Prospects and practicality of antimicrobial stewardship in animal health

Summary

In today’s world, what does antimicrobial stewardship (AMS) mean? Does it have the same meaning to people around the world and across One Health sectors? The objective of this article is to summarise the history and terminology of AMS, the ‘five Rs’ of AMS and key metrics and decision support tools, illustrate concepts through global case studies, identify barriers and facilitators, and propose a standardised definition of AMS in animal health. From the historical origins and uses of the word ‘stewardship’, the concepts of having responsibility, being accountable to someone or something, and the care of a valuable resource have been strong consistent themes. Across human and animal medicine, there are differences in the scope and content of what is considered prudent and responsible use, as well as AMS, and while these differences merit acknowledgement, they arise naturally from the different settings of medicine in these sectors. Fundamentally, the words capturing the concept of AMS are not as important as the intent and meaning they convey; the language should not be considered a barrier to action. When the scope of AMS incorporates aspects of the five Rs – responsibility, review, reduce, refine, and replace – it acknowledges that there are many aspects of AMS already in place in good animal rearing. Across the regions of the world, case studies have demonstrated highly successful and different approaches to stewardship initiatives and programmes in various economic settings. Challenges exist, but they do not prevent improvement and global expansion of AMS. Next steps to facilitate future AMS actions must address clarity and consistency in communication about AMS in animals, including a globally accepted definition. The goal of this article is to advance the concept of practical AMS by reducing the need for antimicrobial use, and, when antimicrobial use is necessary, by responsible and prudent use informed by AMS principles and programmes. Improving and optimising animal health is a key AMS tool.

Keywords

Animals – Antimicrobial stewardship – Prudent and responsible use – Treatment guidelines – Veterinary.