Antimicrobial prescribing guidelines for feedlot cattle

These Guidelines and any recommendations presented in the Guidelines: Persons involved in the preparation of the Guidelines accept no responsibility or liability (in contract, tort including negligence or otherwise) for any consequence, damage, cost, expense, claim or loss (including indirect loss, consequential loss, special loss, loss of profit or loss of business opportunity) arising in any way out of: Antimicrobial resistance (AMR) is one of the most significant emerging threats to human and animal health. Loss of the shared resource of effective antimicrobials jeopardises our ability to manage common infections, an ability that we take for granted in the modern era but one that has not been available at other times in history. Addressing AMR is a global endeavour that requires effective, coordinated action to minimise impacts on people, animals, and our shared environment. AMR is to some extent a natural phenomenon. Each time antimicrobials are used, the susceptible microorganisms are killed and the resistant microorganisms survive. Over time, continued exposure to antimicrobials selects for resistance in microbial populations. Certain human actions accelerate this process of increasing resistance, and the single most powerful contributor to this is inappropriate use of antimicrobials. This includes underuse, overuse, and misuse, and applies to the use of antimicrobials in human and animal health and in agriculture. In human health, AMR infections necessitate additional investigations, more complex and expensive treatments and longer hospital stays and can result in greater mortality. In animals, AMR infections result in poor animal health, welfare, biosecurity, and production outcomes. AMR infections in animals can result in the transfer of resistant bacteria to people through direct contact or via the food chain. The Australian Government has been working to protect humans and animals from the effects of AMR infections for more than 20 years. This work recognises the ongoing importance of antimicrobial stewardship by all prescribers, including veterinarians, and the need for guidance on best practice prescribing to support stewardship practices. These guidelines provide an important resource to inform prescribing decisions by those working with feedlot cattle and complement guidelines available for other livestock sectors. I thank the expert panel members involved in developing these guidelines (Appendix A) and ask veterinarians working with feedlot cattle to use these guidelines in decision making relating to the use of antimicrobials. Your efforts to ensure best-practice prescribing will help to secure the ongoing availability of effective antimicrobials for use in animal health, promote health and welfare in feedlot cattle, safeguard Australia's global reputation as a producer of high-quality food products, and support the global response to AMR. Dr Mark Schipp Australian Chief Veterinary Officer While the published literature is replete with discussions of misuse and overuse of antimicrobial agents in medical and veterinary situations, there has been no generally accepted guidance on what constitutes appropriate use in the context of feedlot cattle. To address this omission, the following principles of appropriate use have been identified and categorised after an analysis of current national and international guidelines for antimicrobial use published in the veterinary and medical literature. Independent corroboration of the validity of these principles has been provided by the publication of a proposed global definition of responsible antibiotic use, derived from a systematic literature review and input from a multidisciplinary international stakeholder consensus meeting.1 The 22 elements of responsible use are outlined below. Efficacious, scientific, evidence-based alternatives to antimicrobial agents can be an important adjunct to good husbandry practices. Make a clinical diagnosis of bacterial infection with appropriate point-of-care and laboratory tests and epidemiological information. Develop outcome objectives (for example clinical or microbiological cure) and an implementation plan (including consideration of therapeutic choices, supportive therapy, host, environment, infectious agent and other factors). Antimicrobials must be prescribed only in accordance with prevailing laws and regulations. Confine off-label use to situations where medications used according to label instructions have been ineffective or are unavailable and where there is scientific evidence, including residue data if appropriate, supporting the off-label use pattern and the veterinarian's recommendation for a suitable withholding period and, if necessary, export slaughter interval (ESI). Report to appropriate authorities any reasonable suspicion of an adverse reaction to the antimicrobial medicine in either treated animals or farm staff in contact with the medicine, including any unexpected failure to respond to the medication. Thoroughly investigate every treated case that fails to respond as expected. Perform an objective and evidence guided assessment of current practices and implement changes when appropriate to refine and improve infection control and disease management. Core principles of appropriate use of antimicrobial agents Each of the core principles is important but CORE PRINCIPLE 11 Off-label (extra-label) Antimicrobial Therapy warrants additional attention as veterinarians treating production animal species, with professional responsibility for prescribing and playing a key role in residue minimisation, must consider the tissue residue and withholding period (WHP) and, if necessary, export slaughter interval (ESI) implications of off-label use before selecting this approach to of animals The following a of effects on with use at than and in animals with example of the the residue and tissue following of a veterinary In a animal tissue to the at a time than the withholding period has been for the on the of the residue in the treated In an if the is tissue only one more and most be the if the to disease or other the and result in the from and is evidence to support the use of the following alternatives to antimicrobials for the and of feedlot or bacterial and is with the and the use of has been by and with have to disease is a by transfer and and bacterial of the is to as in feedlot animals with as and of In the of a to after agents involved and and these agents in the of the and of the with a can bacterial of the agents involved in disease in the from the and is not a of the evidence that most cattle in have not been to and that infection of most animals in the that is a significant contributor to the and is common in and are from to in the and and as the disease of on is by livestock have been by veterinarians on the assessment of and clinical The for diagnosis and of as and assessment of clinical and of can be a if tests are in the in situations the assessment is used for and assessment to has been to have a and of than in the importance of feedlot and livestock staff and of a of health by the to in the of and and of and laboratory analysis and antimicrobial can provide to and the or of by can a more diagnosis of infection with than This can assessment of the of this to in a antimicrobial is the core of husbandry as or appropriate and suitable in are to improve the response to in more or Antimicrobial can be by bacterial or by on from to have at but there can be reasonable that the bacterial agents are in the of as by global and and is common practice to antimicrobial to of cattle for treatments as this the case Antimicrobial can be by on at and consideration of the in to time of slaughter other are not (including those resistant to with single with single and for to at for response on and for response on and with a single at or of in in at or at in at 20 at 20 or of failure be to the is only if the is that appropriate changes can be to improve in of failure of to disease inappropriate antibiotic and The is guided by consideration of the importance and the use of agents more important to human the feedlot the and the microorganisms to be in disease of longer agents in more and that as there is a of resistance to the antimicrobials in Australian of a failure to respond to is in most by and of the disease when the is disease that of antimicrobial resistance and of that additional antimicrobial treatments not be the of the of the therapeutic of the time for response to the use of an effective antimicrobial be before with an additional is to a case with antimicrobial for the that therapeutic The decision to provide additional antimicrobial at the of the is by assessment of the of clinical through in clinical in clinical to disease and the need for to good for identified and treated in the disease and an in and the is to be that published of response to are on a case definition and clinical and are to be by a The is by in the of animals and as more objective to have no have been has been with some if objective of and of are While is with feedlot cattle of to as an of in the interval is on the of by used as a and not as a has and The of is and complex and has been at of is the of these guidelines and the is to these for an review of the This in the after the period for disease is by and is the for the The is of the and of the to is an of with this and is common to with are at of after in The is there is significant evidence for an with a of and bacterial with to common feedlot as and from of infectious is in the of to in the period and more and to with at is on clinical in the from be in the hospital by the and if this the that is the more of will have significant to of This is one of the more to in a feedlot as the as and are not and can and with necessitate the need for and the use of Antimicrobial is for bacterial The is a contributor to of and, be involved in a of bacterial agents be antimicrobials are are to minimise the that is for can the to the this of with a will from the feedlot for slaughter if is not or but can be The is guided by consideration of the importance and the use of agents more important to human the feedlot and the all treatments to the in these consideration must be to the clinical is continued is and the after and is if is in the disease but poor if there is significant and on to with and The is from that of in that the is of the to from infection or by and of the of the and to and of the and of the after of is of 22 This those in there is no or tissue on the from infectious is in the of but to more to and have at a These are but not and, as for clinical can after or in is on the clinical of is by the and if this the of with significant is to and be the bacterial agent in clinical The and of the necessitate with or with and are to and is not a in These are best of the can as a of and bacterial and by and other in the feedlot environment. This is to and requires more and antimicrobial are not in of the response to be with for slaughter an important to at by on the of the every for on the response to The label for is the effective is 22 Off-label use is to of and use of is not for feedlot cattle an appropriate and are available for use at a to be effective in all treatments to the in these consideration must be to assessment of there has been any in the clinical continued is and any on and is if is in the disease but poor if there is significant and on The clinical is of the and of to bacteria of the to the of the via to infections that to the The is not common in the of a cattle can be in the feedlot with is generally by clinical and and of the of to can support the antimicrobial and generally improve the at 20 by on the of the in for of the to treatments are with to is generally good and there is if the is to at the time of The clinical is a to of the or with some of the with a bacteria of the to the of the via to infections that to the The is not common in the of a cattle can be in the feedlot with is generally on the clinical and of the of and of the or with of the and the of of to can support the Antimicrobial is by the of the and for of the be necessary, but this is not in the feedlot environment. and antimicrobial as for is of in the and of all This in a in to the production of a greater of than can be by the The to with as a of than for greater than a in the of clinical animal the of is a and from but can to if there is and the is than the of to is at with at a of to the of the production of by is but there is a in are These the in the at a of than the in and the are at the of this In is by bacteria and not of is a times than the in the and in the and is the in the and the of as not greater if to The most important to of in cattle are the and to the in in response to is by the of the with a greater of the in the from the other is from the through the of is the in the responsible for an an derived can the of the are in the of from increasing the from the the of the In in response to the of and effective to provide to a that in response to an production of is for of by an of can This the from to clinical in and of to animal are a of we can of an of by a in a to an of effective in a and of a as a result of in to to can the to an including a of as increasing the for in no greater than time for the cattle to and on clinical of before to the in the but is for the of and the to the of and the to the of and for the available laboratory of and to and to the in cattle, have not been The for in cattle is the when the is with of in some to the and for direct and as and, the of in have some guidance with cattle if we consider that the of is at a of cattle, the the the more the more is to in cattle, we manage the effective to of for health an of the clinical of for a and of to The for effective in is The appropriate of of on the of in the the in the is we must the of to to availability of the with only be an of with and or and with we of for and for and for must consider the of the when we consider and The the is the more the cattle to and the the is and the the be of the from to and a has been provided to cattle and have to we can a of by the to out and The can if the of the and is the and is more the the cattle has been that the feedlot of the to a in is the period of of can at any time the period and be more the when is a in for the of a period for on that feedlot cattle are susceptible to at any time the not only the of and in the the increasing of the by can that of in the of the This through the of the and to the In with the by the and to the of infections in including the can of the can to the of in animals that have and in In a of can from or and are best The that to the is by the that to the by the out of the in the animal from a of and by the This with the of out of the is as the clinical of The in the are evidence of that the and the of is used as a for the of in the animal the of is by and if the of this clinical of is can at the and is an arising from the of from bacteria as the of by with by a either to the effects of in the of the or the effects of of through the not the of these the In feedlot the of to the of a that the of in the of the is greater at that feedlot is more when and are and is a more common of disease from there are in the of and in the extent of changes and production The that there is a clinical of and greater production is not only to a of animal welfare, has been to be and there a and greater in cattle that a for this in those that a for not improve and there is a more than where the of a and production a cattle clinical of as will have a that is the with and This will the of that more clinical of where cattle are and poor animal In the of is with a greater of disease and greater in the of that and the poor animal welfare that the of have an in of production for our and the welfare of the cattle for we are to of of clinical a failure of management. is on of the in the and to cattle are with and all of is for to the of cattle can from the of at but the most effective for cattle is with and and including to address the is a or are on the of the of the of on a more than on the this to the and of the In the of a more and with an of of or additional be a this will the and the to those of the The is the of the to to is a by an of in the to via The can be by of of in or of to or the In the is more in the period when cattle are on the of with a of to or at this in the period a of of if is to as in of cattle are in the period can be with other as and in and can be with or or from the with the more the is in by is of a with and to is an important as as the and of of the and as can the of through of and of the the is to the and In of a is if animals can be to and in a to the animal is or at of can be a to can be treated by a in the feedlot clinical cattle with be or a in a single or other as and have the to in of are generally to hospital cattle and the and to with is to and are of the and greater of most cattle in to be as with is a and of have been in cattle for slaughter that for as a result of and to feedlot to a and on a feedlot slaughter be can from of a to to with and in is and can be by and of or and a The of is can be by production but infection is by as disease infection and arising from to infection can with The are to those for and to be but is more than and is with in husbandry are important to outcomes. clinical from other cattle, animals, in will This has the of for these animals to of the clinical the time of in the hospital of with is as supportive for to can be and time are in the hospital have antimicrobial resistance, antimicrobial be by and animals that are of a preparation as an of with resistance are common in than in other with appropriate antimicrobials in the of disease is to clinical in and cattle. Antimicrobial prescribing guidelines for cattle in and is one of the of the The bacteria responsible are most and and any of the and in the and and other is a of the of the infection and is at the disease the the and in the and infections with significant in the from the and of tissue from the of a to as the can result in and is on assessment of the clinical of the diagnosis can be by of the suitable as a or of by for in In that are presented in appropriate can be for that to or at by on the of the every for on the response to The label for is the effective is 22 Off-label use is to of and use of is not for feedlot cattle an appropriate and are available for use at a to be effective in with antimicrobials is the is generally in single necessitate if the is to manage the and the for of cattle in the hospital and use of antimicrobials. and be of the as as transfer to where with the including the and as to the Antimicrobial prescribing guidelines for in feedlot cattle after from infections, or from that the infections and are with infection after and can the as a result of to The clinical is with to the of in one or more The the or is and is to the and there is and a of on and be of the diagnosis is by laboratory analysis of a with a of greater than a greater than with more than of the is with the but a failure to bacteria on not the The clinical and analysis are the of a Antimicrobial can be guided by the laboratory analysis of the but this is of the of suitable for and the poor In for any of to an of antimicrobial be is not in the feedlot and result in in the of only be if can be for a of 20 and for This requires a that to the are at the process of of of through the to the after includes and The is guided by consideration of the importance and the use of agents more important to human the feedlot the and the microorganisms to be in infections of longer Antimicrobials that can be used for the The is generally In the feedlot is more appropriate than is an is than that of in the feedlot The disease is by and of from to and to are there is a is the bacterial agent involved and from from a can only be at after of and for and bacterial The clinical if are and can be from by the more of and of is more common in as as a is with is to a of antimicrobials used for disease in including and and can be if are identified in the disease process and of as and are to the These are at the for is not the can to a and at this to respond to in the to and from infections or as a result of as a result of inappropriate when medications are in the the for in feedlot cattle. and have been from of from infections or is in the cattle can with and some of there is in the to and from the and diagnosis requires and of the for bacterial with and be of a if need to be in with of the and of of the is is a more appropriate and a to be for is the best can the by the via a in the and in cattle. The most common is with a the the is with and The disease is in but the period is The disease is only animals and cattle. are in and and can be in in and can for to in the environment. The most for in is a in a at and in by for a The are most in by the and with at the of these with the for the and to loss of control of in of on the the on the be or and to the in by of the and and a This is the more common feedlot infection can to a and with cattle with through a or in a and in more than is with damage, with significant of in the and of and the is analysis a and of is not a as are in of is more in in the has not to the of in with the clinical of is supportive of the diagnosis and of the The is with of and with to manage by therapy, and husbandry and will improve of to poor and the of a In the use of can the of and, of the the of in a and of the of the more to and or in in either of these situations are and can of of the and the in and and as this can to of of the of the is by but can be by appropriate is on and to bacterial are with antimicrobials to the of and are at by on the of the every for on the response to be with and The label for is the effective is 22 Off-label use is to of and use of is not for feedlot cattle an appropriate and are available for use at a to be effective in in a good in that to is and the animal is for to in is an and are and is not common to as if cattle with in there is a that the have been for greater than In adverse effects are of the is on the for with effects on welfare, and for that in the following are a for developing of bacterial agents can be with but the most involved and with are and The approach to is to the animal and to a hospital for ongoing and if not be by but at the of the to the that as a for infection of the The at will be to the for of on but this is transfer of or in a hospital with the in the is of to the and the clinical of as and with a from the the be presented to the hospital for including of is antimicrobials are at by on the of the every for on the response to The label for is the effective is 22 Off-label use is to of and use of is not for feedlot cattle an appropriate and are available for use at a