KEY ELEMENTS FOR IMPLEMENTING …

1 AABP GUIDELINES. KEY ELEMENTS FOR IMPLEMENTING ANTIMICROBIAL. STEWARDSHIP PLANS IN BOVINE VETERINARY practices . WORKING WITH BEEF AND DAIRY OPERATIONS. AABP ANTIMICROBIAL shoulder leadership responsibility including STEWARDSHIP GUIDELINES involvement of other stakeholders such as vet- The goal of this document is to provide bovine erinary technicians, cattle operation managers, veterinarians with best practices for designing, nutritionists, farm employees, drug distributors, IMPLEMENTING , and monitoring antimicrobial stew- animal health companies, pharmacies, and con- ardship programs with their clients. These best tract service providers such as hoof trimmers, in practices are aimed at veterinarians that admin- all settings in which antimicrobial drugs are used. ister antimicrobials, are responsible for oversight of drug use or treatment protocols, or who make VETERINARIANS CAN BE LEADERS.

2 Recommendations for use of antimicrobials. IN ANTIMICROBIAL STEWARDSHIP. The focus is on best practices for veterinarians BY ASKING THE FOLLOWING QUESTIONS: with defined and defensible Veterinarian-Client- Have I made a commitment to apply what I. Patient Relationships (VCPR) or who are Veteri- learn from continuing education and to relay narians of Record. ELEMENTS may be applicable what I learn to my clients and colleagues? to veterinarians with other relationships to clients Have I provided the necessary training and and patients. education about the need for antimicrobial stewardship and ways to use antimicrobial drugs DEFINITION OF ANTIMICROBIAL STEWARDSHIP judiciously for on-farm personnel, if appropriate/. Antimicrobial stewardship is the commitment to necessary? reducing the need for antimicrobial drugs by pre- Have I made the commitment to use what venting infectious disease in cattle, and when antimi- I learn from each of these therapeutic events crobial drugs are needed, a commitment that anti- and investigations to further the training and microbials are used appropriately to optimize health education of all stakeholders?

3 And minimize selection for antimicrobial resistance. Have I considered whether my personal eco- nomic gain has influenced my decisions to treat, KEY ELEMENT 1: LEADERSHIP COMMITMENT dispense, or prescribe an antimicrobial drug? Commitment to leadership in antimicrobial stew- ANTIMICROBIAL STEWARDSHIP. ardship in bovine practice means being respon- Consideration sible for the entire cycle associated with bacte- Diagnosis of non-antibiotic rial disease management. It includes accepting of bacterial disease alternative to prevent, control responsibility and accountability for antimicrobial or treat prescribing, dispensing, and administration. This Cycle of commitment also includes identifying leaders bacterial disease within the practice and client operations to share management in antimicrobial stewardship. Multi-veterinarian practices may find it benefi- Re-evaluation Judicious use of antimicrobial cial to designate one main leader to coordinate of the need for drugs when they antimicrobial use are needed e orts and bring information and opportunities to their colleagues.

4 Everyone in the practice should AMERICAN ASSOCIATION OF BOVINE PRACTITIONERS. 1130 East Main Street, Suite 302 Ashland, Ohio 44805 Phone: Fax: email: July 2017. AABP GUIDELINES. KEY ELEMENTS FOR IMPLEMENTING ANTIMICROBIAL. STEWARDSHIP PLANS IN BOVINE VETERINARY practices . WORKING WITH BEEF AND DAIRY OPERATIONS. ONCE A NEED FOR ANTIMICROBIAL stewardship so that new veterinary graduates DRUGS HAS BEEN IDENTIFIED, JUDICIOUS and those in animal science and related disci- USE INCLUDES CONSIDERATION OF THE plines have the knowledge and skills necessary FOLLOWING: to be good stewards. Have I identified the organ system(s) a ected Bovine practitioners should provide antimi- and the most common infectious agent(s) to crobial use protocols and treatment guidelines make an informed selection of an appropriate specific for each operation as described in the regimen including antibiotic, dose, and route of AABP Guideline Establishing and maintain- administration?

5 Ing the veterinarian-client-patient relationship in Is the regimen safe? bovine practice and Drug use guidelines for Am I committed to complete the cycle of dis- bovine practice. Well-designed protocols make ease management by following the judicious all the steps in antimicrobial decision-making use of antimicrobial drugs with reevaluation of transparent, and provide a tool for accountability their need? and tracking. Am I committed to using antimicrobial drugs in a manner that does not increase short-term KEY ELEMENT 3: TRACKING ANTIMICROBIAL. benefits at the expense of long-term loss of DRUG USE. antimicrobial susceptibility and e ectiveness? Bovine practitioners should periodically review Do I have a veterinary-client-patient- treatment records, drugs present on the farm relationship? in relation to treatment protocols, and on-farm Have I followed the legal requirements antimicrobial drug dispensing and usage.

6 This for using antimicrobial drugs by selecting requires appropriate record systems. approved products when available or choosing Tracking may include monitoring the pathogens legally acceptable extra-label use? associated with clinical disease, including anti- Have I avoided causing a violative residue? microbial susceptibility patterns, or evaluating treatment outcomes such as retreatment, culling, KEY ELEMENT 2: DRUG EXPERTISE and case fatality rates. Knowledge of these pa- It is the responsibility of the veterinarian to con- rameters on a herd basis can help guide further tinuously seek new information about the use of investigation and changes in treatment protocols. antimicrobial drugs. This may take the form of Actual antimicrobial use in treatment records consulting infectious disease specialists, attend- should be compared to protocols for indications ing professional continuing education opportu- of protocol drift.

7 Deviations from protocol should nities, searching for and reading peer-reviewed be addressed through training and other correc- published research, or reviewing rigorously tive actions as appropriate. conducted knowledge summaries. Knowledge summaries may include online decision-support KEY ELEMENT 4: REPORTING. tools, systematic reviews and meta-analyses, or Bovine practitioners should support e orts to critically appraised summaries of published data. report antimicrobial drug use across farms in Veterinary educators are called to include order to benchmark and compare usage, while education about all aspects of antimicrobial maintaining client confidentiality. AMERICAN ASSOCIATION OF BOVINE PRACTITIONERS. 1130 East Main Street, Suite 302 Ashland, Ohio 44805 Phone: Fax: email: July 2017. AABP GUIDELINES. KEY ELEMENTS FOR IMPLEMENTING ANTIMICROBIAL.

8 STEWARDSHIP PLANS IN BOVINE VETERINARY practices . WORKING WITH BEEF AND DAIRY OPERATIONS. KEY ELEMENT 5: ACTION specific antimicrobials for pathogens seen in Stewardship programs require action in addition the practice. to monitoring and tracking. Stewardship leader(s) Pick one or more high prevalence diseases should review activities and recommend appro- in a production class and create a progress priate actions on a regular basis. Below are some plan for: examples of ways to take action. Herd management changes that have the Review the disease prevention programs such potential to reduce disease pressure and as vaccination, nutrition, and environmental man- prevalence over the subsequent period. agement programs for specific disease conditions A review of current treatment protocols for that to assure optimal husbandry and management disease and suggestion of refinements in terms are being employed.

9 Specific examples include: of a decision tree for when and how to treat. Examine processing and arrival programs Providing for reliable treatment and outcome in the feedlot. records for later review. Review pre-weaned dairy calf management Establish a schedule (annual, semiannual, to reduce scours and respiratory disease quarterly) to review disease rates, treatment and need for treatment. frequency, and changes in treatment out- Examine treatment records to estimate the come quality parameters. percentage of entries for a single disease Commit to seeking/creating a learning challenge ( , mastitis on a dairy, bovine system around a selected disease such that respiratory disease complex on a feedlot). repetition of the status quo is an unlikely Make a plan with the owner or manager to long term outcome. Identify and review the reduce the incidence of disease and review disease, diagnosis, treatment and outcome records again in 6 months.

10 With all team members. Review diagnosis/treatment protocols Be able to measure, identify and describe developed for di erent disease syndromes. the benefits of improvements garnered from Are the protocols up to date for the applica- these e orts. ble disease challenges with regard to indica- RESOURCES. tion for use, dosage, route, and duration? Evidence Based Veterinary Medicine Association Food Armor . Examine treatment records to estimate the AABP Guidelines for Establishing and Maintaining The Veterinarian- percentage of entries that include all of the Client-Patient-Relationship in Bovine Practice resources/aabp_ necessary recorded items such as: antimicro- AABP Prudent Antimicrobial Use Guidelines for Cattle http://www. bial drugs used, indication for use, and regi- men (dose, route, duration, and frequency). AABP Drug Use Guidelines for Cattle Practice resources/aabp_ Make a plan with the owner or manager to FDA Guidance for Industry #152 Appendix A: Ranking of Antimicrobial increase this percentage of complete records Drugs According to their Importance in Human Medicine, pg 28.