26 Antimicrobial Resistance and the DVM role

FALSE: Most veterinary antibiotics are from human practice, there are almost no antibiotics engineered for animals and can be taken away if misused.

TRUE OR FALSE: There are several available antibiotics that are engineered with animal welfare in mind.

Natural (Resistance has not developed just due to human use)

Antibiotic resistance is a/n natural/artificial process.

Survival mechanism for competition, and exposure to antibiotics selects for resistant strains (those who are exposed and survive become the dominant and resistant strain)

What is the purpose of antibiotic resistance for bacteria?

Alexander Fleming

Who discovered Pencillin?

Someone underdoses themselves and exposes the microbes to non lethal quantities of the drug to make them resistant

How does antibiotic resistance happen?

18% decrease

How many fewer deaths from antibiotic resistance overall have been reported since 2013 (percentage)?

28% decrease

How many fewer deaths from antibiotic resistance have been reported in hospitals since 2013 (percentage)?

Vancomycin-resistant Enterococcus (largest decrease at 41%), Carbapenem-resistant Acinetobacter, Multidrug-resistant Pseudomonas aeruginosa, Drug-resistant Candida, and Methicillin-resistant Staph aureus (smallest decrease at 21%)

There has been a decrease in what infections since 2019?

35,000

How many deaths are from antibiotic resistance from each year?

There has been a steady increase each year with the amount of New Antibiotic drugs approved for use

What has been going on with new antibiotic approvals from 2008 to now?

This is a response to antimicrobial resistance and a response to what the economics of these drugs are (including the development/research time)

Why would we want to have new antibiotic drug approvals?

Pound for pound, humans and their pets use 10x the amount of antibiotics than what is used in food animal production

Humans and their pets use what amount of antibiotic products in comparison to food animal production?

Penicillin (44%), tetracyclines (4%), cephalosporins (15%)

What types of antibiotics are used in human medicine?

Penicillin (6%), Tetracyclines (44%), and Ionophores (30%)

What types of antibiotics are used in animal agriculture?

Ionophores are NEVER used in people. Cephalosporins are not used in animals. Animals only use a little bit of penicillin (the main human antibiotic), and humans only use a little bit of Tetracycline (the main animal antibiotic).

What is the overlap like in antibiotics used by humans versus animal agriculture?

TRUE

TRUE OR FALSE: 71% of antibiotics used in animals are rarely or never used in human medicine.

Ionophores

What animal antibiotic is NEVER used in humans?

A human is treated with antibiotics that does not kill all microbes. The resistant bacteria develop in the gut. The bacteria are excreted into the environment wherever he goes either by hand contact, fomites, or human-human. Humans can also get it from animals, where an animal is treated with antibiotics that does not kill all microbes. The resistant bacteria develops and then remains on their meat and spreads if unwashed/uncooked. Bacteria can spread through feces/fertilizer which remain on unwashed crops which can be spread to humans.

Describe pathways that humans may become exposed to antimicrobial resistant bacteria

U.S. Food and Drug Administration (FDA NOT USDA)

What program approves all animal and human drugs?

U.S. Food and Drug Administration

Which program considered risks to human health/environment when assessing animal drug applications, can withdrawal drugs with human health risk, and inspects feed mills to assure correct animal antibiotic use?

Injudicious (but not unsafe)

How is "Production Use" (so growth promotion and nutritional efficiency in animals, fed without evidence of disease) of antibiotics termed?

FALSE: Use of antibiotics for production/growth purposes is FORBIDDEN.

TRUE OR FALSE: You can use antibiotics for production and growth purposes in livestock.

Eliminate use of antibiotics that are deemed medically important for human health for growth promotion purposes

What does the FDA's policy on antibiotics used in feed animals say about growth promotion?

Veterinary Feed Directive

What does VFD stand for?

VFD

Which program states producers need to consult with veterinarians before using feed/water medication, requiring vets to provide a written directive with copies for feed manufacturer and client and you MUST HAVE an established Veterinary Client Patient Relationship?

VFD

For which program is an established Veterinary Client Patient Relationship necessary?

VCPR (veterinary client patient relationship)

The VFD's final rule continues to require veterinarians to issue all VFDs within the context of what?

1. Vet assumes responsibility for making clinical judgements regarding the health of the patient
2. Vet has sufficient knowledge of the patient to initiate at least a general/preliminary diagnosis of a patient's medical condition
3. Vet is available for follow-up evaluation
4. Vet provides oversight of treatment, compliance, and outcome
5. Patient records are maintained

What are the 5 requirements for a VCPR?

Issuing a VFD

These responsibilities/burdens and more are all necessary for what?:
1. Vet and client name/address
2. Premise ID
3. Date of issuance and expiration
4. Name of drug
5. Drug class
6. Number of animals
7. Withdrawal time

VFD or a prescription

All medically important antibiotics to be used in feed or water for food animal species require ...?

MUST HAVE VFD even if not intended for food production

What is necessary for giving ANY livestock feed/water antibiotics, even if they are NOT intended for food production?

Animal Medicinal Drug Use Clarification Act

What is AMDUCA?

Extra Label Drug Use

What is ELDU?

Extra Label Drug Use (ELDU)

What is defined as the use of any drug other than as approved and described on the label?

1. To treat disease
2. When there is no approved food animal drug containing the needed ingredient/dosage
3. When vet determines the approved drug is clinically ineffective
4. For prevention of disease if vet proves the health of the animal is threatened

In what 4 scenarios/conditions does the Animal Medicinal Drug Use Clarification Act allow for Extra Label Drug Use in animals?

Extra Label Drug Use in animals

What are these requirements for?
1. A valid VCPR
2. Use only as prescribed
3. Only FDA approved drugs used
4. Injectable or water ONLY
5. Prolonged withdrawal
6. Maintained records for 2 years
7. Treatment use ONLY (not production)

CANNOT use in feed

Which drug administration route is NOT ALLOWED for extra label drug use in animals?

1. Cannot use for production purposes
2. Cannot use in feed
3. Cannot use to save cost
4. Cannot use if it is a restricted/prohibited drug
5. Cannot use if there is already an approved other drug intended for animal use

In which conditions is Extra Label Drug Use NOT ALLOWED in animals?

In the feed is ILLEGAL

It is important to note that any extra label use of a drug in what form is ILLEGAL for food animals?

NARMS

What program monitors antimicrobial resistance among enteric bacteria from humans, retailed meats, and food animals?

Humans, retail meats, food animals

From what 3 sources does NARMS monitor antimicrobial resistance from?

CDC

What organization monitors humans through NARMS for antimicrobial resistance?

FDA

What organization monitors retail meats through NARMS for antimicrobial resistance?

USDA

What organization monitors food animals through NARMS for antimicrobial resistance?

USDA, FDA, CDC

What 3 national organizations are apart of NARMS?