Using medicines audits to reduce the risk of AMR

In the United Kingdom, all antimicrobials licensed for use in food-producing animals are prescription only and may only be administered following a clinical assessment and diagnoses by a veterinarian. Although the veterinarians may not be administering the drugs themselves, it is still their responsibility to make sure that the products they prescribe are used responsibly. Consistent with the One Health approach (One Health Initiative, 2014), it isn’t just their responsibility, though. It is the responsibility of all to protect animal health, human health and the food chain through disease surveillance and the prevention of medicinal residues, in particular, antimicrobials. Doing so, can only be made possible, though, by improving management systems so that animal health, welfare and production are not compromised.  Further, medicines audits, when used in combination with solid herd health management, can also be a powerful vehicle through which lasting change may be achieved.


Research shows that increased awareness leads to big change

In 2009, reducing total antimicrobial use and encouraging more responsible use is said to have directly affected a number of big changes at the Langford Farm Animal Practice, the clinical teaching practice of the University of Bristol’s School of Veterinary Science. At that time, much discussion and evaluation led to a change in the policies surrounding prescriptions, which was done in order to reduce the reliance on protected antimicrobials, particularly third and fourth generation cephalosporins. Great steps were taken to affect change. The first was to raise awareness, which was done by providing farmers with numerous articles and newsletters, and by arranging educational meetings. During that time, veterinarians also continued to raise awareness by providing training on compliance and responsible use at the ground level. Finally, in 2013, farm- and practice-level medicines audits were incorporated as part of herd health management and clinical governance.

David Tisdall explains the importance of the prudent use of antimicrobials to farm clients
David Tisdall explains the importance of the prudent use of antimicrobials to farm clients

Pilot study leads to a practical approach to medicines audits

In 2010, the Langford Farm Animal Practice led a pilot study with the aim to establish and test a practical approach to medicines audits. It was also their goal to develop data capture and analytical tools to streamline that process, and to consider the most appropriate means for monitoring and reporting that data. Finally, their goal was to assess compliance with herd health management protocols and to evaluate the impact of recent policy changes. In the end, areas of good practice and responsible medicines use were identified and encouraged, while poor compliance was highlighted.

The results

Between 2010 and 2013, Langford Farm Animal Practice saw a marked and sustained reduction in the use of protected antimicrobials and intramammary antimicrobial preparations. By milligrams of use, approximately 77 percent fewer protected antimicrobials were used in systemic treatment. An 89 percent reduction in the use of protected antimicrobials by the intramammary route was also recorded.

Looking more closely at udder health, a 13 percent reduction in total intramammary antimicrobial use was documented, as well as an 18 percent reduction in use for lactating cow therapy and a 7 percent reduction in the use of antimicrobials for dry cow therapy.

Interestingly, the reduction in antimicrobial usage did not lead to a deterioration in herd health. In fact, in most cases, altered practices led to improvements, proving that medicines audits , when combined with on-going herd health management, do promote more responsible use of antimicrobials. Farmers, they say, are pleased with the outcomes and, as a result, have a greater appreciation for the threat of AMR.

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