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Letters
Letters ANTIMICROBIAL RESISTANCE
Responsible use of antimicrobials under the prescribing cascade I WOULD like to make vets aware of the position statement recently issued by the Veterinary Medicines Directorate (VMD) regarding the responsible use of antimicrobials under prescribing cascade legislation. Veterinary surgeons have raised concerns over a perceived tension in balancing the responsible use of antibiotics with the legislative requirement to use a UK-authorised veterinary medicinal product before applying the cascade. The VMD supports and encourages the responsible use of antibiotics. Responsible use requires veterinary surgeons to take into consideration not only the most appropriate active substance(s) but also the most appropriate formulation, the posology, the current pattern of resistance in their locality, an awareness of how to reduce selection pressure (considering minimum inhibitory concentration values and clinical breakpoints when available) and related factors (eg, good biosecurity and husbandry/hygiene, avoiding surgical sepsis, etc). If a veterinary surgeon can demonstrate that these steps have been taken, then cascade use of antibiotics is supported. The VMD therefore considers that it is justified, on a case-by-case basis, to prescribe an antibiotic on the cascade in the interests of minimising the development of resistance, particularly where culture and sensitivity data indicate that a particular antibiotic active substance is effective against a bacterial pathogen and where knowledge of pharmacokinetics
indicates that the selected product is likely to be safe and effective for the animal species and condition being treated; that is, the prescription of a narrow spectrum antibiotic on the cascade over a broad spectrum antibiotic that has a specific authorised indication for that condition. The VMD strongly urges the professional bodies, the veterinary schools, research institutions and other interested parties to work together to aid veterinary surgeons by considering options and proposing measures to compile the necessary up-to-date evidence and guidance to enable them to make a more informed choice, based on current scientific findings and peer reviewed data, when prescribing medicines on the cascade. Veterinary surgeons are encouraged to maintain an awareness of guidance already provided by organisations such as the BVA, British Small Animal Veterinary Association, British Equine Veterinary Association, Pig Veterinary Society and the Responsible Use of Medicines in Agriculture Alliance as well as discussions coordinated by the European Platform for the Responsible Use of Antimicrobials and the Federation of Veterinarians of Europe. The full statement and supporting policy paper can be found on the VMD website, www.vmd.defra.gov.uk. Suzanne Eckford, Antimicrobial Resistance Team, VMD, Woodham Lane, New Haw, Addlestone, Surrey KT15 3LS e-mail: [email protected] doi: 10.1136/vr.g5326
August 30, 2014 | Veterinary Record | 207
Downloaded from http://veterinaryrecord.bmj.com/ on June 17, 2015 - Published by group.bmj.com
Responsible use of antimicrobials under the prescribing cascade Suzanne Eckford Veterinary Record 2014 175: 207
doi: 10.1136/vr.g5326 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/175/8/207.1
These include:
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Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Letters
Letters ANTIMICROBIAL RESISTANCE
Responsible use of antimicrobials under the prescribing cascade I WOULD like to make vets aware of the position statement recently issued by the Veterinary Medicines Directorate (VMD) regarding the responsible use of antimicrobials under prescribing cascade legislation. Veterinary surgeons have raised concerns over a perceived tension in balancing the responsible use of antibiotics with the legislative requirement to use a UK-authorised veterinary medicinal product before applying the cascade. The VMD supports and encourages the responsible use of antibiotics. Responsible use requires veterinary surgeons to take into consideration not only the most appropriate active substance(s) but also the most appropriate formulation, the posology, the current pattern of resistance in their locality, an awareness of how to reduce selection pressure (considering minimum inhibitory concentration values and clinical breakpoints when available) and related factors (eg, good biosecurity and husbandry/hygiene, avoiding surgical sepsis, etc). If a veterinary surgeon can demonstrate that these steps have been taken, then cascade use of antibiotics is supported. The VMD therefore considers that it is justified, on a case-by-case basis, to prescribe an antibiotic on the cascade in the interests of minimising the development of resistance, particularly where culture and sensitivity data indicate that a particular antibiotic active substance is effective against a bacterial pathogen and where knowledge of pharmacokinetics
indicates that the selected product is likely to be safe and effective for the animal species and condition being treated; that is, the prescription of a narrow spectrum antibiotic on the cascade over a broad spectrum antibiotic that has a specific authorised indication for that condition. The VMD strongly urges the professional bodies, the veterinary schools, research institutions and other interested parties to work together to aid veterinary surgeons by considering options and proposing measures to compile the necessary up-to-date evidence and guidance to enable them to make a more informed choice, based on current scientific findings and peer reviewed data, when prescribing medicines on the cascade. Veterinary surgeons are encouraged to maintain an awareness of guidance already provided by organisations such as the BVA, British Small Animal Veterinary Association, British Equine Veterinary Association, Pig Veterinary Society and the Responsible Use of Medicines in Agriculture Alliance as well as discussions coordinated by the European Platform for the Responsible Use of Antimicrobials and the Federation of Veterinarians of Europe. The full statement and supporting policy paper can be found on the VMD website, www.vmd.defra.gov.uk. Suzanne Eckford, Antimicrobial Resistance Team, VMD, Woodham Lane, New Haw, Addlestone, Surrey KT15 3LS e-mail: [email protected] doi: 10.1136/vr.g5326
August 30, 2014 | Veterinary Record | 207
Downloaded from http://veterinaryrecord.bmj.com/ on June 17, 2015 - Published by group.bmj.com
Responsible use of antimicrobials under the prescribing cascade Suzanne Eckford Veterinary Record 2014 175: 207
doi: 10.1136/vr.g5326 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/175/8/207.1
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
