25 years of fighting antimicrobial resistance: AVMA’s Committee on Antimicrobials leads the way

Dr. Patricia Gaunt

In 2016, when Dr. Patricia Gaunt joined the AVMA's brand-new Committee on Antimicrobials (CoA), she didn't know what to expect.

"Of course, we all wanted to protect our antimicrobials, but I wondered if the committee would be a waste of time because I felt I didn't have much in common with the bovine practitioners or the equine practitioners, and they wouldn't understand my work as a fish veterinarian," she said.

Fast forward nearly a decade and Dr. Gaunt now chairs the CoA. She has come to see its varied composition as one of its key strengths. The CoA has nine seats, each held by an allied veterinary association, with one seat for a member at large. Each seat is represented by both a primary and alternate representative. The CoA also has four advisors, one each from the Food and Drug Administration's (FDA) Center for Veterinary Medicine, U.S. Department of Agriculture's Animal and Plant Health Inspection Service, Centers for Disease Control and Prevention (CDC), and Animal Health Institute.

"I was so wrong about my preconceptions, and I'm amazed how much I've learned from all the species groups in the CoA," says Dr. Gaunt, now retired from Mississippi State University. "The principles of antimicrobial resistance are the same regardless of species, and that's become an important part of our message."

The CoA's mission

Antimicrobial resistance has become an increasingly important topic globally. Every year, World Antimicrobial Awareness Week is celebrated November 18-24 to improve awareness and understanding of the issue and encourage best practices to reduce the further emergence and spread of antimicrobial resistance. In 2024, the theme remains "Preventing Antimicrobial Resistance Together."

Dr. Michael Costin, an associate director in the AVMA Division of Animal and Public Health notes that, for nearly 20 years, the AVMA has addressed antimicrobial issues through the creation of topic-specific steering committees or task forces as needed.

"But over time, it became apparent that we needed a standing committee to specifically handle antimicrobial issues," he says.

The AVMA Committee on Antimicrobials has created numerous resources to help veterinary professionals to better understand antimicrobial stewardship and implement effective stewardship plans for veterinary practices. Among the resources is a flyer to help educate clients about why veterinarians don't always prescribe antibiotics. (Click to enlarge)

Dr. Costin remembers the CoA's early days, when the larger conversation around antimicrobials was shifting from judicious use to antimicrobial stewardship and One Health.

"During the CoA's first meeting at the AVMA headquarters, everyone sitting at the conference table was asked to define antimicrobial stewardship and explain how it was different from judicious use of antimicrobials," he says. "Every answer was different. At that moment, the CoA's first task was clear: For antimicrobial stewardship in veterinary medicine to be promoted, it needed to be defined in that context."

A history of leadership

Since its inception, the CoA has taken the lead in overseeing and developing the AVMA's stance on antimicrobial issues.

For example, the AVMA-with the CoA's help-has defined antimicrobial stewardship as "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," according to the AVMA policy, "Antimicrobial Stewardship Definition and Core Principles."

The CoA also crafts the AVMA's response and positions to legislative and regulatory proposals, creating tools and resources for AVMA members and others. It also interacts with outside stakeholders involved in antimicrobial issues.

Here's a look back at the timeline of antimicrobial resistance work at the AVMA and how it has become a leading organization on this issue:

• 1998 - The AVMA Board of Directors creates a steering committee to address antimicrobial use in the veterinary profession. This steering committee created the AVMA's first standalone policy addressing antimicrobial use in veterinary practice with the policy "Judicious Therapeutic Use of Antimicrobials."
• 2009 - The AVMA Board creates the Antimicrobial Use Task Force to clarify the role of the veterinarian and level of veterinary involvement in all uses of antimicrobials.
• 2011- The AVMA Board creates the Steering Committee for FDA Policy on Veterinary Oversight of Antimicrobials to work with the FDA on the veterinary feed directive regulations.
• 2013 - The AVMA Board creates the Task Force for Antimicrobial Stewardship in Companion Animal Practice to develop recommendations in this area of practice. The task force also creates resources for practitioners, all of which are available on the AVMA website. Numerous standing AVMA entities help the AVMA develop positions and comments regarding proposed legislation and regulation.
• 2016 - The AVMA officially creates the Committee on Antimicrobials.
• 2018 - The AVMA's House of Delegates unanimously adopt the CoA's definition of and core principles for antimicrobial stewardship in veterinary medicine.
• 2019 - JAVMA publishes the CoA's "The AVMA's definitions of antimicrobial uses for prevention, control, and treatment of disease," noting that "(The CoA) 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." The CoA also releases a veterinary checklist for antimicrobial stewardship that streamlines the development and implementation of an effective stewardship plan for veterinary practices.
• 2020 - The CoA publishes "Antimicrobial Resistant Pathogens Affecting Animal Health in the United States" to complement the CDC's similar report each year about human medicine.
• 2022 - The CoA develops posters for use in small animal clinics. The committee's hope is the resource will stimulate conversation between veterinarians and their clients, giving the veterinarian an opportunity to educate clients on antimicrobial stewardship.
• 2023 - The CoA develops six resources for veterinarians on antimicrobial susceptibility testing.

Dr. Costin says he and CoA are currently updating the antimicrobial threats report with a target completion date of June 2025.

"It's a big report and we are expanding the report's scope and are currently awaiting first drafts of pathogen templates," he says. "This has been our major effort this year."

Educating the next generation

A survey of 24 AVMA Council on Education-accredited veterinary schools published last month revealed some encouraging results regarding the uptake of the AVMA's antimicrobial resources. It found that 79% of the surveyed schools incorporate antimicrobial stewardship into their preclinical curricula. The survey also found that 46% of the veterinary schools perform at least one activity focused on each of the AVMA's five core principles of antimicrobial stewardship, and half of the veterinary schools already have a functioning antimicrobial stewardship program.

Dr. Gaunt finds this dissemination of the CoA-created resources to be one of the most gratifying aspects of her work on the committee.

"Today's students are very lucky to be getting this education so early in their training," she says. "We were aware of factors like antimicrobial resistance back when I graduated, but not nearly to the same extent as students are today."

Dr. Costin agrees. "One of the actions we as veterinarians can take as a profession is to make sure we educate ourselves on new concepts and ideas on how to practice veterinary medicine, and that includes antimicrobial stewardship," he says. "Of course, we want to not only improve our own skills but also to educate and reinforce those concepts in the next generations of veterinarians."

Darcy Lewis is a freelance health and medical writer based in Chicago.

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