Applying lessons from veterinary clinical trials to antimicrobial stewardship

Abstract

Antimicrobial stewardship has been one of the largest buzzwords in veterinary and human medicine for several years. The American Veterinary Medical Association (AVMA) defines antimicrobial stewardship as: “…the actions veterinarians take to preserve the success and availability of antimicrobial drugs through conscientious oversight and responsible medical decision-making while safeguarding animal, public, and environmental health.” Definitions for antimicrobial stewardships are used repetitively throughout the veterinary profession with varying interpretations. This can cause difficulties for veterinarians “in the trenches” as decisions must be made daily on how to best support stewardship for the veterinarian, client, and the rest of the population. Livestock veterinarians have a unique role in antimicrobial stewardship, with their decisions on antimicrobial usage having potential effects on the foodstuffs that the public consumes. It is partly due to this reason that the usage of antimicrobials in veterinary livestock medicine have been under ever-increasing scrutiny over the last decade. An overwhelming number of different metrics have been developed and discussed over the last several years to measure and monitor usage patterns of antimicrobials in livestock systems. These metrics are beyond the scope of this discussion, but are noted here because it is likely that the veterinary livestock practitioner and their clients need to be prepared to justify and document antimicrobial treatments at some point in the future. The veterinarian and producer must continue to challenge themselves to improve preventative and management practices in order to minimize the need for therapeutic interventions in the first place. The veterinarian must work with producers to ensure that a stewardship plan is in place and also to identify ways to monitor the outcomes of treatment to be able to adjust antimicrobial usage as necessary.