February 22, 2018

AVMA Establishes Antimicrobial Policy for Veterinary Medicine

The AVMA’s antimicrobial policy aims to change how veterinarians prescribe and administer antimicrobial drugs to their patients.
By Amanda Carrozza
A unanimous vote by the American Veterinary Medical Association (AVMA) House of Delegates in January to enact a policy on antimicrobial stewardship has been touted as a “call to action” for the profession to advocate for preserving antimicrobial effectiveness.

Enacting the policy is an important development toward the committee’s goals of working with counterparts in human medicine and regulatory agencies, among others, to determine how antimicrobials should be used, AVMA board member Rena Carlson-Lammers, DVM, said.

A Rising Need for Antimicrobial Stewardship
Developed by the AVMA’s Committee on Antimicrobials, the policy comes as a response to the call to reevaluate how often antimicrobial drugs are prescribed in veterinary medicine and, more specifically, how the overuse or misuse of antimicrobials relates to increased instances of resistance. As previously reported by American Veterinarian®, it is likely that the amount of inappropriate use of antimicrobials in companion animal settings is close to the Centers for Disease Control and Prevention’s (CDC) most recent estimates in human medicine of 50%.

Previously, the AVMA board had considered proposals that would have called on veterinarians to change their use of antimicrobials, but those proposals were thought to be too prescriptive. Recognizing the importance of taking a One Health approach and encouraging joint efforts between human and veterinary medicine, the new AVMA policy adapted much of its language from the CDC’s “Core Elements of Outpatient Antibiotic Stewardship Programs.”

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The CDC noted that a “growing body of evidence [in human medicine] demonstrates that hospital-based programs dedicated to improving antibiotic use, commonly referred to as antibiotic stewardship programs, can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. These programs help clinicians improve both the quality of patient care and patient safety through increased infection cure rates, reduced treatment failures, and increased frequency of correct prescribing for therapy and prophylaxis.” They also significantly reduce antibiotic resistance.

The same is expected to be true in veterinary medicine. According to Michael Whitehair, DVM, chair of the AVMA board of directors, the policy shows veterinarians’ commitment to their patients, clients, and the public.

The AVMA Policy
The AVMA defines antimicrobial stewardship as “the actions veterinarians take individually and as a profession to preserve the effectiveness and availability of antimicrobial drugs through conscientious oversight and responsible medical decision-making while safeguarding animal, public, and environmental health.” As outlined in the policy’s core principles listed below, antimicrobial stewardship is an all-encompassing policy and includes both veterinary teams and clients in the movement toward using antimicrobials judiciously and sparingly.
  1. Commit to stewardship: This principle involves engaging practice members in the stewardship effort and developing plans that incorporate dedication to disease prevention. It also includes creating plans to optimize the prescribing, administration, and oversight of antimicrobial drugs.
  2. Advocate for a system of care to prevent common diseases: Not only should veterinary teams identify barriers to improving disease prevention, they should begin working with clients to adopt preventive strategies to minimize the need for antimicrobial drugs. 
  3. Select and use antimicrobial drugs judiciously: The policy calls for veterinarians to refer to relevant veterinary guidelines for judicious therapeutic use and to assess outcomes when antimicrobials are used.
  4. Evaluate antimicrobial drug use practices: Develop a program for the evaluation of antimicrobial drug prescribing with veterinary practices that would include the sharing of antimicrobial drug use data while preserving veterinarian-client confidentiality.
  5. Educate and build expertise: Clinics should strive to remain up-to-date on innovative uses of antimicrobial alternatives and educate clients on instances when antimicrobial drugs are not needed.

The complete policy and extended details on each of the core principles are available on the AVMA website.

Instituting the Policy
The AVMA said it will rely heavily on staff and leadership to circulate the new policy to veterinarians across the country. The association also said it hopes to work with the FDA and US Department of Agriculture as they develop regulations that guide daily antimicrobial use. Additionally, the AVMA plans to lobby for regulations and laws that preserve veterinarians' ability to administer or prescribe needed antimicrobials.

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