These guidelines were produced by the BVA and published in the Veterinary Record of 14th November 1998, pp565 - 566. The NZVA is working on something similar, to be published some time soon (?!). Check the website http://www.vets.org.nz
Following guidelines such as these is a good way of making sure that you are using these drugs responsibly. The section on regulatory concerns is not directly relevant to NZ, but gives some idea of the shape of things to come!
These guidelines are intended to act as an adjunct to clinical judgment. It may not be possible for every consideration to be observed in every case, but they should always form part of an automatic checklist when deciding on an antimicrobial use regime
(1) The use of antimicrobial agents provides an effective method for the control and treatment of infectious or contagious diseases caused by bacteria and certain other micro-organisms. Their application in veterinary.practice since the 1950s has assisted.in ensuring the health of livestock and.companion animals. Antimicrobial use has.also enabled the production of meat and.milk products which are unlikely to present disease problems for the consumer or those concerned with their production. Antimicrobial use is also justifiable on animal welfare grounds (‘freedom’ to receive treatment for disease is incorporated in the Welfare Codes).
(2) It must be remembered at all times that widespread use of antimicrobials is not a substitute for efficient management or good husbandry practice.
(3) The appropriate selection of antimicrobials in practice is a critical decision and should be based on:
(a) accurate diagnosis;
(b) known or predictable sensitivities (sensitivity testing);
(c) known pharmacokinetics/tissue distribution to ensure the selected therapeutic reaches the site of infection;
(d) known status of immunocompetence.
(4) Antimicrobial agents should only be used when it is known or suspected that an infectious agent is present which will be susceptible to such therapy.
(5) When antimicrobial agents are used, every effort should be made to determine the origin of the problem and to ascertain the most effective treatment.
(6) While therapy may need to be initiated before the results of diagnostic or sensitivity tests are known, it will need to be reassessed as test results become available. In such circumstances, before the results are known, decisions as to the choice of antimicrobial will need to be made:
(a) in the light of what has previously been effective in similar types of problems;
and
(b) on any knowledge of previous antimicrobial efficacy on the premises.
(7) Infectious disease should be treated with the antimicrobial found, on appropriate testing, to be most efficacious and also based on the previous history of effective antimicrobial use on the premises.
(8) Careful calculation of dose is always important, but in particular if an extra-label use of a product is being considered. In such cases, caution needs to be exercised regarding meat and milk withholding periods.
(9) The efficacy of all disease treatments should be monitored and, if part of the treatment regime was undertaken by the livestock or pet owner, a check should be made to ensure that they have understood fully the instructions on dosage and duration of any antimicrobial use. Quantities of antimicrobials left with the animal owner should correctly reflect the needs, to avoid an over-supply.
(10) Antimicrobial usage should always be part of, and not a replacement for, an integrated disease control programme. Such a programme is likely to involve hygiene and disinfection procedures, biosecurity measures, management alterations, changes in stocking rates, vaccination, etc.
(11) Continued antimicrobial use in such control programmes should be regularly assessed as to effectiveness and whether their use can be reduced or stopped.
(12) Protocols should be agreed between the veterinary surgeon and the client as to when veterinary involvement is required in on-going disease conditions. These protocols must be regularly and frequently reviewed and updated.
(13) Protocols should be agreed and docu-mented for treatment of all endemic conditions on the farm or other livestock-rearing or production premises. These protocols must be regularly reviewed and updated.
(14) In order to minimise the likelihood of broad antimicrobial resistance developing, it is recommended that where an appropriate narrow spectrum agent is made available it should be selected in preference to a broad spectrum agent, which will exert a greater selection pressure on commensal bacteria.
(15) It is recommended that optimal therapeutic dosage strategies be used and that all efforts be made to avoid administration of sub therapeutic dosages, which can lead to a lack of efficacy (and, in some specific cases, such as fluoroquinolones and erythromycin, has been shown to induce resistance). Dosage recommendations as laid down in the relevant data sheet should always be followed.
(16) Should there be recurrence of disease following successful treatment (and control) of an outbreak, it will need to be investigated thoroughly to ascertain why this has occurred and the most suitable therapy to be used.
(17) Use of antimicrobials for the prevention of disease can only be justified where it can be shown that a particular disease is present on the premises, or is likely to become so, and that strategic antimicrobial use will prevent clinical outbreaks of that disease.
(18) Antimicrobials need to be used with care to maintain their efficacy. If possible, look for alternative methods of disease control (vaccination) to reduce antimicrobial use.
(19) Any use of antimicrobials outside normal data sheet recommendations (in accordance with the prescribing ‘cascade’) should be carefully justified and documented.
(20) Note must be made, and documented, of any adverse reactions which may be observed or a decline in efficacy of a previously effective antimicrobial.
(21) All antimicrobials in use must be used and stored correctly in the manner outlined in the BVA Code of Practice on Medicines. In accordance with statutory requirements, full records must be kept of all products used.
(22) Consideration must always be given to the health of the person administering the products. Any necessary warnings should be issued.
