What are the best metrics to monitor antibiotic use?

More, James

doi:10.1136/vr.l1675

Cited by 3 publications

(4 citation statements)

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“…However, if the intention is to compare AMU across classes of AMD (for example, comparing macrolide to tetracycline use) or among different sized animals, the gAMD metric is problematic. Furthermore, because many of the more medically important category AMD, such as cephalosporins and macrolides, have lower dosage per kg rates, emphasis on mg/kg reduction targets could inadvertently discourage appropriate stewardship (35). In summary, weight of AMD can be a useful, intuitive metric if comparing AMU of the same AMD type.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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The accurate quantification of antimicrobial use (AMU) in production animals is critical for monitoring trends in exposure to antimicrobial drugs (AMD) over time and examining potential associations with antimicrobial resistance in bacteria. In this study, a census sample of cattle was used to quantify individually-dosed and in-feed AMU as both numbers of animal daily doses (nADD) and total grams of AMD (gAMD) used in cattle placed in 36 western Canadian feedlots between 1-November, 2008 and 31-October, 2012; representing about 21.5% of fed cattle in Canada during that time period. Of the ~2.6 million cattle placed during the 48-month period, 45% were calves, 63% were male, 62% arrived in the fall or winter, and 39% were assessed as high risk for developing bovine respiratory disease (BRD). The proportion of cattle categorized as high risk (HR) for developing BRD was consistent over the 4 years of placement cohorts. Both medically important AMU and ionophore use were summarized but presented separately. A decrease in AMU was observed over the study period, both as nADD and total gAMD, which was primarily driven by a decline in the in-feed administration of tetracyclines. Most in-feed AMU was directed toward prevention and control of liver abscesses. The majority of individually dosed AMU was administered as metaphylaxis to address BRD risks, with category III AMD (medium importance to human medicine as categorized by Health Canada Veterinary Drugs Directorate) used most frequently. Not surprisingly, risk level for developing BRD influenced parenteral AMD exposures, with 95% of cattle categorized as being HR for developing BRD receiving individually dosed AMD compared to 59% of cattle categorized as being low risk (LR) for developing BRD. Cattle categorized as HR for developing BRD were more likely to receive macrolides for BRD metaphylaxis compared to cattle categorized as LR for developing BRD, and cattle categorized as LR for developing BRD were more likely to receive tetracycline for the same purpose. In summary, these data provide an unprecedented representation of AMU in fed cattle in western Canada and direction for future monitoring of AMU in fed cattle.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Employing weight-based metrics, herds administering more parenteral tetracyclines over macrolides would appear to have heavier AMU than herds administering more parenteral macrolides over tetracyclines, whereas dose-based metrics would tend to indicate the reverse. Consequently, emphasis on weight-based metrics and mg/kg reduction targets could even promote the use of macrolides in preference to tetracyclines, inadvertently encouraging the use of AMD of higher medical importance to humans (41). Comparing national sales data in mg/kg to animal census AMU data available in Denmark and the Netherlands, Bondt et al (42) concluded that “simple country comparisons, based on total sales figures, entail the risk of serious misinterpretations, especially if expressed in mg per kg.” They noted that to make meaningful international comparisons, the average dosage of the AMD used as well as relative differences in production animal species needed to be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Calculation of Antimicrobial Use Indicators in Beef Feedlots—Effects of Choice of Metric and Standardized Values

et al. 2019

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The potential for antimicrobial use (AMU) to lead to the development of antimicrobial resistant bacteria is an increasingly important priority in human and veterinary medicine. Accurate AMU quantification is essential to assessing the risk of antimicrobial resistance due to AMU. The quantification of AMU in production animals can be difficult, and feedlot beef cattle present a number of unique challenges. This paper presents selected parenteral data from western Canadian beef feedlots to illustrate variations in interpretation of AMU that can arise from the use of different metrics and standards. Specific examples presented compare the number of animal daily doses calculated from a given amount of antimicrobial drug (AMD) using actual and estimated weights of cattle at exposure, dose-based to weight-based indicators representing the same amount of antimicrobial, dose-based AMU indicators using different estimated durations of effect (DOE), and AMU indicators calculated using different standard weights of cattle at exposure. Changing these factors when calculating AMU indicators can have notable influences on the results obtained. Transparency about the methods used to calculate AMU indicators is critical to ensure that comparisons of use among different populations is meaningful and accurate.

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“…Brault et al effectively demonstrated the contrast of using massand dose-based metrics in a specific case of macrolide use on beef cattle feedlots, where the use of the mass-based metric resulted in the interpretation of less macrolide use than if the dose-based metric was used (Brault et al, 2019b). Their results demonstrated that massbased indicators should be used in conjunction with dose-based indicators for creating effective stewardship strategies, especially for macrolides and other medically important antimicrobials with relatively low dose/kg rates (More, 2019). This also demonstrates the value of standardized AMU indicators resulting from this study and the value of simultaneous calculation and visualization of multiple AMU indicators discussed above.…”

Section: Evaluated Indicators Can Only Partially Inform Antimicrobial...mentioning

confidence: 99%

“…The length of therapeutic effect is important to consider in planning stewardship efforts (More, 2019) and to study the association between antimicrobial exposure in animals and subsequent potential selection of AMR organisms in humans, animals or the environment. In our study, the texle criterion focused on indicators' ability to provide information on the duration of treatment (DOT).…”

Section: Evaluated Indicators Can Only Partially Inform Antimicrobial...mentioning

confidence: 99%

Standardization and evaluation of indicators for quantifying antimicrobial use on U.S. dairy farms

et al. 2023

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Antimicrobial resistance (AMR) is a global One Health threat. A portion of AMR development can be attributed to antimicrobial use (AMU) in animals, including dairy cattle. Quantifying AMU on U.S. dairy farms is necessary to inform antimicrobial stewardship strategies and help evaluate the relationship between AMU and AMR. Many AMU indicators have been proposed for quantifying AMU in dairy cattle. However, these indicators are difficult to interpret and compare because they differ in the type of data used, the calculation approach, and the definitions of variables and parameters used in the calculation. Therefore, we selected 16 indicators (count-based, mass-based, and dose-based) applicable for quantifying AMU on U.S. dairy farms. We systematized the indicators by standardizing their variables and parameters to improve their interchangeability, interpretation, and comparability. We scored indicators against six data-driven criteria (assessing their accuracy, data and effort needs, and level of privacy concern) and five stewardship-driven criteria (assessing their ability to capture trends and inform antimicrobial stewardship). The derived standardized indicators will aid farmers and veterinarians in selecting suitable indicators based on data availability and stewardship needs on a farm. The comparison of indicators revealed a trade-off requiring farmers to balance the granularity of data necessary for an accurate indicator and effort to collect the data, and a trade-off relevant to farmers interested in data sharing to inform stewardship because more accurate indicators are typically based on more sensitive information. Indicators with better accuracy tended to score better in stewardship criteria. Overall, two dose-based indicators, estimating the number of treatments and administered doses, scored best in accuracy and stewardship. Conversely, two count-based indicators, estimating the length of AMU, and a mass-based indicator, estimating the mass of administered antimicrobials, performed best in the effort and privacy criteria. These findings are expected to benefit One Health by aiding the uptake of farm-level AMU indicators by U.S. dairy farms.

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What are the best metrics to monitor antibiotic use?

Cited by 3 publications

References 0 publications

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

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

Calculation of Antimicrobial Use Indicators in Beef Feedlots—Effects of Choice of Metric and Standardized Values

Standardization and evaluation of indicators for quantifying antimicrobial use on U.S. dairy farms

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