A five step process is used here to assist work to improve antibiotic use practices in food animals: Engage, Assess, Plan, Implement and Evaluate. Materials are especially aimed at advisors of farmers. Guidelines set by national-level authorities may exist and when possible should be consulted and incorporated, and interventions should always be adapted to the local situation.
A key to success is to identify which actors to involve and reach in the effort. This could for example be farmers, veterinarians, paraprofessionals, extension workers, nutritionists and consultants from government and academia, depending on the end goal. A stakeholder analysis tool can be used to help identify stakeholders and their level of interest and power to influence. It is useful to assemble a team of relevant people to plan and coordinate the work and find ways to motivate and help farmers to take action. An important component is to have a continuous dialogue with the identified stakeholders involved in or affected by the work. Participatory processes have been shown to be effective tools to motivate engagement by creating ownership in the process.
Assess the situation
A wide range of animal species are kept as food animals, and they are held in different animal husbandry systems. Any rational use initiative at the individual farm level has to be adjusted to the local situation at the actual farm.
A challenge for the farmer is to determine the most important factors that first should be addressed. An initial step can be to analyze the current use of antibiotics and the animal health situation at the farms with the help of veterinarians, husbandry experts or other relevant professionals. A base-line assessment also makes it possible to evaluate progress and set targets.
Plan the work
The long-term goal of rational use efforts should be a transition to sustainable farming systems where routine use of antibiotics is not needed. The involved team should plan which interventions to use and how to evaluate progress. Setting aims and objectives will help the team know where to focus its energy and how to direct its resources. A good plan will cover which actions need to be taken by whom and when, as well as what resources are needed and how to measure progress. The plan can include risk assessments, a monitoring and evaluation framework and a communication plan. An important aspect to consider is if there might be economical losses for involved farmers during the project/transition to production with less antibiotics, and how those losses may be compensated for.
A combination of strategies and tools (a multifaceted approach) is best to reach sustainable results. Some possible areas to focus on are to:
- Improve animal health through better hygiene, biosecurity routines, and animal husbandry in farms. Infection prevention measures, including vaccines, reduce disease so that less antibiotics are needed. Learn how in PREVENT INFECTION – Food animals.
- Improve record keeping to monitor antibiotic use and resistance. See also MEASURE – Antibiotic resistance; Consumption and; Appropriate use.
- Perform audits and feedback.
- Provide support for treatment decisions through diagnostics and guidelines.
- Train and educate animal health professionals and farmers. See RAISE AWARENESS – Training manuals and courses. Awareness raising and education is important if rational use interventions are to be accepted and implemented properly. Passive educational strategies (such as posters and leaflets) are easier to implement but less effective compared with active strategies, such as one-on-one educational sessions addressing relevant topics.
- Raise awareness in the community on the use of antibiotics in food animal production and agriculture and the consequences. Consumers can drive change in the food industry. See RAISE AWARENESS for guidance and materials to set up an awareness raising campaign.
See also Interventions for more details (also for different types of animals).
No matter how much planning is done, it is difficult to know how well an implementation will go in real life. Unforeseen problems can arise and the needs or resources can rapidly change. By piloting an intervention, the team can test the impact of theory put into practice and make adaptations as necessary.
Pilot projects can be scaled up in time, size or breadth of their reach. The length of time can be extended, or a project can be implemented in additional farms or cooperatives. Challenges may arise when scaling up interventions that did not exist in the original iteration. As with any implementation, the context and setting should always be considered and adjustments made appropriately.
Evaluating the work is important to see if goals are being reached and can identify areas for improvement for scale-up and replication. It is also important to encourage improvement and promote learning from experience without fear of negative consequences.
Communication of results gives feedback to collaborating partners and interested stakeholders. Communication methods and content need to be tailored to the audience, and reporting should be transparent to promote confidence. Positive progress should be acknowledged and public recognition should be made of the contributions and successes of all partners involved in the work. Affirmation of hard work will provide incentive for stakeholders to continually improve and be involved in the process.
In MEASURE, you can access tools and resources to help determine the impact of interventions and conduct studies on a variety of topics that relates to rational use. The following pages include specific information for animal settings:
- Burden of antibiotic resistance
- Antibiotic resistance
- Consumption of antibiotics
- Appropriateness of use
- Quality of antibiotics
- KABP – Knowledge, attitudes, behaviors and perceptions
Resources below have been separated into the following tables:
- Guidelines and standards (reference documents/guidelines from international organizations).
- Engage and assess
- Plan, implement and evaluate
Guidelines and standards
|CODEX ALIMENTARIUS International Food Standards: Antimicrobial Resistance||Standards for the responsible use of antimicrobials in food-producing animals. The “Code of practice to minimize and contain antimicrobial resistance” (CAC/RCP 61-2005) describes the responsibilities for regulatory authorities, veterinary pharmaceutical industry, wholesalers, retailers, veterinarians and farmers. “Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance” (CAC/GL 77-2011) gives guidance on assessing the risk to human health from foodborne antibiotic resistant bacteria, and determining appropriate management strategies to control those risks. Available in English, French and Spanish.|
|Guidelines for Infection Prevention and Appropriate Antimicrobial Use in the Animal Sector||Guidelines developed by the Ministry of Agriculture, Animal Industry and Fisheries of the Republic of Uganda to optimize appropriate antimicrobial use practices, infection prevention practices, and record keeping of medicines used in farming. The documents are focused on five livestock production systems: cattle farming, fish farming, goat and sheep farming, pig farming, and poultry farming.|
|List of antimicrobial agents of veterinary importance (PDF, 0,49Mb)||Assessment developed by WOAH describing the most important antimicrobial agents in veterinary medicine. Substances are categorized into three groups: Veterinary Critically Important Antimicrobial Agents, Veterinary Highly Important Antimicrobial Agents and Veterinary Important Antimicrobial Agents. Provides specific notes on uses of different classes and specific diseases for which certain antimicrobials are of high importance, and considerations for their use.|
|WHO list of critically important antimicrobials for human medicine||Assessment from WHO of which antimicrobials are of highest importance to human health. Substances are categorized into three groups: critically important, highly important, and important. Interventions can be built upon recognising the need to preserve effectiveness of the antimicrobial agents used in human medicine and careful consideration should be given regarding their use (including extra-label/off-label use) / authorization in animals. Also available in French and Spanish.|
|Guidelines for the prudent use of antimicrobials in veterinary medicine (2015/C 299/04)||Guidelines from the European Commission that provide authorities, farmers and veterinarians with recommendations and examples of possible strategies for prudent use of antimicrobials in veterinary medicine. Lists possible measures, both general and for specific holding systems: Pigs, poultry, bovines and small ruminants, aqualculture, rabbits and pets. Available in a number of languages, including English, French and Spanish.|
|WOAH Terrestrial Animal Health Code||Standards for the improvement of terrestrial animal health and welfare and veterinary public health worldwide. Intended for use by Veterinary Authorities. Chapter 6.10 covers Responsible and prudent use of antimicrobial agents in veterinary medicine.|
|WOAH Aquatic Animal Health Code||Standards for improvement of aquatic animal health worldwide, to be used by the Competent Authorities. Chapter 6.2 covers: Principles for responsible and prudent use of antimicrobial agents in aquatic animals. Outlines roles and responsibilities of the Competent Authorities.|
Engage and assess
|Building Coalitions for Containing Antimicrobial Resistance: A Guide||Guide by SIAPS for how to identify key stakeholders for addressing drug resistance, mobilize their support, formulate and implement a plan and subsequently evaluate outcomes. Also provides a number of templates and sample interview forms that can be adapted for different local contexts. For ex. the chapter “Mobilize support” details how to identify stakeholders, organize a working group, and define the key issues, and “Understand the local situation” describes tools and strategies for compiling, analyzing, and presenting information about the local antibiotic resistance situation. An older version is available in Spanish and French.|
|Procurement criteria: Responsible antimicrobial use in products of animal origin||Document developed by Health Care Without Harm that provides procurement criteria to incentivize food producers to ensure responsible antimicrobial consumption. Procurers can adapt this set of criteria according to their own local policies and procurement practices.
|Criteria and questionnaire for responsible use of antibiotics in food-producing animals||Manual from the Axfoundation with criteria that aim to ensure responsible use of antibiotics in the food animal sector. Primarily intended for use by Swedish food companies, as they interact with suppliers of food products. Useful in other settings as well. Contains an appendix with guiding questions that can assist in follow-up discussions with suppliers.|
|Community Toolbox, chapter 7: Encouraging Involvement in Community Work||Guidance. The Community Toolbox aims to offer people engaged in local and community work a depository of tools and advice for building healthier communities. Chapter 7 for example covers: The importance to involve all people affected by the problem (section 7) and Identifying and analyzing stakeholders (section 8).|
|Keeping veterinary medicine records||Template and instructions on how to keep veterinary medicine records. Includes an example format on record keeping (word document). Well kept records help to assess antibiotic use. Guidance for England, but can be used for inspiration/adapted for other contexts.|
|Dairy Antimicrobial Usage (AMU) Calculator||Tool to assist in calculating antibiotic use on dairy farms. The tool is a macro-enabled spreadsheet where heard and antibiotic use data are entered and gives consumption data as both mg/PCU and DDD. A benchmarking tool is also available at the same site.|
Plan, implement and evaluate
|Framework for Antibiotic Stewardship in Food Animal Production||Comprehensive framework for animal agriculture that will enable the full range of stakeholders to adopt, implement and evaluate best practices on existing and future antibiotic stewardship programs. The core components include commitment and culture, appropriate veterinary care, effective record-keeping, disease prevention strategies, and optimal treatment approach.
|Prudent and efficient use of antimicrobials in pigs and poultry||Manual to help farmers and animal health workers to use antibiotics prudently and prevent infections. Gives an overview of measures that can be taken and practical recommendations on how to improve the use of antibiotics and animal productivity. Pigs, Poultry.|
|Community Toolbox, chapter 6, section 1: Developing a plan for communication||Manual for how to develop a communication plan for good, consistent, clear communications both internally and externally.|
|TDR: Implementation research toolkit||Toolkit designed to help identify system bottlenecks and stakeholders to be involved, formulate appropriate research questions, conduct the research and develop a plan for implementing the study results. Although it is not focusing solely on antibiotic resistance, it provides a template on how issues related to resistance could be addressed.|
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