Storage of prescription veterinary medicines on UK dairy farms: A cross-sectional study

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordPrescription veterinary medicine (PVM) use in the UK is an area of increasing focus for the veterinary profession. While many studies measure antimicrobial use on dairy farms, none report the quantity of antimicrobials stored on farms, nor the ways in which they are stored. The majority of PVM treatments occur in the absence of the prescribing veterinarian, yet there is an identifiable knowledge gap surrounding PVM use and farmer decision making. To provide an evidence base for future work on PVM use, data were collected from 27 dairy farms in England and Wales in Autumn 2016. The number of different PVMs stored on farms ranged from 9 to 35, with antimicrobials being the most common therapeutic group stored. Injectable antimicrobials comprised the greatest weight of active ingredient found, while intramammary antimicrobials were the most frequent unit of medicine stored. Antimicrobials classed by the European Medicines Agency as critically important to human health were present on most farms, and the presence of expired medicines and medicines not licensed for use in dairy cattle was also common. The medicine resources available to farmers are likely to influence their treatment decisions; therefore, evidence of the PVM stored on farms can help inform understanding of medicine use.Langford Trust for Animal Health and Welfar

‘It's cheaper than a dead cow’: Understanding veterinary medicine use on dairy farms

This is the final version. Available on open access from Elsevier via the DOI in this recordThis study offers a detailed and original assessment of the practices of prescription veterinary medicine use on UK dairy farms. The emergence of antimicrobial resistance as a global threat has necessitated an increasing focus on medicine use in agriculture. While an abundance of studies have recently emerged to demonstrate and evaluate strategies for medicine reduction, this paper seeks to understand the context and the on-farm culture within which treatment practices occur on a sample of UK dairy farms. Arguing that the experiential knowledge, on-farm culture and informal information flows are as important as ‘science’ in the practice of treatment decision making and drawing on extensive participant observation fieldwork combined with semi-structured interviews, this paper identifies and discusses three key themes that develop and, in places, challenge our current understanding of farmer treatment practices. These areas - treatment knowledge and understanding, a duty of care and autonomy of treatment practice - are seen to have complex effects on the use of veterinary medicines in dairy cattle and, as such, highlight critical areas for further research and opportunities for policy interventions aimed at improving responsible medicine use.Langford Trust for Animal Health and Welfar

‘I Believe What I’m Saying More Than the Test’: The Complicated Place of Rapid, Point-of-Care Tests in Veterinary Diagnostic Practice

This is the final version. Available on open access from MDPI via the DOI in this recordData Availability Statement: Data in this study are not readily available due to ethical restrictions. Given the personal nature of participatory event discussion material, participants consented to material derived being used only for scientific and research purposes/outputs coordinated by the research team. As such, datasets generated are deposited in a UKRI depository at termination of contract research. Requests to access the datasets should be directed to www.dialamr.com.Antimicrobial resistance (AMR) is a global health and development threat, with calls for the optimisation of antimicrobial use (AMU) in the treatment of both humans and animals prevalent across national and international policy. Rapid, low-cost and readily available diagnostics that specifically identify pathogens and their antimicrobial susceptibility profiles have been identified as essential parts of this optimisation process, yet questions over the assumed utility of novel rapid technology as a cornerstone of tackling agricultural AMU still exist. To understand whether this technology may support the optimisation of AMU in the treatment of animal disease, this study qualitatively examines the discourse between veterinarians, laboratory representatives, veterinary researchers and (cattle) farmers within three participatory events concerning diagnostic testing on UK farms, to offer a critical examination of the interaction between veterinary diagnostic practice and agricultural AMU. Veterinarian-led discussion suggested that veterinary rationales for engaging with diagnostic testing are nuanced and complex, where veterinarians (i) were driven by both medical and non-medical motivators; (ii) had a complex professional identity influencing diagnostic-test engagement; and (iii) balanced a multitude of situated contextual factors that informed “gut feelings” on test choice and interpretation. In consequence, it is suggested that data-driven diagnostic technologies may be more palatable for veterinarians to promote to their farm clients in the pursuit of better and more sustainable AMU, whilst also being in synergy with the emerging preventative role of the farm veterinarian.Economic and Social Research Council (ESRC

Participatory policy making by dairy producers to reduce anti-microbial use on farms

This is the author accepted manuscript. The final version is available from Blackwell Publishing via the DOI in this record.Pressures for more responsible use of anti‐microbial (AM) medicines in food animals are likely to increase from policymakers and the food industry, including retailers. To address this challenge, participatory approaches to welfare interventions and disease prevention may also be necessary alongside more conventional regulatory measures. This article describes the process of enabling groups of dairy producers to use a participatory policy making approach to develop an AM stewardship policy. The policy includes measures agreed to by all producers for more responsible use of AMs, whilst maintaining or improving dairy herd health and welfare. This process provided a unique opportunity for collaboration and dialogue between producers, veterinarians, industry and researchers. Its participatory nature encouraged comprehensive learning for all involved. This integration of science with producers’ knowledge and experience led to credible and practical recommendations designed to deliver real and lasting change in AM use. The multidisciplinary nature of this research marks a significant contribution to embedding social science skills and approaches into the veterinary sphere. As an initial step in creating better understanding of how participatory approaches with farmers can be applied in a UK context and more widely, this work serves as a pilot for promoting more responsible use of veterinary medicines in other livestock species

Diagnostics and the challenge of antimicrobial resistance: a survey of UK livestock veterinarians’ perceptions and practices

This is the author accepted manuscript. The final version is available from BMJ Publishing Group via the DOI in this recordBackground This paper explores the current role and place of diagnostic tests in the treatment of farm animal disease. With the growing focus on reduced reliance on antibiotic medicines in both animal and human patient care, attention is increasingly being focused on the practice, the technology and the function of diagnostic tests and how these can support responsible antimicrobial use. Emerging diagnostic technologies offer the possibility of more rapid testing for bacterial disease, while food chain actors and others are increasingly seeking to make diagnostic tests mandatory before the use of critically important antibiotics. Method This paper reports the findings of a recent large-scale online survey of UK farm animal veterinarians (n=153) which investigated current veterinary diagnostic practice with particular attention to the relationship between diagnostic test use and antibiotic treatment. Results Results revealed a range of factors that influence veterinary diagnostic practice and demonstrate the continuing importance of clinical observation and animal/herd knowledge in the selection of antibiotic treatment. Conclusion The findings identify a considerable ambivalence on the part of farm animal veterinarians regarding the current and future uses of rapid and point-of-care diagnostic tests as a means of improving clinical diagnosis and addressing inappropriate antibiotic medicine use.Economic and Social Research Council (ESRC

One Health drivers of antibacterial resistance: Quantifying the relative impacts of human, animal and environmental use and transmission

This is the final version. Available on open access from Elsevier via the DOI in this recordData accessibility statement: All model code is open source and available for download on GitHub https://github.com/rdbooton/OHDARTmodelObjectives Antibacterial resistance (ABR) is a major global health security threat, with a disproportionate burden on lower-and middle-income countries (LMICs). It is not understood how ‘One Health’, where human health is co-dependent on animal health and the environment, might impact the burden of ABR in LMICs. Thailand's 2017 “National Strategic Plan on Antimicrobial Resistance” (NSP-AMR) aims to reduce AMR morbidity by 50% through 20% reductions in human and 30% in animal antibacterial use (ABU). There is a need to understand the implications of such a plan within a One Health perspective. Methods A model of ABU, gut colonisation with extended-spectrum beta-lactamase (ESBL)-producing bacteria and transmission was calibrated using estimates of the prevalence of ESBL-producing bacteria in Thailand. This model was used to project the reduction in human ABR over 20 years (2020–2040) for each One Health driver, including individual transmission rates between humans, animals and the environment, and to estimate the long-term impact of the NSP-AMR intervention. Results The model predicts that human ABU was the most important factor in reducing the colonisation of humans with resistant bacteria (maximum 65.7–99.7% reduction). The NSP-AMR is projected to reduce human colonisation by 6.0–18.8%, with more ambitious targets (30% reductions in human ABU) increasing this to 8.5–24.9%. Conclusions Our model provides a simple framework to explain the mechanisms underpinning ABR, suggesting that future interventions targeting the simultaneous reduction of transmission and ABU would help to control ABR more effectively in Thailand.Antimicrobial Resistance Cross Council Initiativ

Immunization of young heifers with staphylococcal immune evasion proteins before natural exposure to Staphylococcus aureus induces a humoral immune response in serum and milk

Background: Staphylococcus aureus, a leading cause of mastitis in dairy cattle, causes severe mastitis and/or chronic persistent infections with detrimental effects on the cows' wellbeing, lifespan and milk production. Despite years of research there is no effective vaccine against S. aureus mastitis. Boosting of non-protective pre-existing immunity to S. aureus, induced by natural exposure to S. aureus, by vaccination may interfere with vaccine efficacy. The aim was to assess whether experimental immunization of S. aureus naïve animals results in an immune response that differs from immunity following natural exposure to S. aureus. Results: First, to define the period during which calves are immunologically naïve for S. aureus, Efb, LukM, and whole-cell S. aureus specific serum antibodies were measured in a cohort of newborn calves by ELISA. Rising S. aureus specific antibodies indicated that from week 12 onward calves mounted an immune response to S. aureus due to natural exposure. Next, an experimental immunization trial was set up using 8-week-old heifer calves (n = 16), half of which were immunized with the immune evasion molecules Efb and LukM. Immunization was repeated after one year and before parturition and humoral and cellular immunity specific for Efb and LukM was determined throughout the study. Post-partum, antibody levels against LukM and EfB were significantly higher in serum, colostrum and milk in the experimentally immunized animals compared to animals naturally exposed to S. aureus. LukM specific IL17a responses were also significantly higher in the immunized cows post-partum. Conclusions: Experimental immunization with staphylococcal immune evasion molecules starting before natural exposure resulted in significantly higher antibody levels against Efb and LukM around parturition in serum as well as the site of infection, i.e. in colostrum and milk, compared to natural exposure to S. aureus. This study showed that it is practically feasible to vaccinate S. aureus naïve cattle and that experimental immunization induced a humoral immune response that differed from that after natural exposure only.</p

Achieving responsible medicines use at practice and farm level

Medicines use in farm animals and the potential for antimicrobial resistance development and transfer to humans is of increasing scientific, public and political concern. Veterinary surgeons must take the lead in driving change: challenging the currently accepted norms of prescribing and administration, advocating and adopting an evidence-based approach to therapeutic decision making, and monitoring patterns of medicines use to identify opportunities for intervention and measure impact, while at the same time partnering with farmers to improve herd health management. This article discusses how such a multifaceted, collaborative approach, which involves the whole practice team working in partnership with farm staff, can be highly successful in achieving and sustaining more responsible medicines use on farm and improving animal health