In this short presentation, I really want us to explore together the idea of antimicrobial stewardship. But more specifically, I want us to get to the nub of the question of what antimicrobial stewardship really means for each of us within our local context. Now, when we each think about antimicrobial stewardship, I’m sure lots of different ideas and concepts, words and phrases come to mind.
We perhaps all have an individual picture or perspective on what antimicrobial stewardship would look like within our local context, and that’s not surprising, I guess, because it’s going to be informed by our own experience of practise, by the culture of the environment that we work in, by our undergraduate training, by our engagement with the ideas of one health, by our value system, by so many different experiences that we’ve all had.
And so it’s really difficult to get to the nub of what this idea of antimicrobial stewardship might really mean and why it’s so important for us to reflect on what it means for us in our own local context in light of the big global challenge, the real true one health issue that antimicrobial resistance is.
When you ask undergraduate veterinary students about the idea of antimicrobial stewardship, it’s unsurprising that they come up with lots and lots of different ideas. But usually, these tend to fall within perhaps two or three different themes. And the first is an idea surrounding evidence-based decision making. We can see that picked up in some of the comments that they’ve made here. The second theme that comes up is one of diligent prescribing and user compliance. I guess two elements to this, there’s a responsibility of the vets to get the dose correct for the body weight of the animal to make sure that the right antimicrobial is prescribed. There’s all those elements.
But there’s also the role of the animal keeper, the owner, the farmer here and their responsibility to comply with the guidance that’s been provided by the vets. That’s all part of antimicrobial stewardship. And the third theme is one of moral duty and responsibility, doing the right thing, only using antimicrobials when necessary. The British Veterinary Association talks about antimicrobial stewardship, but it tends to do so in the context of thinking about the responsible use of antimicrobials, and the term responsible use of antimicrobials is more or less synonymous with the idea of antimicrobial stewardship.
And the BVA has produced a very helpful seven point plan for the responsible use of antimicrobials in veterinary practice, and it picks up many of the themes that you might expect to be in such a document. I’d really like to highlight the one that’s put first, which is working with clients to avoid the need for antimicrobials, and that surely has to be the starting point for antimicrobial stewardship. And some of these other themes we’re going to go on and explore throughout the rest of the course, so we’re going to think about what’s in appropriate uses, and how to make a good choice of what antimicrobial to pick. We’re going to do that in the second week.
We’ll also be thinking about how we monitor antimicrobial sensitivity, how we can keep use to a minimum, and how we can record and monitor medicines use effectively. So many of these themes that the BVA would encapsulate within this idea of responsible medicines use are going to be discussed within this course. And actually, they sum it up in this definition here. So the BVA speak about antimicrobial stewardship in terms of responsible medicines use. I wonder if that’s something that chimes and resonates with you. The World Health Organisation perhaps offer a different perspective, again, on what antimicrobial stewardship might be, and they often cage it in terms of the idea of critically important antimicrobials for human health, the CIAs.
Now, the CIAs are a group of antimicrobial as defined by the fact that either they are a soul or one of a limited number of substances that are available to treat serious human disease, or that pathogens, which are zoonotic or where there exists the potential for resistance gene transfer from non-human sources. And they’re antimicrobials that would be used to treat those two groups of conditions. The World Health Organisation produced a list of these every few years. The most recent addition has just come out actually. And in fact, there’s a further crested category again. And those are those CIAs that are considered of highest priority. They’re the ones that actually meet both those criteria.
And I’ve listed some of them on the right hand side of the screen there, but perhaps the ones that matter most within our context would be the fluoroquinolones for third and fourth generation cephalosporins and the macrolites, those antimicrobials that the BVA deems higher risk antimicrobials. And they’re important for human health. And so we need to be really careful as veterinary practitioners when we’re making prescribing decisions around these particular classes. Really, what I’m saying is that I want you to start to think about what’s antimicrobial stewardship might mean in your local context. And for me, that’s something that’s changed over time.
So when I was leading a clinical practice in Somerset for the University of Bristol, antimicrobial stewardship meant the way that I was leading that team in terms of a clinical governance of the past prescribing decisions that that practice would make, in terms of my own prescribing decisions on farm, in terms of a way that I worked with farm clients in order to inform them and educate them to agree, plans to improve the health and welfare of those animals on those farms, so that we reduce the need of antimicrobials in that very first instance. But now, antimicrobial stewardship looks different for me. There’s a real focus in my role as an educator working at the University of Surrey.
So antimicrobial stewardship means something differently, depending on our different local contexts or at least the application of it really changes, depending of where we find our place of work. And so what I really want you to think about is what might antimicrobial stewardship mean for you in your local practice. Have a think about those questions. Discuss them on the forums.