Antimicrobial stewardship in practicality

By Kevin J. Jacque, DVM, PAS – Clinical Assistant Professor, OSU Large Animal Services at Marysville

In 2021, the FDA provided a guidance document and timeline for the removal of medically important antimicrobial products from over-the-counter status to prescription status (OTC to Rx). This guidance was titled GFI 263, “Recommendations for Sponsors of Medically Important Antimicrobial Drugs Approved for Use in Animals to Voluntarily Bring Under Veterinary Oversight All Products That Continue to be Available Over-the-Counter Guidance for Industry.” This governmental issue was officially started in practice in June 2023 which allowed for the removal of products like penicillin, oxytetracycline, sulfa antibiotics, tylosin, lincomycin, and mastitis intramammary tubes. Most of you may remember not being able to buy Penicillin or LA200 at the farm store after a while (once current stocks were depleted from inventory). This may have caused some stress to farm animal owners, but many notices were sent.

The change from OTC to Rx has been part of a long line of documents, guidance, and federal regulations to curb the growth of antimicrobial resistance, or when an antimicrobial doesn’t work anymore in its intended use due to microbial population selection. The main goal of changing the status was to reduce overuse, mitigate improper use, and improve veterinary oversight to ensure that there was adequate antimicrobial stewardship. The term stewardship is thrown around a lot about many different things. Accorinding to the World Health Organization, “Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials.” Stewards tend to be those who are entrusted with responsibility of a particular place, thing, or person. As stewards of antimicrobials, farmers, employees, and veterinarians should know the proper reasons for selecting an antimicrobial product, how to dose a regimen (regimen = dose, route, frequency, duration, amount, etc.) of that product, and how to establish a withdrawal period in food producing species.

Jumping to today – three years after the institution of Rx status for common antimicrobials, how are you fairing in being a steward of antimicrobial drugs? Have you discussed treatment protocols with your veterinarian? Have you seen your veterinarian within the last 12 months? Have you properly stored your antibiotics? Did you open a bottle more than a year ago and just used that bottle this week? Did you pull out a dose from the bottle with the same needle and syringe you used to treat several other animals? These could all be within the realm of good or poor stewardship. As animal owners, we should feel the moral duty to be the best steward to our livestock species. What do we do on a routine basis that may jeopardize our antibiotic status? Do we provide proper antibiotic therapy within a timely manner? Or do we wait until the animal degrades in quality before seeking more treatment or at the lowest point, euthanasia?

In practical terms, most people likely use antimicrobial drugs within a normal range. We commonly see outliers that stretch the intended range due to poor treatment decisions, unapproved use, illegal use, and lack of veterinary oversight. Here are some practical considerations:

1. Read the drug label.
2. Identify the proper dose, route, frequency, and duration of treatment.
3. Correctly estimate your animal’s weight by visualization or use a scale or weight tape.
4. Ensure safe handling areas for administering treatments.
5. Correctly identify the disease.
6. Engage your veterinarian in oversight.
7. Choose the proper syringe size and needle size for injectable drugs.
8. Store your drugs out of sunlight and away from extreme heat and cold (usually store in room temperature) unless a product requires refrigeration (i.e., Penicillin).
9. Work with your veterinarian to establish written treatment protocols and best management practices for common diseases in your animal herds or groups.

Now, as far as veterinary medicine, we are doing an excellent job in curtailing poor stewardship of antibiotics, but we can always improve. According to the FDA, the amount of antimicrobials in food animal production does remain lower today than ten years ago, but there is not a good knowledge of how well the products are being used on the farm. The use of the products all comes down to you, the producer, the veterinarian, and the company sponsoring the drug. Are you still treating every animal with diarrhea with an antimicrobial even if it doesn’t need it? Are you undertreating respiratory disease? Are you providing means to reduce your antibiotic use through management, facility changes, ventilation, nutrition, and housing? Do you have a veterinarian to consult? Be a steward, not a destroyer. Engage in healthy systems-based management of your animals and provide the means to know when to seek outside help – there is always someone who could!