Introduction

The AVMA has a long history, stretching back more than 20 years, of work promoting and developing antimicrobial stewardship in veterinary medicine. In 1998, the AVMA created a steering committee to address antimicrobial use in the veterinary profession. This steering committee created the AVMA’s first standalone policy addressing antimicrobial use in veterinary practice with the Judicious Therapeutic Use of Antimicrobials policy.¹ This policy was then expanded upon by our allied veterinary groups as they used it as a foundational document to create judicious-use policies specific to the species under their care. For example, the American Association of Bovine Practitioners (AABP) used the AVMA’s Judicious Therapeutic Use of Antimicrobials policy as an example as they created the AABP’s judicious use policy for cattle.²

In 2009, the AVMA created the Antimicrobial Use Task Force to clarify the role of the veterinarian and level of veterinary involvement in all uses of antimicrobials. Then, in 2011, the Veterinary Oversight Steering Committee was created to work with the FDA on the Veterinary Feed Directive.³ This steering committee’s influence led to inclusion of the requirement that a proper veterinarian-client-patient relationship⁴ should exist when a Veterinary Feed Directive is issued.

In 2013, the Taskforce for Antimicrobial Stewardship in Companion Animal Practice was created. They developed a report with recommendations for implementing antimicrobial stewardship in companion animal practice and numerous resources for practitioners, all of which are available on the AVMA website.⁵ Additionally, during this time, numerous standing AVMA entities were involved in helping the AVMA develop positions and comments regarding proposed legislation and regulation.

For nearly 20 years, the AVMA addressed antimicrobial issues through either a variety of existing AVMA entities or the creation of topic-specific steering committees or task forces. But over time, it became apparent that we needed a standing committee to specifically handle antimicrobial issues.

In 2016, the AVMA created the Committee on Antimicrobials (CoA).⁶ The CoA has 9 seats, each held by an allied veterinary association, with 1 seat for a member at large. Each seat is represented by both a primary and alternate representative. The representatives must have a background in pharmacology, microbiology, epidemiology, or public health or a documented history of productive and collaborative contributions in the area of antimicrobials and/or antimicrobial resistance. The CoA also has 4 advisors, 1 each from the FDA Center for Veterinary Medicine, USDA APHIS, CDC, and Animal Health Institute.

The CoA serves as the AVMA’s lead entity on antimicrobial issues. They are tasked with overseeing and developing the AVMA’s antimicrobial policies, crafting the AVMA’s response and positions to legislative and regulatory proposals, creating tools and resources for AVMA members and others, and interacting with other stakeholders involved in antimicrobial issues.

In 2016, when the CoA was first created, the conversation around antimicrobials was shifting from judicious use to antimicrobial stewardship and One Health. During the CoA’s first meeting at the AVMA headquarters, everyone sitting at the conference table was asked to define antimicrobial stewardship and explain how it was different than judicious use of antimicrobials. Every answer was different. At that moment, the CoA’s first task was clear: in order for antimicrobial stewardship in veterinary medicine to be promoted, it needed to be defined in that context.

The CoA created a definition of and developed a set of core principles for antimicrobial stewardship in veterinary medicine (Figure 1). This document was adopted as AVMA policy in 2018 when it was unanimously approved in the AVMA’s House of Delegates (the veterinary version of Congress, in which every state veterinary medical association and allied veterinary association is represented). The unanimous vote meant the veterinary profession had a unifying definition of stewardship, regardless of the practice type or species with which a veterinarian works.

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Definition of antimicrobial stewardship for veterinarians and core principles of antimicrobial stewardship in veterinary practice.

Citation: Journal of the American Veterinary Medical Association 262, 11; 10.2460/javma.24.08.0528

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The CoA created the core principles to help the veterinary profession implement stewardship programs, but there were no specific how-to instructions. The CoA realized that antimicrobial stewardship programs would need to look different across the wide variety of veterinary practice types and species focus areas. For example, a large veterinary teaching hospital associated with a veterinary school administering care to numerous species would require a different stewardship program than a multidoctor, dairy-centric veterinary practice in a rural area. The core principles were created to serve as a foundational document upon which the allied associations could build, creating more specific recommendations for implementing a stewardship program within their practice type and more suitable to work with different species.

The CoA also developed a veterinary checklist for antimicrobial stewardship (Figure 2). This checklist complements the AVMA’s definition and core principles of antimicrobial stewardship in veterinary medicine and details more specific actions under each of the core principles that can be taken to help implement an antimicrobial stewardship program within the various practice type settings and species focus areas.

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The veterinary checklist for antimicrobial stewardship complements the AVMA’s core principles, indicating specific actions under each core principle that veterinarians can take to help implement a stewardship plan within their practice.

Citation: Journal of the American Veterinary Medical Association 262, 11; 10.2460/javma.24.08.0528

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A survey⁷ of 24 AVMA-accredited veterinary schools revealed some encouraging results regarding the uptake of these AVMA resources. It found that 79% of the surveyed schools incorporate antimicrobial stewardship into their preclinical curricula. The survey also found that 46% of the veterinary schools perform at least 1 activity focused on each of the AVMA’s 5 core principles of antimicrobial stewardship, and half of the veterinary schools already have a functioning antimicrobial stewardship program. However, there is still much room for improvement. Antimicrobial stewardship training of clinical faculty, support staff, and house officers in the surveyed schools was limited. The survey authors stated that “Lack of faculty, house officer, and staff training in [antimicrobial stewardship] may undermine efforts in preclinical [antimicrobial stewardship] education.”⁷

A white paper⁸ summarizing the findings of the inaugural Small Animal Antimicrobial Stewardship Workshop for US Veterinary Schools provides an example of how a specific practice setting (veterinary teaching hospitals) serving small animals is embracing the AVMA core principles and teaming together to move these efforts forward. The group shared successes and identified barriers and opportunities to improve antimicrobial stewardship in veterinary schools.

Antimicrobial stewardship refers to the actions veterinarians take individually and as a profession to preserve the effectiveness and availability of antimicrobial drugs through conscientious oversight and responsible medical decision-making while safeguarding animal, public, and environmental health. One of the actions we as veterinarians can take as a profession is to make sure we educate ourselves on new concepts and ideas on how to practice veterinary medicine to not only improve our own skills but also to educate and reinforce those concepts in the next generations of veterinarians.

Disclosures

The author has nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.

Funding

The author has nothing to disclose.