The AVMA's definitions of antimicrobial uses for prevention, control, and treatment of disease

Abstract

Recent state and federal legislative actions and current recommendations from the World Health Organization seem to suggest that, when it comes to antimicrobial stewardship, use of antimicrobials for prevention, control, or treatment of disease can be ranked in order of appropriateness, which in turn has led, in some instances, to attempts to limit or specifically oppose the routine use of medically important antimicrobials for prevention of disease. In contrast, the AVMA Committee on Antimicrobials believes that attempts to evaluate the degree of antimicrobial stewardship on the basis of therapeutic intent are misguided and that use of antimicrobials for prevention, control, or treatment of disease may comply with the principles of antimicrobial stewardship. It is important that veterinarians and animal caretakers are clear about the reason they may be administering antimicrobials to animals in their care. Concise definitions of prevention, control, and treatment of individuals and populations are necessary to avoid confusion and to help veterinarians clearly communicate their intentions when prescribing or recommending antimicrobial use.

Antimicrobial Use on 36 Beef Feedlots in Western Canada: 2008–2012

“…Because of these concerns, the concept of antimicrobial stewardship has risen to the forefront of discourse in veterinary medicine. Antimicrobial stewardship in veterinary medicine, as defined by the American Veterinary Medical Association (AVMA), “includes providing systems of care to reduce the incidence of common diseases, making evidence-based decisions about the use of AMD, and using AMD judiciously, with ongoing evaluation of the outcomes of use and consideration for animal caretakers' available resources (6). ” Recognizing the particular need to preserve the effectiveness of those AMD relevant to human medicine, the World Health Organization (WHO) has published guidelines presenting evidence-based recommendations and best practice statements on the use in food animals of “medically important antimicrobials,” defined as antimicrobial classes used in human medicine.…”

“…As defined by the AVMA, therapeutic use of antimicrobials includes applications for prevention, control and treatment of disease (6). In the context of BRD, AMD are commonly used in feedlot cattle for BRD control (i.e., metaphylaxis) in certain groups of cattle (based on their BRD risk classification) in which there are already individuals with evidence of infectious disease and for individual treatment of clinically affected animals (6, 11).…”

“…As defined by the AVMA, therapeutic use of antimicrobials includes applications for prevention, control and treatment of disease (6). In the context of BRD, AMD are commonly used in feedlot cattle for BRD control (i.e., metaphylaxis) in certain groups of cattle (based on their BRD risk classification) in which there are already individuals with evidence of infectious disease and for individual treatment of clinically affected animals (6, 11). The antimicrobials used in risk group protocols for on-arrival use are specifically chosen based on the level of expected exposure to infectious agents, the types of pathogens most commonly encountered (past or present), the predicted ability of the host to mount an appropriate immune response, and in some cases past research documenting efficacy of the AMD in the different cattle populations.…”

Modification of empirical antimicrobial regimens in large animal medicine

“…Secondly, manual review of the medical record of each patient visit was performed to determine whether the antimicrobials were administered concurrently or sequentially. Thirdly, if the antimicrobials were given sequentially, the initial choice of antimicrobials was characterised as administered for purposes of disease prevention or disease treatment, 14 and the reason for modifying the regimen was recorded. Administration of antimicrobials for purposes of disease prevention was defined as administration to prevent an infection perioperatively or for advanced reproductive procedures.…”

The pharmacokinetic/pharmacodynamic paradigm for antimicrobial drugs in veterinary medicine: Recent advances and critical appraisal

“…In the United States, the American Veterinary Medical Association (AVMA) considers three levels of “ disease ” but uses the same terminology as OIE with prevention (synonym prophylaxis), control (synonym metaphylaxis) and treatment of disease to ensure that all comply with the principle of AMD stewardship, i.e. not ranked in order of appropriateness (Smith et al., 2019) because all correspond to a disease condition whereas for OIE, prophylaxis is just a management option of a risk factor. In the EU, where the routine use of AMDs for disease prevention is no longer allowed, the term “ for treatment and prevention of ….” “ should only be read in combination” as it reflects one use, which does not include routine preventive use in healthy animals, in which bacterial disease has not been established in the group/flock at the time of treatment (Anonymous, 2016c).…”