Best practices to avoid the need for use. Plus, stewardship principles ensuring proper use
By Dennis L. Erpelding, Science Advisor, International Poultry Council, TRANSFORM - IPC Project Leader, and Chairman, Global Farm View, LLCAntimicrobial use and antimicrobial resistance are priority concerns globally due to resistance development that can result in untreatable illnesses and potential death. Further, the discovery and authorization for new antimicrobials is scarce so society needs to protect those antimicrobials currently available for use globally. The International Poultry Council (IPC) recognized the concern and challenge thus IPC took the initiative to develop antimicrobial use stewardship principles seeking to ensure the responsible use of antimicrobials in poultry meat production. With stewardship principles, IPC also recognized that best practices on the farm could reduce the need for antimicrobials, thus they also developed best practice guidance for poultry production. IPC recognized that ultimately, action needs to start with the private sector at the farm to address antimicrobial resistance in the food animal sector.
Issues as antimicrobial resistance are global, complex, and multidimensional as there are risks to humans and animals. Leveraging the private and public sectors roles, engaging cross-sector expertise, and working nationally and globally, this all needs to come together for the needed actions and desired results. One recently launched partnership is the Transformational Strategies for Farm Output Risk Mitigation (TRANSFORM) which is a USAID-financed activity implemented by Cargill, Inc., in partnership with Ausvet, Heifer International, and the International Poultry Council. The goal of TRANSFORM is to sustainably strengthen animal-sourced food systems to prevent or minimize antimicrobial resistance, zoonoses, and transboundary animal diseases (TADs).
“One Health” is used globally as we think antimicrobial resistance’s impact on people, animals, the environment, and our planet. Regarding antimicrobial resistance, the concern is: A person becomes sick with a foodborne bacterial infection that cannot be appropriately treated with antibiotics as a result of animal-derived antibiotic-resistant bacteria or genes. Thus, for farmers and those involved in food animal production, what is our role in “One Health” as we look to a global approach in addressing antimicrobial use stewardship?
Antimicrobial use stewardship is an important aspect as farmers and veterinarians work together to provide proper animal care for their animals. Via the use of antimicrobials there is the risk of antimicrobial resistance development which is a natural biological process of bacterial survival. Thus, farmers and veterinarians need to work together to ensure appropriate stewardship practices are in place at the farm level to minimize antimicrobial use and thus also antimicrobial resistance. It is recognized that for bacterial diseases causing animal morbidity or mortality, antimicrobials are still needed for therapeutic uses of disease treatment, control, or prevention. Farmers together with their veterinarian or other professionals need to work together on stewardship practices.
A critically important first step of stewardship with a global approach is common terminology and definitions. The following terminology from the International Poultry Council provides for consistency globally. Key definitions include:
Antimicrobial: the broadest term used, refers to any type of product that has activity against a variety of microorganisms, which can include bacteria, viruses, fungi and parasites. This includes products such as antibiotics and anti-protozoals.
Antibiotic: a type of antimicrobial, specifically antibiotics are compounds produced naturally by a fungus or another microorganism, or synthetic analogues of these, which kill or inhibit the growth of bacteria that cause disease in humans or animals.
Anticoccidials: compounds with a unique mode of action that are used to control the common protozoan parasite which causes coccidiosis in poultry and thus can be categorized differently by various regulatory authorities. This class of compounds is currently not used in human medicine and thus not considered as medically important for humans. Ionophores and chemicals are used as anticoccidials. Due to their uniqueness and use some authorities do not categorize anticoccidials as antibiotics, although they are generally captured by the term antimicrobials.
Also, common definitions globally around uses are important to include:
Therapeutic use, which includes:
Disease treatment (curative) use: any specific procedure used for the cure or the amelioration of a disease,
Disease control (metaphylaxis) use: practices aimed at reducing the spread of, or incidence of, a disease, and
Disease prevention (prophylaxis) use: reducing the likelihood of a disease where there is a high probability of the occurrence of a disease in a susceptible population.
Growth promotion / production use: shifting the microflora in the gastrointestinal tract for better balance of beneficial and harmful bacteria, thus improving nutrient utilization to support healthy growth and improved performance. Nutritional efficiency, feed efficiency and average daily gain are indicators of response.
With common terminology and definitions, one looks to antimicrobials use stewardship principles that have two high level points, first are all efforts being made to avoid the need for the use of an antimicrobial, and second, if needed, is an antimicrobial being used properly. Each of these points have important steps involved. The International Poultry Council has developed materials for points one and two, materials that are poultry focused but also applicable to all food animal species.
Regarding efforts to avoid the need for use of an antimicrobial, the International Poultry Council has developed a document for “Best Practice Guidance to Reduce the Need for Antibiotics in Poultry Production”. The guidance outlines the key practices involved in reducing the need for the use of antibiotics which include: stockmanship and training, biosecurity - external environment, biosecurity - internal environment, bird environment, hygiene - houses, hygiene - hatcheries, flock health and welfare plans, nutrition, antibiotic medication - stewardship principles, antibiotic growth promotion - restricted, and data collection. Based on scientific understanding and global learnings, when farmers implement each of these practices, they will reduce the need for antibiotics.
Regarding ensuring antimicrobials are being used properly, the International Poultry Council has developed “Antimicrobial Use and Antimicrobial Stewardship Principles”. These include the following principles:
All participants in the poultry industry adopt risk analysis based principles of antimicrobial stewardship to ensure best practices are used throughout all phases of poultry production so as to minimize the use of all antimicrobials while ensuring proper animal care. To achieve stewardship IPC will encourage its members to:
Understand and control why and when we use antimicrobials,
Understand and control which antimicrobials we use,
Understand and control how much antimicrobials we use, and
Transparently communicate our actions.
Management practices around biosecurity, housing, nutrition and hygiene, and the use of preventive measures, such as vaccines, should be prioritized to provide the best animal care to reduce the need for antimicrobial use.
Antimicrobials will only be used in compliance with national authorizations.
Those antimicrobials critically important for human medicine should be used for therapeutic purposes only and under a supervising veterinarian’s diagnosis and oversight.
The best practices and stewardship principles, when adopted and fully implemented at the farm level will reduce the need for antimicrobials and thus reduce the development of antimicrobial resistance. Farmers can see the results via healthier, more productive animals and reduced medication costs, thus a more profitable system. Global experiences have demonstrated that focused efforts on the farm will yield very positive outcomes. Farmers and those involved in the food animal sector can do their part in advancing “One Health” objectives globally by taking action through implementing best practices, thereby reducing the need for antimicrobial use, and when antimicrobials are needed, ensuring their proper use by following antimicrobial use stewardship principles.
Global and complex issues can best be addressed via private and public sector partnerships leveraging the roles of each. Further for scale and impact, global oriented, market-based mindsets are needed for long-term sustainable and economically viable programs. TRANSFORM is on this journey with associations endorsing and companies adopting antimicrobial use stewardship principles. The journey starts with one association, one company, and one farm, but as momentum builds, more associations, more companies, and more farmers act, ultimately leading to a new global approach that becomes the new best practice standard for all. Transformational change starts with one but ultimately happens through amplifying and scaling globally – a journey that IPC and its members, in collaboration with private and public sector stakeholders, have begun in addressing antimicrobial resistance at the farm level and in the food animal sector value chains.