AVMA updates antimicrobial policies

The AVMA has updated two of its policies concerning the judicious therapeutic use of antimicrobials and endorsed a joint statement from the American Association of Bovine Practitioners (AABP) and Academy of Veterinary Consultants (AVC) on the therapeutic use of medically important antimicrobials in cattle.

The actions by the AVMA Board of Directors (BOD) occurred June 19 while meeting in Austin, Texas, held concurrently with AVMA Convention 2024.

The AVMA Board of Directors recently took actions regarding the judicious therapeutic use of antimicrobials, including endorsing a revised joint policy by the American Association of Bovine Practitioners and the Academy of Veterinary Consultants directed at judicious use of medically important antimicrobials in cattle.

During the meeting, the BOD also approved modifying membership terms on the AVMA Committee on Antimicrobials (CoA) as recommended by the committee itself. Now a CoA member can serve two consecutive terms as a primary representative, then they can choose to serve a three-year term as an alternate representative but are not required to do so.

Policy revisions

The Board approved CoA recommendations to revise two AVMA policies, "Judicious Therapeutic Use of Antimicrobials" and "Judicious Therapeutic Use of Antimicrobials in Aquatic Animal Medicine."

Concerning the first policy, the CoA explained in its recommendation to the BOD that the third core principle of antimicrobial stewardship in veterinary medicine, according to the AVMA policy "Antimicrobial Stewardship Definition and Core Principles," is "select and use antimicrobial drugs judiciously." This is expanded upon with content organized in five bullet points. The CoA recommended the AVMA's "Judicious Therapeutic Use of Antimicrobials" policy be reorganized to align with the content of the third core principle.

Therefore, the new policy reads as follows:

"Antimicrobial stewardship refers to the actions veterinarians take individually and as a profession to preserve the effectiveness and availability of antimicrobial drugs through conscientious oversight and responsible medical decision-making while safeguarding animal, public, and environmental health. Management and prevention strategies should be employed to minimize the need for antimicrobial drugs. Judicious therapeutic use of antimicrobials is a core principle of the broader goal of antimicrobial stewardship. In accordance with the FDA, therapeutic uses are associated with the prevention, control, and treatment of specific diseases that are necessary for assuring the health of animals.

Judicious use principles

• Maintain veterinary oversight by establishing Judicious use should include veterinary oversight in the context of a veterinarian-client-patient relationship (VCPR), the basis for interaction among veterinarians, their clients, and their patients, regardless of the distribution system through which the antimicrobial was obtained.
• Identify barriers to appropriate antimicrobial prescribing and usage.
• Use an evidence-based approach for making a diagnosis and determining whether an antimicrobial drug is indicated.
  • Investigate the problem to understand the population or individual level risk factors.
  • Perform diagnostic testing to confirm the likelihood that an infectious pathogen is present and causing or likely to cause disease.
  • Avoid antimicrobial therapy for uncomplicated viral infections, self-limiting bacterial infections, and non-bacterial inflammatory conditions.
• Make an informed selection of an appropriate antimicrobial drug and regimen.
  • Determine whether the purpose of therapy is for prevention, control, or treatment.
  • Target antimicrobial therapy to ill or at-risk animals when possible and discern if individual treatment of ill or at-risk animals is sufficient to improve the overall group morbidity, mortality, and herd well-being; or if herd or group therapy is needed to control clinical outcome properly.
  • Perform culture and antimicrobial susceptibility testing when indicated and feasible, to guide the selection of antimicrobials.
  • Use current pharmacological science, principles, regulatory guidance and contextual understanding of resistance in the animal population of concern.
  • Determine duration of therapy by evaluating scientific and clinical evidence, where available, to obtain the desired health outcome while minimizing selection for antimicrobial resistance, as allowed by law.
  • Follow scientifically based withdrawal periods to prevent violative residues in foods of animal origin.
• Refer to relevant veterinary medical guidelines for judicious therapeutic use.
• Assess outcomes of antimicrobial use.
  • Maintain accurate records of therapy and outcome.
• Ensure proper handling of antimicrobials.
  • Avoid environmental contamination with antimicrobials whenever possible including proper disposal according to guidelines and local, state, or federal law.
  • Adhere to and promote proper storage and handling according to the label."

As for the policy on "Judicious Therapeutic Use of Antimicrobials in Aquatic Animal Medicine," the CoA proposed numerous changes in wording of the policy to make it more contemporary and relevant. Additionally, several of the bullet points were combined to improve the policy's clarity and make it more concise.

For instance, the revised policy now directs veterinarians to "Develop biosecurity plans based on risks of pathogen introduction and transmission, especially if the captive population shares water sources with wild populations."

Regarding disease diagnosis, it suggests practitioners "Make a thorough assessment to identify root cause(s) and develop appropriate mitigation measures to address predisposing factors when there is an increased disease incidence. This could involve an evaluation of husbandry and routine health management practices such as nutrition, stocking density, vaccination, health assessment and water quality."

AABP and AVC

During its April conference call, the CoA was notified by the AABP primary representative to the CoA that the AABP, jointly with the AVC, had adopted a revised policy on the judicious therapeutic use of antimicrobials in cattle.

The AABP and AVC changed the title of the policy to "Joint AABP-AVC Policy on the Judicious Therapeutic Use of Medically Important Antimicrobials in Cattle" to indicate that it is primarily directed at judicious use of medically important antimicrobials in cattle, according to the CoA recommendation for the BOD to endorse the revised policy as it aligns with AVMA policy.

Additional changes were made to the verbiage to make it more contemporary and relevant. Both the AABP and the AVC boards of directors have approved the revised policy.

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