Antibiotic stewardship slow to catch on among veterinarians — Stakes high for human, animal health
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* Mark Barna

When Gail Hansen was a practicing veterinarian, a pet owner brought in a dog with a skin condition. Hansen wanted to run diagnostic tests to figure out how to treat the animal, but the owner was not interested.

The customer went to another veterinarian and got prescriptions for a steroid, an antifungal and an antibiotic, Hansen learned three weeks later.

“I suspect the underlying problem was never dealt with,” Hansen, DVM, MPH, now a consultant on public health policy, told *The Nation’s Health.*

Some 20-odd years since that appointment, the issue largely remains in veterinary circles. Overprescribing antibiotics is relatively common at veterinary clinics, several studies show. And though stewardship progress has been made, the lifesaving medicines are still used generously on both companion animals and farm animals.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/49/9/1.3/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/49/9/1.3/F1)

A veterinarian inspects a dairy cow inside a barn in 2012. While antimicrobial resistance in pets is a problem, most of the concern in veterinary medicine is antibiotic use on farm animals.

Photo by Edwin Remsburg, courtesy VW Pics/Getty Images

“It’s still unregulated, there is still no oversight and still no true buy-in from a lot of veterinarians that antibiotic stewardship is something they have to deal with,” said Hansen, an APHA member.

Antimicrobial resistance happens when bacteria develops immunity to medicines used to treat bacterial infections in humans and animals. Resistant bacteria can be transmitted through the environment, such as from contaminated soil or water, and eating raw or undercooked meat.

The public health and medical field shares antibiotic stewardship programs, in which doctors strive to use antibiotics responsibly on human patients. But similar programs are rare in veterinary medicine, said APHA member David Wallinga, MD, a senior health advisor at the National Resources Defense Council who specializes in antibiotic overuse on farm animals.

As much as 50% of antibiotics prescribed by veterinarians for pets may not be needed, according to a 2015 report from an American Veterinary Medical Association task force on antimicrobial stewardship. At a veterinary teaching hospital, 38% of canine antibiotics prescribed over a 12-month period were for dogs with no infections, a study published in 2011 in the *Journal of Small Animal Practi*ce found. And in a study published this year in the *Veterinary and Animal Science,* almost 90% of students surveyed at a major veterinary medical center had not read or rarely read the antimicrobial resistance guidelines for judicious use created by the American Veterinary Medical Association and U.S. Food and Drug Administration.

The stakes are high for human and animal health.

“On this issue, we are literally talking about resistance changing the face of modern medicine,” Wallinga told *The Nation’s Health.*

A soon-to-be published study delves into why general practice veterinarians may be overprescribing. Through extended interviews with 36 veterinarians, Sondra Lavigne, a research-er at the University of Pennsylvania’s Perelman School of Medicine, and her team found that most were unaware of antimicrobial resistance guidelines, which recommend how and when the medications should be used.

Reasons given for writing prescriptions ranged from not having the energy to challenge animal owners to wanting to to keep costs low for customers.

Diagnostic testing to determine which antibiotic to prescribe for a urinary tract or skin infection can cost several hundred dollars, a steep price for some pet owners. So animal doctors skip the test and prescribe a general antibiotic. If that is not effective, they cycle through prescribing other antibiotics, said Lavigne, an APHA member who will lead a discussion on her research at session 2085 during APHA’s 2019 Annual Meeting and Expo in Philadelphia on Nov. 3.

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[Figure2](http://www.thenationshealth.org/content/49/9/1.3/F2)

A veterinarian checks the eyes of a puppy in Washington, D.C., in 2011. Antibiotics are often oversprescribed in domestic pets.

Photo by Mark Gail, courtesy The Washington Post/Getty Images

“Many felt that when they came out of veterinary school, they weren’t really prepared with the tools to figure out how to diagnose and treat these patients when they were restricted by the money clients had available,” Lavigne told *The Nation’s Health.*

Guidance on how to appropriately prescribe antibiotics for cost-conscious animal owners are needed, veterinarians say. Pet insurance can also help reduce costs.

“Promoting pet insurance can be a great way to promote antibiotic stewardship,” Lavigne said.

Other ways to prevent overuse are to use treatments such as a cough suppressant for kennel cough rather than an antibiotic, or adopting a “watchful waiting” approach to see if a condition clears up before prescribing, she said.

## Antibiotics in farm animals bigger issue

While antimicrobial resistance in pets is a problem, most of the concern in veterinary medicine is antibiotic use on farm animals. Nearly two-thirds of medically important antibiotics — those used in human medicine — are used in animal agriculture, FDA estimates.

In January 2017, FDA issued a rule requiring veterinary oversight on antibiotic use in feed and water on farms and banned antibiotic use to promote growth. Antibiotic use decreased by over 30% in 2017 compared to the previous year, according to pharmaceutical company estimates cited in a report by Pew Charitable Trusts.

In December 2018, FDA outlined a 5-year plan to control antibiotic use on farms. Expanding veterinary oversight, establishing duration guidelines and improving data gathering are the main goals.

Karin Hoelzer, DVM, PhD, part of Pews’ antibiotic resistance project, said she is hopeful FDA will extend veterinary oversight to injected antibiotics too.

“That is a change we anticipate in a couple years,” she told *The Nation’s Health.*

Another way to reduce antibiotics use is through better animal management practices. Improved housing and nutrition can reduce animal stress and prevent illnesses and diseases, Hoelzer said. Vaccinations can also help herds stay healthy.

The National Pork Board, overseen by an arm of the U.S. Department of Agriculture, has worked with veterinarians and farmers to create better management practices, said Heather Fowler, VMD, PhD, MPH, DACVPM, the board’s director of producer and public health. Outcomes will be available in future USDA reports.

“I, as a public health veterinarian, don’t talk about reducing (antibiotic) use,” Fowler told *The Nation’s Health.* “I talk about reducing the overall need — putting into place those practices that optimize swine health and welfare to make sure we can reduce the overall need. We want to make sure that every time we use antibiotics, they are in fact necessary.”

Even so, Wallinga said he is skeptical that farm animal veterinarians are routinely putting stewardship over profit margins. But Andrew Maccabe, DVM, MPH, JD, head of the Association of American Veterinary Medical Colleges, said significant stewardship progress has been made, partly driven by consumers demanding antibiotic-free food from meat farms. In recent years, McDonald’s, Tyson’s Food and Walmart have urged meat suppliers to practice stewardship.

“The trend is continuing because it is as much consumer driven as economically driven,” Maccabe told *The Nation’s Health.* “When consumers demand things, that drives the industry, and if industry doesn’t meet those demands, it lose market share.”

For more information, visit [www.avma.org](http://www.avma.org) and [www.fda.gov](http://www.fda.gov).

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