Lynda McDonald International Milk Quality Specialist€¦ · Antibiotic resistance kills around 700,000 people worldwide each year. That number is expected to climb to 10 million

Basic Principles

Antiobiotic Stewardship in Mastitis Treatment

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International Milk Quality SpecialistLynda McDonald

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Basic principles of antibiotic stewardship

Agenda

• Background on antibiotic concerns internationally• How does resistance happen? • Why antiobiotic stewardship is necessary • Key risk factors for a post-antimicrobial world • What are the major risk contributors in China?• So what is happening in other countries? • An insight into antibiotic useage in dairy farms in China • Basic principles of antibiotic stewardship • Summary

MANG REN MO XIANG

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Antibiotic resistance kills around 700,000 people worldwide each year. That number is expected to climb to 10 million by 2050.

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Background on antibiotic concerns internationally

Antiobiotic Stewardship

http://naturalsociety.com/superbug-resistant-to-all-antibiotics-found-in-china/

• Antibiotic stewardship is: the development, promotion, and implementation of activities to ensure the appropriate use of antibiotics. By adopting antibiotic stewardship principles, organizations can improve how antibiotics are used and prescribed, and can slow the rise of antibiotic resistant infections. CDC USA




http://www.cdc.gov/drugresistance/federal-engagement-in-ar/stewardship-commitment/index.htm

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8http://www.bloomberg.com/news/features/2016-09-19/china-s-five-star-pig-pens-are-latest-weapon-in-the-superbug-war

9 http://phenomena.nationalgeographic.com/2016/05/26/colistin-r-9/

• Antimicrobial resistance (AMR) is an extraordinarily complex global problem • The spread of resistant bacteria occurs naturally, but also through human actions, in animal agriculture and medical practice.• Consumers driving change with increasing interest in having “antibiotic-free” options at grocery stores and restaurants



Sales of veterinary antimicrobial agents in 26 EU/EEA countries in 2013 Fifth ESVAC reporthttp://www.ema.europa.eu/docs/en_GB/document_library/Report/2015/10/WC500195687.pdfhttp://www.cdc.gov/drugresistance/federal-engagement-in-ar/stewardship-commitment/index.htmhttp://www.milkproduction.com/Library/Editorial-articles/Antibiotic-resistance--a-complex-issue-and-serious-threat/http://www.who.int/mediacentre/factsheets/fs194/en/l


• Bacteria develop antibiotic resistance in two ways

‒ . Mutations in genomes that allow them to withstand antibiotics

‒ . They get infected with a plasmid, a small piece of DNA, carrying a gene for antibiotic resistance. That makes resistance genes more dangerous because plasmids can replicate and transfer the genes they carry to other bacteria, without having to develop it through evolution‒ KPC‒ MCR-1‒ NDM-1

Human misuse of antibiotics - not using them for the time period recommended by doctors, or not using the recommended dose.


How does resistance happen?


World Health Organisation WHO Fact Sheets


Why antiobiotic stewardship is necessary


http://phenomena.nationalgeographic.com/2015/11/21/mcr-gene-colistin/https://www.cdc.gov/drugresistance/

Scientists and public health officials have long warned that if the resistant bacteria continue to spread, treatment options could be seriously limited. Routine operations could become deadly. Minor infections could become life-threatening crises.

Pneumonia could be more and more difficult to treat.

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• . New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability, and death

• Without effective antimicrobials for prevention and treatment of infections, medical procedures can become very high risk

• . Antimicrobial resistance increases the cost and duration of health care with more intensive care required• Antimicrobial resistance is putting the gains of the Millennium Development Goals at risk and endangers

achievement of the Sustainable Development Goals.

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Why antiobiotic stewardship is necessary

• Primarily the current levels of use of antimicrobials in human medicine• Current levels of use in both companion and food animals• Presence in the environment especially from contaminated food and disposal of wastes • Growing globalization such that both bacterial infections and AMR may spread rapidly


Key risk factors for a post-antimicrobial world

Use of antimicrobials for animals in New Zealand, and in comparison with other countrieshttp://dx.doi.org/10.1080/00480169.2016.1171736


• Pigs and Poultry• Antimicrobial use for growth promotion in food animal production – especially Colistin• The specific antibiotic use in the Chinese food animal production sector is unclear – needs to be measured.• Estimated high quantities of antimicrobial use - because of reports of high concentrations of antimicrobials

in animal waste and surface waters surrounding animal feeding operations.• High levels of antimicrobials in soil samples and ground water throughout China


What are the major risk contributors in China?

Antimicrobial use in Chinese swine and broiler poultry productionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412119/http://phenomena.nationalgeographic.com/2016/06/23/colistin-resistance-the-pig-is-out-of-the-barn/


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Estimated antimicrobial use (mg active ingredient per kg biomass) in food-producing animals (including horses) compared with use for humans in 30 countries during 2012.


• Estimated usage of antimicrobials in food producing animals in 2012 varied from 3.8mg to 341 mg active ingredient/kg biomass, in Norway and Italy respectively.

• No records for China.


• Global action plan on antimicrobial resistance adopted by WHO ‒ Requires individual countries to develop & implement comprehensive action plans to optimize

the use of antimicrobial medicines.

• New Zealand. 3rd lowest antiobiotic useage in the world ‒ Develop a national stategy. ‒ First, understand uses of antimicrobials for animal health, welfare, and food production. ‒ Compare with best and worst practices globabally to address concerns


So what is happening in other industries?



• Scandinavia. Lowest use rates of antibiotics in the world. All useage on farm must have a prescription from a veterinarian.

‒ . USA. To fight the growing problem of human infections that can't be treated, the administration of Obama is implementing a five-year national action plan at a cost of $1.2 billionUSD, double present amount .

‒ Research for new antibiotics and vaccines will accelerate. The plan calls for two new options for people, and three for animals, by 2020

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So what is happening in other industries?

CNN http://edition.cnn.com/2015/03/27/health/obama-antibiotic-resistance/


The World Bank (Sept 2016) said antimicrobial resistance in China would cause annual global gross domestic product to fall 1.1-to-3.8 percent by 2050, raise annual health-care costs by as much as $1 trillion, and lead to a 2.6-to-7.5 percent a year decline in livestock production.• Leaders of the Group of 20, who met Sept 2016 in Hangzhou, China, pledged to promote

prudent use of antibiotics, and affirmed the need to fight resistance, including through supporting drug research.

• At the United Nations in New York (Sept 2016), world leaders will discuss a global response, including tackling the irrational human- and veterinary-use of antibiotics and how to support efforts in developing countries


重大新闻 Breaking News! Antiobiotic Stewardship

CNN http://edition.cnn.com/2015/03/27/health/obama-antibiotic-resistance/

What you can measure you can manage

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How does the dairy industry fit in?


•How many cows in your herd? •What is your mastitis rate? •What is your major mastitis pathogen? •How many antibiotic treatments are given in your herd each year?

‒Per cow? - What price is a dose of antibiotics per mastitis treatment? ‒ How much money do you spend on Mastitis treatments annually?

•Does your farm have it‘s own lab?•How do you test for mastitis pathogens? (Agar plates, pcr etc).

•What is your mastitis protocol?(What type of drugs, how long they‘re given, when treatment is started and finished). •When do you make a decision to treat a cow?•If you see flakes do you treat? •Do you ever allow a cow to self cure? •What proportion of antibiotics used are :

‒Locally produced ‒Produced by market leading brands Boehringer and Zoetis

•Do you understand what antibiotic resistance is? Please give your own definition.

•Do you understand the connection between animal antibiotics use and human health and antibiotic resistance? Please explain.


An insight into antibiotic useage in dairy farms in China


SURVEY RESULTS TO BE ADDED DURING OCTOBER


An insight into antibiotic useage in dairy farms in China


GOAL: To optimise the use of antiobiotics.• To understand at farm level, and national level, the useage rate of antimicrobials • To manage and optimise at farm level and national level, the useage rate of antimicrobials


Basic principles of antibiotic stewardship


1. Take preventive measures to keep cattle from getting sick. 2. Identify the root cause for every case that needs antibiotic treatment.3. Management need to implement practices that will reduce the need for antibiotic treatment (based on root

cause analysis)

4. . Evaluate the effectiveness of management and practices focused on the root cause reasons that animals require treatment with an antibiotic


Basic principles of antibiotic stewardship – Beef Industry

Cattle Industry Convention hosted Jan. 27-29 2016, in San Diego, California USA. http://www.angus.media/News/Article/113/Antibiotic-Stewardship-in-Animal-Agriculture


1. Define the Treatment Team 2. Determining the Appropriate Treatment 3. Criteria for Justifiable Antibiotic Usage

1. Antibiotic usage should involve veterinary guidance. 2. Antibiotics should only be used when there is a reasonable likelihood that a bacterial infection

is present.

3. . Narrow spectrum antibiotics that are less critical for treating human illnesses should be used as a first choice

4. Antibiotics should be used for as short a duration as possible 5. Characteristics of affected cows should be reviewed before antibiotics are administered6. Extralabel use should be avoided when on-label use is a possibility

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Basic principles of antibiotic stewardship – Dairy Industry


Drug Residue Déjà vu: How to Use Antibiotics Responsibly Pamela L. Ruegghttp://nmconline.omnibooksonline.com/62771-nmc-2016r-1.3162720/t001-1.3162729/f001-1.3162746/a001-1.3162747

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• Antimicrobial resistance is a complex global problem.

• The world needs to collaborate within the fields of human, companion animal, and food production animals to reduce the risks

• The dairy industry must be leaders in practicising antiobiotic stewardship.• Veterinarians and farms should work together to focus on on early detection and diagnosis• Farms should have appropriate management structures and protocols

Summary



• 2015 symposium, Antibiotic Stewardship: From Metrics to Management http://www.animalagriculture.org/resources/Documents/Conf%20-%20Symp/Symposiums/2015%20Antibiotics/2015%20NIAA%20ABX%20White%20Paper-Final.pdf

• CDC Centre for Disease Prevention and Control http://www.cdc.gov/drugresistance/federal-engagement-in-ar/stewardship-commitment/index.html

• Sales of veterinary antimicrobial agents in 26 EU/EEA countries in 2013 Fifth ESVAC report http://www.ema.europa.eu/docs/en_GB/document_library/Report/2015/10/WC500195687.pdf

• Milk Production http://www.milkproduction.com/Library/Editorial-articles/Antibiotic-resistance--a-complex-issue-and-serious-threat/l• World Health Organisation http://www.who.int/mediacentre/factsheets/fs194/en/ • World Health Organisation http://www.who.int/en/• NMC Proceedings 2016 Drug Residue Déjà vu: How to Use Antibiotics Responsibly - See more at: http://nmconline.omnibooksonline.com/62771-nmc-2016r-1.3162720/t001-

1.3162729/f001-1.3162746/a001-1.3162747#sthash.soX5fiii.dpuf• Antibiotic Stewardship: From Metrics to Management http://www.animalagriculture.org/resources/Documents/Conf%20-

%20Symp/Symposiums/2015%20Antibiotics/2015%20NIAA%20ABX%20White%20Paper-Final.pdf• Antimicrobial use in Chinese swine and broiler poultry production http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412119/• Antibiotic Stewardship in Animal Agriculture http://www.angus.media/News/Article/113/Antibiotic-Stewardship-in-Animal-Agriculture• JE Hillerton, CR Irvine, MA Bryan, D Scott & SC Merchant (2016): Use of antimicrobials for animals in New Zealand, and in comparison with other countries, New Zealand Veterinary

Journal, DOI: 10.1080/00480169.2016.1171736 http://dx.doi.org/10.1080/00480169.2016.1171736• Phenomena National Geograph http://phenomena.nationalgeographic.com/2016/06/23/colistin-resistance-the-pig-is-out-of-the-barn/• Phenomena National Geograph http://phenomena.nationalgeographic.com/2015/11/21/mcr-gene-colistin/• http://naturalsociety.com/superbug-resistant-to-all-antibiotics-found-in-china/• http://www.scientificamerican.com/article/new-superbug-gene-found-in-animals-and-people-in-china/• CNN http://edition.cnn.com/2015/03/27/health/obama-antibiotic-resistance/• https://www.washingtonpost.com/news/to-your-health/wp/2016/05/27/what-we-know-so-far-about-the-superbug-in-the-pennsylvania-case/?tid=a_inl• http://www.bloomberg.com/news/features/2016-09-19/china-s-five-star-pig-pens-are-latest-weapon-in-the-superbug-war


References



References


Antimicrobial Resistance of Mastitis Pathogens https://projects.ncsu.edu/cals/an_sci/extension/dairy/newsletters/0306nlet.pdf

Milk and Dairy Beef Drug Residue Prevention Manual http://www.nmpf.org/latest-news/press-releases/nov-2015/new-2016-farm-residue-prevention-manual-focuses-antimicrobial