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Changes in the prescription of antimicrobials in the EU: questions and answers (II)

Is the current categorization of antibiotics definitive? What measures will the authorities take to encourage a better pig health status? Can a veterinarian have any kind of problems if following his diagnosis and his judgment uses a group B antibiotic?

Considering the different initiatives aimed at the reduction in the use of antibiotics that are being implemented in the European Union (EU), we will try to solve some doubts.

In intensive farming, the approach regarding treatment and prevention is, in many cases, population-based, and not individual. The veterinarian frequently acts based on the opinion that the use of antibiotics today in lighter and younger animals prevents a greater amount of the drug tomorrow, because the animals will be heavier. Will this use be forbidden in the future?

The legislation clearly establishes that antibiotics must not be used to compensate for the lack of hygiene, biosecurity or proper animal management. This strategy of treating “animals beforehand” does not only have no scientific basis, but is also one of the most detrimental practices for favouring the development of antimicrobial resistance. Antibiotics are therapeutic tools for the treatment of infectious diseases.

If we treat “low weight” animals, we are not treating a disease but compensating for some management deficiencies. What we need is a good analysis of the causes and a good management of those animals, as these will avoid the treatment in the future.

The veterinarian uses many tools to make a diagnosis (clinical observation, necropsies, etc.) and, consequently, to prescribe a treatment. Is the use of antimicrobial susceptibility testing compulsory? When or under which conditions will the carrying of an antimicrobial susceptibility testing be required?

As a professional, the veterinarian can make a first clinical diagnosis and implement a treatment. Nevertheless, what is different today is that there are groups of antibiotics that we must avoid and use only in human health, and there are others that although we share, we must use with great caution due to their impact on public health. They are “last resource” tools, and we need data that confirm that they are the only possibility we have. To be sure, we need a diagnosis and a sensitivity profile linked to the treatment that confirms their suitability/need. In the case of some of them (group B) it is already necessary, as in the information regarding the product this requirement is included as something necessary before using them. On the other hand, a new legislation is being developed, but all seems to tell that this susceptibility testing will be further requested before the use of certain antibiotics or of their use in prophylaxis/metaphylaxis.

One of the subjects that has generated a greater confusion in the last months is that of the classification of antibiotics in four categories: A-avoid, B- restrict, C-caution and D-prudence. Is this, currently, a definitive classification or is t the actual list still being reviewed? When is it expected that its use will become compulsory? Can a veterinarian, to this date, have any kind of problem if, after a diagnosis done under his/her criteria and following their opinion, uses a group B antibiotic?

The categorisation is a recommendation that is currently being checked bearing in mind the many comments received. It is expected that the definitive one is adopted in January 2020. Legislation s being developed that will identify those antimicrobials that will be set aside for their use only in human medicine and those that will be reserved to be used in veterinary medicine only under certain conditions.

So far, the product information of the groups included in category B (quinolones, 3rd and 4th generation cephalosporines and colistin) include the requirement of not using them as the first choice, and that their use must be based on the identification of the pathogen and its sensitivity profile. If this is not possible due to the urgency of the treatment, it must be based on epidemiologic information and knowledge on the susceptibility at a farm or a local/regional level. Therefore, having a diagnosis and a sensitivity profile is already a compulsory requirement in these specific cases and very recommendable in the rest of the cases.

If an antibiotic is deemed especially important for humans, wouldn’t it be better to directly take it off the market?

The different decisions will be taken step by step, and always based on a risk analysis. But we must bear in mind that in veterinary medicine we also need antibiotics to treat the animals, for animal welfare and public health, because we have the obligation of ensuring the production of healthy food. It is evident that the obligatory notification of the prescriptions in force since January will provide a useful information to the authorities on the real use of antimicrobials in livestock production, and the possibility of making decisions depending on what we find along the way.

The intensive production of pigs is a fact. Many farms carry a great number of diseases. The situation worsens in areas with a high pig density. Reversing this situation is not going to be easy nor quick. How to coordinate this with a reduction in the use of antibiotics? What measures will the authorities take to promote an improvement in pig health status?

In Spain, a strategic and action plan was created to reduce the risk of selection and spreading of antibiotic resistances. Among the most prominent advances in the animal health area we find the “Agreement for the Voluntary Reduction in the Consumption of Colistin in Pigs”, in which the 54 companies that have joined it, have reached a reduction in the use of colistin by 97% from 2015 to 2018. To reach it, the pig sector has made great efforts to improve production. The pig sector has mainly worked on improving nutrition and vaccination plans, changes in management and, obviously, in a great improvement on biosecurity and hygiene on the farms.

The current goals are: to reduce the total consumption of antibiotics, but above all to reduce the need to use them. In Spain, within the framework of the National Plan Against Antibiotic Resistances (PRAN), a working group on biosecurity and hygiene has been created to work directly with farmers, lorry drivers, farm workers, etc. to improve biosecurity and hygiene on the farms through, among other things, training courses.

Undoubtedly, all this is aimed at achieving a change in attitude that makes us do things differently.

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