Antimicrobial Use in Animals – Position Statement
November 14, 2014
The CVMA strongly supports the responsible use of antimicrobials by the veterinary profession to protect both animal and human health and welfare.
Veterinarians are best positioned to assess the benefits and risks of antimicrobial use in animals, and must explain to their clients the importance of judicious use of antimicrobials. To conserve the efficacy of antimicrobial drugs, veterinarians must strive to achieve a balance between maximizing animal health and welfare and minimizing bacterial resistance.
Antimicrobials of high importance in human medicine (Veterinary Drugs Directorate Category I-III) should only be used in animals under veterinary oversight and pursuant to a prescription generated by a veterinarian, who has established medical need and appropriateness, through application of the principles of a valid veterinary-client-patient relationship (VCPR) (1).
Antimicrobials approved by Health Canada for the treatment of the diagnosed condition should be used whenever possible and the dose, frequency, and duration stated on the label should be followed in absence of evidence-based support for extra-label use (2).
- Veterinarians engage in research and educational programs supporting the science of prudent use of antimicrobials to prevent antimicrobial resistance. Veterinarians have a unique responsibility in ensuring health, and are committed to improving the health and welfare of the animals they treat in a manner that also protects human health. The CVMA strongly supports a “One Health” approach that brings the expertise of veterinary and human health sciences together to collaborate on critical cross-cutting health issues, such as prudent antimicrobial use and how it relates to the control of antimicrobial resistance. The goal is to improve health for both animals and humans. The CVMA supports veterinary continuing education in the judicious use of antimicrobials.
- The CVMA recognizes that the emergence of antimicrobial resistance is a global concern. The CVMA holds that the human medical, veterinary medical, agricultural, and regulatory communities must work co-operatively to minimize the emergence and continued spread of antimicrobial resistance. The use of some antimicrobials in animals may result in an unjustified higher risk of antimicrobial resistance, particularly with sub-therapeutic and growth promotional antimicrobials administered to production animals in feed and water (3,4).
- Veterinary oversight of antimicrobial use pursuant to a veterinary prescription within a valid VCPR is a principle that is regulated by the provincial veterinary licensing bodies. This principal incorporates investigation by the veterinarian, medical knowledge regarding antimicrobial use, medical record management and other documentation and education/instruction of the end user (owner). Availability for follow up and recording of treatment failure or adverse reactions is also the responsibility of the veterinarian. The CVMA recognizes that availability of medically important antimicrobials by prescription only will require extensive consultation with veterinary and livestock producer stakeholders, as it could mean changes to the current animal production business model.
- In promoting antimicrobial stewardship, veterinarians should take an approach of continuous improvement based on responsibility, reduction, refinement, replacement, and review. Good stewardship practice is a dynamic approach that includes the elements of: ongoing continuing education, ensuring owner compliance, following relevant practice guidelines, pharmacokinetic and pharmacodynamic considerations affecting dosage, the use of clinical microbiology data, good infection control practices, and compliance with national regulations, among other considerations (5-7).
- Antimicrobials approved by Health Canada for the treatment of the diagnosed condition should be used whenever possible. The dose, frequency, and duration stated on the label should be followed whenever possible. Although there are circumstances in which appropriate extra-label drug use (ELDU) is essential in veterinary medicine, antimicrobials should not be used in an “extra-label” manner unless there is evidence-based support for efficacy, dosage regimen, indication, and withdrawal times (2). The Canadian Global Food Animal Residue Avoidance Database (CgFARAD) is recommended as an appropriate resource for extra-label uses of antimicrobials. If an antimicrobial is selected for extra-label use, the veterinarian must provide (in writing) the appropriate information on dose, route, frequency, duration, and withdrawal time (if applicable) to avoid any risk to human health. Veterinarians should be familiar with Health Canada’s Veterinary Drug Directorate “Categorization of Antimicrobials Based on Importance in Human Medicine” and make antimicrobial selections within less important categories whenever the patient can be appropriately treated by this category (1). This applies to on-label and extra-label use of antimicrobials. The CVMA promotes general and specific guidelines for the prudent use of antimicrobials by the veterinary profession.
- The CVMA recognizes that provincial regulatory authorities license veterinarians in Canada and thus regulate the practice of veterinary medicine and determine elements that include:
- What constitutes a valid VCPR.
- Any provincial requirements for the use of antimicrobials (on-label and extra-label) by veterinarians.
- Veterinary Drugs Directorate’s (VDD) Categorization of Antimicrobial Drugs Based on their importance in Human Medicine (Table 23). Available from: http://www.hc-sc.gc.ca/dhp-mps/vet/antimicrob/amr_ram_hum-med-rev-eng.php. Last accessed November 10, 2014.
- Canadian Veterinary Medical Association, CVMA Extra-label Drug Use (ELDU) — Position Statement, Ottawa, Ontario. Revised July 2010. Available from: http://www.canadianveterinarians.net/documents/extra-label-drug-use-eldu. Last accessed November 10, 2014.
- Final Report to Health Canada of the Advisory Committee on Uses of Antimicrobials in Food Animals in Canada: Impact on Resistance and Human Health. Available from: http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/pubs/amr-ram_final_report-rapport_06-27-eng.pdf. Last accessed November 10, 2014.
- American Veterinary Medical Association One Health Initiative Task Force: Final Report July 15, 2008. Available from: https://www.avma.org/KB/Resources/Reports/Pages/One-Health.aspx. Last accessed November 10, 2014.
- CVMA General Guidelines on the Prudent Use of Antimicrobial Drugs in Animals 1999. Available from: http://canadianveterinarians.net/documents/cvma-general-guidelines-prudent-use-of-antimicrobial-drugs-in-animals-1999 Last accessed November 10, 2014.
- CVMA Antimicrobial Prudent Use Guidelines 2008 for Beef Cattle, Dairy Cattle, Poultry and Swine. Available from: http://canadianveterinarians.net/documents/cvma-antimicrobial-prudent-use-guidelines-2008-for-beef-dairy-poultry-swine Last accessed November 10, 2014.
- CVMA Antimicrobial SmartVet App. Available from: http://www.canadianveterinarians.net/practice-economics/antimicrobial-smartvet. Last accessed November 10, 2014
Revised November 2014