in pigs?

requirement to follow Pig Veterinary Society Prescribing Principles

HP-CIA

high priority critically important antibiotic

What is considered regarding AMR surveillance in animals in the UK?

• antibiotic use

• sales

• usage per sector

• monitoring

• control programmes

• scanning surveillance

What sectors are involved in the Veterinary Antibiotic Distribution Channel?

• pharmaceutical company

• feedmill company

• wholesalers

• veterinary practice

• producer

• animal

Which countries tend to have higher use of antibiotics?

countries with lots of pigs

What does this graph show?

shift away from in-feed use and increase of in water use

What are reasons for collecting antibiotic use data?

• monitor trends and impact of control measures/legislation

• target setting

• link with resistance data

• benchmarking and behaviour change

• supporting trade and market access

• reputation, trust and transparency

• link with disease management programmes

What are the key elements of holistic animal health management?

• good animal husbandry

• prudent and medically efficient use of antibiotics

• effective biosecurity

• relevant vaccinations

What is a legal requirement regarding antibiotic use in the EU?

antibiotic use data collection

What food-producing animal species have the highest antibiotic usage (from most to 4th highest)

• pigs

• broilers

• gamebirds

• laying hens

What food-producing animal species have the highest HP-CIA usage (from most to 5th highest)?

• gamebirds

• trout

• pigs

• laying hens

• meat poultry

How has the use of antibiotics in companion animals changed?

decreased

What are the challenges regarding getting antibiotic use data?

• fragmented supply chain/diverse farm types

• technical barriers - lack of integration with PMS

• motivation barriers

• resources/infrastructure

• data sharing/trust

What is considered regarding the future of antibiotic data?

• expectation that antibiotic use data collection will be collected

• focus on greater automation/links to PMS/continuous ‘real-time’ data collection - guide to vet-farmer discussion and decision making

• move towards companion animals

• integration with other datasets including health and welfare, disease & resistance

PMS

practice management system

What harmonised outcome indicators measured for?

antibiotic sales

What does overlaying indicators for sales with those for resistance illustrate?

how reductions in antibiotic sales since 2014 are reflected in reductions in resistance over the same time period

What are the 3 main ways of administration of antibiotics?

• treatment

• metaphylaxis

• prophylaxis

Why is there success in reducing antibiotic use?

government focus

• leadership

• relationship building

• antibiotic sales and resistance monitoring

industry ownership

• sector stewardship groups

• data collection - benchmarking & target setting

• vet and farmer education and goal-setting