College Connection Spring 2018

ANTIMICROBIAL STEWARDSHIP: A TOOL TO IMPROVE, NOT RESTRICT, PATIENT CARE By J Scott Weese DVM DVSc DipACVIM Antimicrobials revolutionized human and veterinary medicine, saving countless lives. Antimicrobials have also facilitated advancement of medicine, by making invasive techniques and treatments possible through the ability to prevent infections. Unfortunately, bacteria continue to make parallel advances, developing means to evade antimicrobial therapy. In recent years, it has been clear that the ability of bacteria to develop resistance outpaces drug development, leading to the international epidemic of antimicrobial resistance (AMR). AMR has been called the global health crisis of our time. Effective antimicrobials are required for the health and safety of humans and animals, and AMR puts modern healthcare at risk, with challenges ranging from complications treating common and simple conditions such as urinary tract infections or resistance that threatens the treatment of complex conditions such as cancer care and surgery. Antimicrobials are also important for the health and welfare of food producing animals, facilitating humane, safe and economically viable food production and helping assure food security. The health and economic impacts of AMR are undeniable and there is no indication that these are on the decline. The World Bank had estimated that, by 2050, if left unchallenged, AMR will result in global economic damage at least equivalent to the financial collapse of 2008. While warnings that we are entering the ‘post-antibiotic’ era are sensationalist, there is no doubt that the relationship of veterinarians with antimicrobials will (and must) change in coming years. Spring 2018 Vol. 34 No. 1 ISSN 2370-5965 FEATURED A spotlight on public health This issue of College Connection explores various areas where veterinary medicine intersects with public health. Antimicrobial Stewardship Concerns about antimicrobial use and AMR have led to development of the concept of ‘antimicrobial stewardship’. This is a coordinated approach to optimizing the use of antimicrobials, maximizing patient care while minimizing the risk of resistance, toxicity or other adverse events. It involves a multifaceted approach to determine when to prescribe antimicrobials, what drug, dose and duration to use, how antimicrobials are administered and whether other approaches are needed in addition to or in lieu of antimicrobials (e.g. surgery, wound care, management of underlying disease). This is done through a broad approach to disease prevention, disease diagnosis, antimicrobial selection and antimicrobial use. While some aspects of an antimicrobial stewardship program (ASP) may implement controls, an ASP is not meant to complicate patient care, remove access to needed antimicrobials or decrease practice efficiency. Rather, a well-structured and functioning ASP can improve patient care and facilitate timely and effective treatment. Despite the increasing attention being put towards antimicrobial stewardship, there has been limited specific implementation of ASPs in veterinary clinics and limited practice- or patient-level guidance. While general statements about the need for ‘prudent’ use of antimicrobials have existed in veterinary medicine for some time, 1-4 practical clinical guidance has been limited. However, in recent years, there has been an increase in available information, including broad national treatment guidelines, as well as detailed guidelines for specific diseases (e.g. urinary tract infections continued on page 2 CONTENTS Managing Opioids . . . . . . . . . . . . . . . . . . . . 3 Public Health Veterinarians . . . . . . . . . . . . . . 5 HPPA Amendments . . . . . . . . . . . . . . . . . . . . 7 Rabies Update . . . . . . . . . . . . . . . . . . . . . . . 4 Learning in Practice . . . . . . . . . . . . . . . . . . . 6 Council News . . . . . . . . . . . . . . . . . . . . . . . . 8 Instilling public confidence in veterinary regulation. www.cvo.org