While the medical community recognizes that the emergence and
spread of antimicrobial resistance (AMR) in humans is a potential
disaster for humanity and that it is the overuse of antimicrobials
in human medicine that is the largest contributor, there is a broad
consensus that the use of antibiotics in animals contributes to the
problem, though the scale is still unclear. This uncertainty is due
mainly to a failure to adequately control and monitor the use. As
we saw last month, Health Canada (HC) lacks the authority to
control and monitor use because the practice of veterinary medicine
falls under provincial jurisdiction. Recognizing that almost all
practical efforts to reduce the level of antibiotics in meat depend
on the more active participation of veterinarians, HC announced
recently that it wanted "to develop options to strengthen the
veterinary oversight of antimicrobial use in f ood
What can veterinarians and their provincial regulatory licensing
bodies do now to reduce the threat of AMR? Here are four
1. Enhance awareness among members
While the Canadian Veterinary Medical Association (CVMA) has
developed voluntary Prudent Use Guidelines, I'm told that many
vets are hardly aware of the issue and may not even know of the
Guidelines. Concerned enough about this, Ontario's regulatory
body, the College of Veterinarians of Ontario, just announced that
it was launching a project to study the use of antibiotics among
food animal veterinarians and to determine if they use the
CVMA's Guidelines in daily practice. Quebec requires a
mandatory day-long AMR program and a test. All provinces should
follow Quebec and develop mandatory continuing education programs
on antimicrobial stewardship.
2. Fill the regulatory gaps
As long as vets continue to prescribe off label use and the use
of Active Pharmaceutical Ingredients (APIs) in production medicine,
it's impossible to know the level of antibiotic use. Own Use
Importation (OUI) by animal owners is another avenue for which use
information is unavailable. As one recent report stressed:
"The gap in reliable usage data makes it difficult to state
with confidence which antimicrobials are used, in what quantities,
and for what purposes." The recent critical assessment by a
group of experts, titled "Stewardship of antimicrobial drugs
in animals in Canada: How are we doing in 2013?" (Canadian
Veterinary Journal, March 2014), highlighted the absolute
importance of improving Canada's monitoring of antimicrobial
3. Conflict of interest issue
This issue has been flagged by several reports going back to the
landmark McEwen Report of 2002. Veterinarians obtain income from
the profitable sale of antimicrobials. Decoupling veterinary
prescribing from dispensing raises several issues because the
current veterinary practice business model is based on an income
stream from antimicrobial sales. Veterinarians should lead a
dialogue on this important issue that clearly needs closer
4. Antibiotics for disease prevention
As we saw last month, the real issue is not the use of
antibiotics for growth promotion or the treating of disease, but
whether they should continue to be used for disease prevention.
While some antibiotics of very high importance to human health
should only be used to treat infection, there are several arguments
that some of high or medium importance to human health (what HC
calls Category ll and lll, for example tetracyclines) should still,
with closer veterinarian oversight, be used for disease prevention.
Because major retailers, processors and consumers increasingly
demand meat with "raised without antibiotic" claims, the
marketplace is forcing changes in practice. But we mustn't lose
sight of the fact that while there are risks to using
antimicrobials in animal production, there are also risks with
Two thirds of animal diseases are zoonotic, meaning the disease
is transferable to humans. For this and other reasons, I have been
a long-time proponent of strengthening the connections between
human and animal medicine — the concept known as One Health.
In this context, AMR represents an historic opportunity for vets to
step up and provide greater leadership.
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