dr. ron dehaven - antimicrobial use in veterinary medicine today and tomorrow
DESCRIPTION
Antimicrobial Use in Veterinary Medicine Today and Tomorrow - Dr. Ron DeHaven , AVMA Executive Vice-President, from the 2012 NIAA One Health Approach to Antimicrobial Resistance and Use Symposium, October 26-27, 2012, Columbus, OH, USA. More presentations at: http://www.trufflemedia.com/agmedia/conference/2012-one-health-to-approach-antimicrobial-resistance-and-useTRANSCRIPT
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Antimicrobial Use in Veterinary Medicine
Today and Tomorrow...
W. Ron DeHaven, DVM, MBAExecutive Vice President and CEOAmerican Veterinary Medical Association
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Definitions
MicroorganismsAntimicrobialsAntibioticsAntimicrobial Resistance
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Uses of Antibiotics
Treatment Control Prevention Production Uses
(Growth Promotion/Feed Efficiency)
Animal uses currently approved by FDA
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Sources and Regulatory Oversight of Antimicrobials
Over-the-Counter (OTC) Producers, only as approved on label; can be feed or water Added to feed by a feed mill or producer as directed on the
FDA approved label Veterinary Feed Directive (VFD)
Currently only 2 drugs are approved - florfenicol (Nuflor) and tilmicosin (Pulmotil)
OTC => VFD medically important antimicrobials in feed Prescription (Rx) –
GFI 213 transitions medically important antimicrobials in water from OTC to Rx and allows mechanism to seek therapeutic claims for production use antimicrobials
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Differences in Use
Human Medicine For treatment or prevention Physician determines indication and route of administration,
dose, frequency, and duration of treatment No restrictions on extra-label or "off label" uses
Food Animals Drug only approved for specific indications, e.g., respiratory
disease due to Pasteurella multocida Only allowed at specific dosage, duration, frequency, and
route of administration Extra label uses heavily regulated
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A Source of Controversy…
Antimicrobial use in food producing animals can serve as a reservoir for antimicrobial resistance, i.e., the more we expose the organisms to antimicrobials the more we give them the opportunity to develop resistance.
Although that may be true in a very simplified, general sense, there is no clear scientific evidence of how, and to what extent such exposure affects human health.
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Additional Complexity
While plausible, there is no hard evidence that cases of human infection with a resistant bacteria have been caused by use of antimicrobials in food animals.
There is little to no evidence that restricting or eliminating the use of antimicrobials in food-producing animals would improve human health or reduce the risk of antimicrobial resistance to humans.
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Benefits vs. Risk
Benefits of AntibioticsAnimal welfare
Prevent, control, & treat diseaseFood safety
Healthy animals produce safer foodEconomic - EfficiencyEnvironmental
Disadvantages Antimicrobial resistant bacteria can develop
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Impact of Animal Health on Foodborne Risk
Healthy: Passed FSIS antemortem inspection (not visibly ill)
Some (~7%) had internal adhesions from previous chronic infectionCarcasses 90% more likely to be contaminated with Salmonella
Photo credit: Hudson ISD FFA
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Which is Preferred?
Less Use vs. More UseLower dose in more animals (today)Higher dose in fewer animals (tomorrow?)
Stronger drugs? Or more culls?
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Differing Approaches
Discontinue Use Although we may not know the degree of risk, why
should we take any chances? Let’s eliminate or reduce the use of antibiotics in animals
on the possibility that this is jeopardizing human health.
Continue Use Let’s not take any action that is not based on a scientific
risk assessment. The benefits to animal health, welfare, and food safety
outweigh the risks to human health based on risk assessments done to date.
Novel Approach ?
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We Need a Collaborative Approach!
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AVMA's Current Approach
Judicious use of antimicrobialsMaximize benefit, minimize risks
Supports veterinary involvement in any use of antimicrobials
Actions to limit use should be based on: Available scientific researchRisk-based assessments
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Preservation of Antibiotics for Medical Treatment Act (PAMTA)
Purpose Preserve the effectiveness of medically important antibiotics used in
the treatment of human and animal diseases by reviewing the safety of certain antibiotics for nontherapeutic purposes in food-producing animals.
Nontherapeutic Use Use of the drug as a feed or water additive for an animal in the
absence of any clinical sign of disease in the animal for growth promotion, feed efficiency, weight gain, routine disease prevention, or other routine purpose.
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AVMA’s Position on PAMTA
Not supported by science (based on AVMA’s interpretation)
Lacks risk-based assessments Has potential to eliminate 2 or 3 of the 4
approved uses of antibiotics in animals Animal welfare implications
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Greater Veterinary Oversight
Some believe this is the way to go – supported by market research
General agreement within AVMA (We think!) Workforce shortage issue (some disagree) VFD is primary vehicle for greater oversight in
antimicrobials in feed Degree of oversight proportionate to risk AVMA would do all we can to make it work!
Veterinary Oversight Steering Committee
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Legislation versus Regulation
Legislation Less opportunity for scientific input & evaluationCan be more politically motivated
Regulation (rulemaking process)Provides months/years for inputMore of a deliberative processStatutory authority already exists
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FDA-CVM Perspective
Innovative use of VFD Supportive of and recognition of the importance of
treatment, control, and prevention Phase in greater veterinary oversight Phase out growth promotion/feed efficiency
Data needed – Is Growth Promotion really prevention?
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So, where are we headed?
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Pathogenesis of Baldness
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So, where are we headed?
More Veterinary OversightWorkforce concernsMore responsibility and more credit - yet also
more blame Role of Veterinarians? Huge!
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