Introducing the safe use of medicines campaign

Global concern over the potential spread of antibiotics resistance from livestock to humans, coupled with the risk of the development of antibiotics resistance in livestock, has placed on-farm medicine use high on the government’s radar.

Claims by organisations such as the Alliance to Save our Antibiotics and the Soil Association have ensured the livestock industry has taken some serious hits in the blame game surrounding antibiotics resistance (AMR) in humans.

This, coupled with the highly emotive language used by government officials and the wider media – comparing resistance to a “ticking time bomb” and global warming – has also ensured the issue is at the forefront of the public’s minds.

As a result, the way in which UK farmers access and use their medicines looks likely to undergo a complete shake-up in the very near future.

The UK government looks set to cement its commitment to tackling antibiotics resistance later in the year through the release of a new cross-government Five Year Antimicrobial Resistance Strategy and Action Plan for 2013-18.

The document is believed to recognise both the human and animal health sectors have a role to play in tackling the problem, through a “one health” approach.

Suzanne Eckford from the Veterinary Medicines Directorate (VMD) says that, although use of antibiotics in humans is now understood as the main reason for AMR in humans, there is the potential for resistance to be passed through the food chain.

“The risk to humans from resistance developing in animals must be kept to a minimum. We are therefore continuing with our efforts to promote the responsible use of antibiotics and develop actions by working closely with all those, including farmers, with an interest in AMR.”

Government policy

The UK Antimicrobial Resistance Strategy is expected to reaffirm existing strategies outlined by the government, including an emphasis on prevention and control of disease. Aims are also likely to include improving education, awareness and research surrounding AMR and encouraging the development of new medicines.

The UK’s approach to AMR has been partly influenced by recommendations outlined by the EU Commission, which is strongly committed to tackling the problem. A range of EU legislation is under review, including the Veterinary Medicinal Products Directive. This could include a number of changes to how antibiotics are used and accessed.

What could this mean for UK farmers? There is no definitive answer as to what changes may look like, and any suggestions will have to be debated by all 27 EU member states before policy is implemented. However, potential changes as part of various legislation could include:

• 1. Vets will no longer be allowed to sell antibiotics to farmers.There is the potential for the sales of antibiotics to be decoupled from vets. This could mean vets will have to issue farmers with an antibiotics prescription and the farmer will then have to go to a pharmacy for collection in a similar way to the NHS.There is uncertainty about how this would be implemented, but there is a precedent for it, as it has already been implemented by other EU countries.
  
• 2. Restriction or banning of some key antibiotics. Farmers could face restrictions on the use of classes of antibiotics viewed as critically important (CIA) for human medicine.These include flouroquinolones and third- and fourth-generation cephlasporins – broad spectrum antibiotics that can be used for a wide range of problems including mastitis, endometritis and control of infectious lameness. Because there are few new antibiotics being developed for human use and a growing level of resistance in humans to existing antibiotics, several bodies are calling for a ban on, or restricted use of, these classes in livestock. Regulation might mean these CIAs have restricted use in certain species and could be used only as a last resort after sensitivity testing of bacteria. However, Tim Potter of the Westpoint Vet Group shares the opinion of many vets and believes these CIAs should not be used as the first port of call anyway, but as second- or third-line therapy.
  
• 3. A new animal health law. At the moment there are a number of different regulations relating to animal health. The intention is to replace these with one overarching animal health law so it is more streamlined. It is possible this law will include a legal basis for AMR surveillance of veterinary pathogens to help improve understanding of where resistance is a problem.
  
• 4. Clampdown on preventative use of antibiotics. Preventative (prophylactic) use of antibiotics to stop the development of an infection is likely to come under particular scrutiny.Farmers and vets will have to justify preventative blanket treatment of groups of animals. For example, treating a batch of calves for pneumonia before disease has developed.
  

Is farming to blame for antibiotics resistance in humans?

• Research and opinion is split when it comes to the link between resistance in humans and animals. For example, a report from the alliance to Save Our Antibiotics, released in March, cited farm antibiotics use as the principal cause of resistance in human salmonella and campylobacter infections.
  
• However, research carried out by the University of Glasgow found more resistant strains of Salmonella DT104 bacteria in the human population than in Scottish cattle, suggesting resistance in humans is unlikely to have come from livestock.
  
• Recent months have seen general recognition that antibiotics use in humans is the main cause of resistance in people, which should help farm leaders who are arguing for a science-led approach to any future legislation.

What changes to medicine use have already happened?

• A ban on antibiotics advertising to farmers will come into force later this year. Those in favour argue it will reduce the pressure some farmers are placing on vets to use new medicines.
  
• The British Poultry Council introduced a voluntary ban on the preventative use of flouroquinolones in day-old chicks.
  
• Some organic contracts already ban the use of third- and fourth-level cephlasporins and flouroquinolones
  
• Supermarkets are becoming more interested in antibiotic use on the farms that supply them.

Antibiotics or antimicrobial?

Much of the current debate around antibiotics uses the term “antimicrobial”.

• An antimicrobial is capable of destroying or inhibiting the growth of a microbe, including bacteria, fungi, viruses and protozoa
  
• An antibiotic is a substance capable of destroying or inhibiting the growth of bacteria (antibacterial)
  
• For the purposes of this campaign, we’ll be talking about antibiotics.

Concerns around medicine use do not just lie at the door of antibiotics.

The Federation of Veterinarians of Europe (FVE) and the British Veterinary Association (BVA) are also calling on the EU Commission to tighten up the accessibility of wormers, to reduce the development of wormer resistance.

Peter Harlech Jones, president of the BVA, claims the current ease of accessibility to wormers in the UK has compounded the growing level of wormer resistance seen in livestock.

“We’re absolutely sure the availability of these products to farmers, without proper clinical diagnosis, has meant they have been used inappropriately and led to resistance. There is so much resistance in grazing animals, and particularly in sheep. We need to change.”

The extent of the problem in sheep is believed to be significant. Sustainable control of parasites in sheep data identified 100% of English lowland sheep flocks and 83% of upland flocks as resistant to white drenches (benzimidazole).

Seventy-five percent of eight sheep farms surveyed also had triple resistance to white, yellow and clear wormers. The problem is also believed to be growing in cattle. Mr Harlech Jones thinks the situation is more serious in liver fluke because of growing resistance to triclabendazole – the only effective treatment against immature fluke.

Twenty-eight percent of sheep farms sampled as part of an AHVLA study were suspected of having resistance to triclabendazole. However, the true extent of resistance is unknown. Mr Harlech Jones says resistance, coupled with the worst fluke challenge on record this year, means there’s a “crisis already happening”.

In most EU countries, wormers are POM-V meaning they can only be prescribed by a vet after a clinical diagnosis. However in the UK, they are POM-VPS which means they can be prescribed by any RQP (registered qualified person, such as a vet or pharmacist) or an SQP (suitably qualified person). A clinical assessment of the animal(s) is not required. Some organisations are calling for wormers to become POM-V in the UK.

However, calls for wormer rules to be brought into line with the rest of the EU have been challenged by the Animal Medicines Training Regulatory Authority (AMTRA). Secretary general Stephen Dawson says the current system of suitably qualified people (SQPs) being able to prescribe wormers works well in the UK.

He argues a “pseudo-monopoly” by vets on supply would do nothing to help farmers in difficult times and that countries with vet-only channels of prescription still have resistance problems.

Look at prevention and how to reduce the likelihood of disease – When you’re using antibiotics, it means your preventative measures have failed. Look at disease control as a holistic approach to reduce the need for antibiotics, full stop.

• Act to reduce the chances of resistance – Using the right wormer and antibiotics to treat the exact cause of a problem will prevent resistance from building.
  
• Follow vet and medicine instructions – Underdosing or not finishing a course of treatments could lead to resistance build up, whereas incorrect storage and vaccination timings could leave treatments ineffective. Weigh animals and check dosing guns to ensure correct treatment.
  
• Make informed treatment decisions through records and testing – Establish the cause of infection and identify the best treatment strategy. Using the wrong medicine will be a waste of money and could cause treatment failure and resistance.
  
• Challenge traditional practices and “farm blindness” – It’s easy to slip into bad habits and do what you’ve always done. Step back, speak to your vet and assess what you’re doing.
  
• Have an effective and active health plan – Revise it regularly; don’t just stick it on the shelf and forget about it.