Critically important antimicrobial (CIA) use

When discussing why we prescribe, we also have to look at what we prescribe. In this video, Robert Hyde explains what critically important antibiotics (CIAs) are.

Certain antibiotic classes are categorised by the World Health Organisation (WHO) as critically important antibiotics for human use, of which several are designated as ‘highest priority critically important antibiotics’ (HP-CIA). The WHO list of critically important antimicrobials can be found here.

CIAs are usually used as a last resort, in cases where no other antibiotic would be effective. In veterinary medicine, antibiotics are categorised in the same way; it is the same antimicrobials that are classed as critically important for both veterinary and human medicine. These are:

• 3rd/ 4th generation cephalosporins.
• Fluoroquinolones.
• Colistin.

Each livestock species has their own specific antimicrobial usage targets, but they all include the need to reduce the use of HP-CIA’s. This has been successful since 2016, where there has been a dramatic decrease in their usage.

If you would like further reading on this topic, take a look at the see also section, where the articles suggested in the video from NOAH, the VARRS report, RUMA, and EMA can be found.

You should now feel confident with the theory behind AMR and why AMS is so important. However, AMS is not always easy to implement. The next steps will introduce you to some challenges that might be faced in achieving good antimicrobial stewardship.

Please find a downloadable copy of the PowerPoint slides used in the video in the downloads section below.