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