Hi, I’m Dr. Dave VanDelay. I’m a large animal veterinarian who works with many different farmers; a modern day James Herriot. I see many sick animals, and I often rely on antimicrobials to treat infections. But treating certain infections has become more difficult because of antimicrobial resistance; an issue driven by widespread use and, in certain cases, overuse of antimicrobials around the world. Not only does antimicrobial use in farmed animals lead to resistant bacteria in animals and the environment, those resistant bacteria can also be transferred to people. The scary thing is that if we don’t act, common infections that were once easily treated could end up causing more human deaths worldwide every year than cancer!
So, it’s time we started looking at how we prevent and treat infections to make sure that, when we need to, we use the right drug, in the right amount, at the right time, for the right reasons. We need to practice the five “Rs” of antimicrobial stewardship: Responsibility, Reduction, Refinement, Replacement, and Review.
As a veterinarian, I play a critical role in stewardship, and so do my clients. Everyone on the farm team must understand and accept their role in managing the use of these drugs, which covers the first ‘R’: responsibility. From veterinarians to technicians, workers, owners, and other farm advisors – everyone who uses antimicrobials is responsible for using them appropriately. This is especially true for veterinarians, who prescribe and dispense antimicrobials on a regular basis.
Antimicrobials are important tools for fighting infections, but we shouldn’t rely on them to be the solution. Reduction, the second R, is all about being proactive and minimizing the need for antimicrobials. An ounce of prevention is worth a pound of cure. For example, Albert, one of my veal clients, was finding that many of his calves were developing pneumonia and he was using a lot of antimicrobials. After walking through the calf barn, I suggested changing the ventilation system and stocking density to improve air quality and prevent disease. Over my next few visits we found the changes greatly improved the air quality of the calf barn and he was treating far fewer pneumonia cases! These strategies have helped improve Albert’s bottom line, lessen his reliance on antimicrobials, and ultimately slow the development of resistance.
Sometimes, despite our best efforts, animals get sick and our best course of action is to treat the infection. This brings us to our next ‘R’: refinement. As a veterinarian, it’s my job to determine the cause of illness and, if necessary, select the most appropriate antimicrobial to use. I work with my clients, like Vicki here, to develop and establish standard operating procedures for common illnesses. Through our discussions we develop and refine our plans for identifying and treating infections in her pigs. When she’s unsure, she calls me and we examine the pigs together. If necessary, we send samples to the lab to determine the specific cause of illness. Armed with this knowledge, we determine the best course of action for her herd.
Replacement is our next ‘R’. Whenever possible, I recommend effective alternatives to antimicrobials. Take my client Bill for example. Bill is a broiler chicken producer who recently started having Salmonella in his flock. Upon my visit, we treated sick birds with antibiotics and then focused on alternative approaches to remedy the issue. We decided to try replacing our treatment program with a new program that involved vaccination of chicks to prevent infection and the use of probiotics to improve the gut health and immune system of his flock. Upon my next visit I was pleased to hear that not only were his next flock of birds healthier, Bill had found the probiotics easy to administer, safe to use, and more affordable.
The last ‘R’ is Review. The decisions we make today may not always be applicable tomorrow. I work with many of my clients, like Stacey here, to track and monitor changes over time. We routinely evaluate her dairy herd for rates of illness, and we track the amount and type of antimicrobials she is using. We also hold quarterly management meetings to discuss this information with her staff. Not only do these discussions act as useful checkpoints to evaluate how she’s doing, they also confirm that the actions she’s taking are leading to the best possible outcomes for her cattle.
These stewardship principles are the roadmap for preventing resistance and ensuring the optimal health of all farmed animals. Anyone using or prescribing antimicrobials has a role to play in this global issue. Like one of my professors used to say: “We’re all in this together”.