REVIEW OF ANTIBIOTIC STEWARDSHIP;
RESPONSIBLE NOT RESTRICTED USE OF
ANTIMICROBIALS IN EQUINE PRACTICE
Mark Bowen
Associate Professor of Veterinary Internal Medicine, Faculty of Medicine and Health
Sciences University of Nottingham
Take home messages
The 2005 ACVIM consensus statement1 developed a series of recommendations for
responsible antibiotic use that mirror principles adopted in human medicine. The use
of standard treatment guidelines are often shunned in veterinary practice as
‘removing the art of veterinary medicine’. This review will demonstrate that light touch
protocols can impact on antimicrobial usage in equine practice without detrimental
effects on clinical outcomes.
Introduction
Antibiotic resistance is observed but is only an occasional clinical problem in equine
practice 2-10; The threat of a ‘post antimicrobial era’ in equine practice would appear
unlikely to most. However both Methicillin resistant Staphylococcus aureus (MRSA)
and Methicillin resistant Staphylococcus pseudintermedius are being encountered on
an increasing basis6,9,10. In addition there is an emerging pattern of resistance in
E.coli, which although rarely pathogenic in the horse, is used as a sentinel for
monitoring emerging resistance patterns2,3. A more immediate threat to antibiotic
effectiveness in equine practice comes from the potential for imposed formulary
restrictions from national governments that could prevent the use of certain classes
of antibiotics in certain species. The World Health Organisation (WHO) has ranked
the importance of certain antimicrobials to human health and has lobbied for
restrictions to be placed on veterinary use of certain Critically Important
Antimicrobials (CIAs)11.
Critically important antimicrobials (CIAs)
The WHO list of CIAs includes many antimicrobials, such as the penicillins and
aminoglycosides, that are critically important for equine health and therefore our
continued use of many of these agents is essential for the work of the equine
veterinarian12. The ‘highest priority’ CIAs are those for which judicious use is most
important. This includes the flouroquinolones (enrofloxacin, marbofloxacin and
ofloxacin being most commonly used in equine practice), the 3rd and 4th generation
cephalosporins (ceftiofur and cefquinome) and the macrolides. They remain essential
for veterinary use, but have seen increasing international pressure to restrict their
usage in veterinary species, due to the widespread development of resistance in
bacteria that result in significant disease in humans. To date, the call for restrictions
has focussed on food producing animals, impacting on the use of flouroquinolines
and cephalosporins in food producing species. However the pressure to reduce
veterinary use of these agents, irrespective of species continues. As a result, the
need to act responsibily and to be seen to be acting responsibly has never been
more important.
Recently an alternative classification system has been proposed by The Euopean
Medicines Agency (EMA) that defines risk based on three categories13.
1. Category 1: Antibiotics with low or limited risk to public health (including
Macrolides)
15-‐18
February
2016
East
London
Convention
Centre,
East
London,
South
Africa
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