Thursday, September 24, 2015
Prudent Antimicrobial Use in an Antimicrobial-Resistant World
TULSA, OKLAHOMA—“In a perfect world, antimicrobials used in animals would be unrelated to those used in humans. But, we are not in a perfect world,” says J. Scott Weese, DVM, DVSc, DACVIM, Editor in Chief, Clinician’s Brief. “All of the antimicrobial drug classes that we use clinically in companion animals are also used in humans. As a result, we have to be cognizant of the potential impact of veterinary antimicrobial use on public health while maintaining a high level of patient care.”
In an effort to lend direction to the veterinary community, Clinician’s Brief is instituting an antimicrobial stewardship policy, adapted from one recently launched by the Equine Veterinary Journal. As such, our new policy states:
Authors who provide antimicrobial treatment recommendations must consider the potential impact of veterinary drug use on public health. In particular, authors should avoid recommending extralabel use of fluoroquinolones and extended-spectrum ß-lactam antimicrobials (eg, third- or fourth-generation cephalosporins) or recommended drugs such as carbapenems, glycopeptides and oxazolidinones used for treatment of multidrug-resistant pathogens in humans. If use of any of these is recommended, there must be a specific mention of the relevant issues, and evidence supporting the recommendation must be provided.
This policy focuses on careful consideration, not prohibition, and we recognize there are certain instances when these drugs are clinically indicated. Authors may still recommend extralabel use of fluoroquinolones, third-generation cephalosporins, and use of other classes such as carbapenems; however, those recommendations must be justified, and those justifications will be scrutinized.
“Antimicrobial stewardship is key. We need to make sure we use antimicrobials (all antimicrobials) properly. We need to take special care with drug classes that are of particular importance in humans,” Dr. Weese says. “Veterinarians need to take the lead here—because if we do not, someone else might. In some European countries, use of various drug classes in companion animals is banned. That raises the specter of having a patient with a life-threatening infection that would probably respond to a specific antibiotic, but would instead perish because use of the required drug is banned in animals. Whether that will happen in other countries is hard to say, but it is far from impossible. If we show that we are addressing the issue, perhaps we can stem the tide of resistance and pressure to restrict access to antimicrobials.”
“Our new stewardship policy puts veterinarians at the forefront of effective public health practices,” says Brief Media Chief Veterinary Officer, Indu Mani, DVM, ScD, FNAP. “Most importantly, it provides guidelines for practitioners to make judicious antimicrobial use actionable every single day at work.”
Brief Media’s Antimicrobial Stewardship policy went into effect with the June 2015 issue of Clinician’s Brief.