Antimicrobial resistance: an issue for all veterinarians
From Australian Government Department of Agriculture published in Vetboard Victoria's newsletter in December 2019
Why should you be concerned about antimicrobial resistance?
Antimicrobial resistance (AMR) has been identified as a critical global issue, with the World Health Organization (WHO) describing it as an ‘urgent global health priority’. At least 700,000 people currently die of resistant infections every year globally, and it is estimated that by 2050 up to 10 million lives a year may be lost to AMR, exceeding the 8.2 million lives a year currently lost to cancer. In April 2019, a United Nations ad hoc Interagency Coordination Group on AMR took this sentiment further and stated that there is no time to wait, as AMR will have a disastrous impact within a generation unless the world acts urgently.
Antimicrobial use is considered the single most important factor leading to resistance. Resistance is increasing at a pace that far exceeds our capacity to develop new antimicrobials, with very few products brought to the market in recent years.
Inappropriate and unrestrained use of antimicrobials in human and animal health globally exerts a strong selection pressure on microbial populations to evolve resistant traits. As a result, antimicrobials have become less effective over time. Resistant organisms are also able to spread between humans, animals and the environment. Globalisation and international travel help facilitate its spread between countries.
Given the scale and importance of the AMR problem, the international response has seen several major human and animal health bodies, including the WHO, the World Organisation for Animal Health (acronym OIE) and the Food and Agriculture Organization of the United Nations (FAO) work together to develop global strategies to combat AMR. The FAO/OIE/WHO Tripartite Collaboration on AMR has recently published a Monitoring and Evaluation Framework to help monitor national and global progress under the WHO’s Global Action Plan on AMR.
Australia's response to AMR
Nationally, the Department of Agriculture (the department) has been working with governments, non-government organisations, professional bodies (such as the Australian Veterinary Association and universities), research organisations, and our human health counterparts, to implement Australia’s first National AMR Strategy 2015-2019 and associated Implementation Plan. The current strategy expires at the end of this year, and Australia’s National Antimicrobial Resistance Strategy – 2020 and Beyond (the next national AMR strategy) will continue its ‘One Health’ approach through the inclusion of the environment alongside human and animal health. It will also expand the focus from antibiotic resistance to include antifungals, antiparasitics and antivirals.
In mid-2018, the Australian Government also released an update of the Importance Ratings and Summary of Antibacterial Uses in Human and Animal Health in Australia (Antibacterial Importance Ratings). This document provides information and guidance to inform decision making about the registration and use of antibacterial medicines in Australia for human and animal health professionals.
How is Australian animal health performing?
From an animal health perspective, the risk of the development of AMR from animals in Australia is considered to be low due to factors such as strict regulation on registration, low levels of antimicrobial use in food-producing animals, high levels of biosecurity, and extensive farming systems that do not favour bacterial disease.
AMR surveillance undertaken to date in food-producing animals through ad hoc studies generally supports this view, noting that there are some areas for improvement.
Combating AMR - the role of the veterinarian
With the expected release of the next national AMR strategy in early 2020, it is a timely reminder to reflect on the significant role that we, as veterinarians, play in limiting and minimising the spread of AMR.
As veterinarians, our prescribing rights come with significant responsibilities. Following are some of the things prescribing veterinarians can do to help minimise the spread of AMR:
- Pause and consider each antimicrobial prescription: can you use a lower rating or narrow spectrum antimicrobial? Veterinarians need to familiarise themselves with the Australian Antibacterial Importance Ratings to help with these decisions.
- Talk to clients about ways to minimise the use of antimicrobials, including the use of vaccinations to prevent and control infection.
- Promote and apply best practice biosecurity and hygiene measures.
- Use published therapeutic guidelines, where available.
To help make optimal decisions when prescribing antibiotics, an online package about effective antimicrobial stewardship (AMS) practices is available. Developed by the Veterinary Schools of Australia and New Zealand and funded by the Australian Government, this practical online resource is available nationally to all veterinarians at www.vetams.org. Additional modules are being developed by the University of Sydney and Charles Sturt University with further Australian Government funding.
Fighting AMR is the Australian Veterinary Association’s strategic priority and they have developed AVA AMR factsheets and resources about best-practice antibiotic prescribing and infection prevention and control practices to help clinical veterinarians in their day-to-day use of antimicrobials.
Australian Pork Limited has recently published AMS factsheets for pig producers, and Meat and Livestock Australia has developed an online AMS program for cattle feedlot staff.
The food-producing animal industries are also developing an Animal Industry AMS Research, Development and Extension Strategy to allow industries to identify and collaborate on cross-sectoral AMS priorities.
AMR and veterinarians - final thoughts
Antimicrobial resistance is a significant global health priority driven by inappropriate use of antimicrobials in human and animal health, and agriculture.
The veterinary and medical professions need to work together to ensure a combined, global effort towards preserving the effectiveness of important antimicrobials for the necessity of human health (your health), and animal health and welfare.
Veterinarians are an integral part of the solution to safeguarding the efficacy of antimicrobials. Your commitment has minimised spread of AMR to date, but we need you to continue your contribution towards collective national efforts in preserving the effectiveness of antimicrobials for all of us, and the animals in our care.