Responsible Antibiotic use in Mastitis Control

ANIMAL HEALTH IRELAND Contributing to a profitable and sustainable farming and agri-food sector through improved animal health

Responsible Antibiotic Use in Mastitis Control

NATIONAL MASTITIS CONTROL PROGRAMME

CellCheck AnimalHealthIreland.ie Animal Health Ireland, 2-5 The Archways, Carrick-on-Shannon, Co. Leitrim, N41 WN27

AHI gratefully acknowledges the financial and other contributions of our stakeholders.

NATIONAL MASTITIS CONTROL PROGRAMME Animal Health Ireland, 2-5 The Archways, Carrick-on-Shannon, Co. Leitrim, N41WN27

CellCheck AnimalHealthIreland.ie

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Antimicrobial Resistance

Antimicrobial resistance (AMR) is fast becoming part of our everyday vocabulary, and it is now recognised as being a significant threat to human health. AMR is resistance of a microorganism to a drug to which it was previously susceptible, for example when a bacterium develops resistance to a particular antibiotic that used to kill it. It is now well recognised that the use of antibiotics in both animals and humans increases the risk of AMR developing. Responsible antibiotic use is being widely encouraged as part of a global strategy to slow down the development of AMR and to reduce the related risks. In 2005 theWorld Health Organisation (WHO) first classified all antibiotics into three different categories, based on their importance to human health; important, highly important and critically important. A list of ‘Highest Priority Critically Important Antibiotics for Human Health (HP-CIA)’ was developed, which identifies those antibiotics that must be protected for use in human health. Although the overall use of HP-CIAs in the treatment of mastitis was limited, there was evidence of an increase from 2003 to 2015 in the number of intra-mammary tubes used (both in lactation and at drying off), that contain at least one HP-CIA. (ref. More et al.) In 2018, 8% of antibiotic dry cow tubes used contained a HP-CIA. For some time, there has been a growing awareness that the use of these antibiotics in the animal sector in Ireland was being called into question, but without clarity around what changes should be made. I used to think that this talk of “superbugs” was a bit dramatic, but it’s much closer than we might think….. my son has had a horrible ear infection for 4 weeks now, and 3 courses of antibiotic later we’ve discovered that it’s resistant to them all……where do we go next if this one doesn’t work? “ ” PARENT

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HP-CIA Guidelines In October 2018, the Irish Department of Agriculture, Food and Marine (DAFM) published a ‘Policy on Highest Priority Critically Important Antibiotics’ . In January 2019, a new Veterinary Medicines Regulation was agreed by Europe, following several years of negotiation, with all EU member states having three years to implement it i.e. by January 2022. Both documents provide guidelines and clarity on what is expected of us as an industry, regarding the use of antibiotics in general, and HP-CIA in particular, in farm animals. In support of this, CellCheck has produced this communication to present these new guidelines in the context of mastitis management. Sometimes farmers don’t understand why I just don’t go straight for the “good stuff” when I’m treating their animals, but very often it’s not necessary! If we don’t start protecting these CIAs for times when we really need them, eventually they might not be available to us at all. “ ” VET

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Approach to Clinical Mastitis Treatment

1. Firstly, prevention is most important! a. See the ‘CellCheck Farm Guidelines for Mastitis Control’. 2. If or when clinical mastitis treatment is required: a. Highest Priority Critically Important Antibiotics (see table below) should not be used as a first line of treatment . b. If milk culture and/or sensitivity results indicate that there is no effective alternative treatment, then a HP-CIA can be used to treat the animal(s). c. In exceptional cases, based on a veterinary practitioner’s clinical judgement, treatment with a HP-CIA can commence before the milk culture and sensitivity results are received from the laboratory. d. Records of all relevant laboratory results must be kept, to support any decision to treat an animal with HP-CIA. Yes, it’s a bit of a pain having to take a milk sample from a cow just to use a particular tube that we’ve been able to use in the past……but my vet has explained that this tube contains a drug that’s used as a last resort in humans……I never realised that…I think it’s only right that we should only be using them in cows if nothing else works and it’s absolutely necessary. “ ” FARMER

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1. Antibiotics can no longer be used in a preventive fashion. a. This means that Irish dairy farmers need to move away from ‘blanket dry cow’ therapy (treating all cows with dry cow antibiotics at drying off, as a matter of course). b. Farmers will need to adopt ‘ Selective Dry Cow Strategies’ at drying off. (http://animalhealthireland.ie/?page_id=14313) 2. When using antibiotic dry cow therapy, HP-CIAs should not be used as a first line of treatment. Approach to Drying off responding to treatments that would have worked in the past. We all need to play our part in slowing down this growing problem. “ ” GP I really worry about the whole area of antibiotic resistance - I regularly see patients that aren’t

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Culture and Sensitivity

Milk culture and sensitivity results are an important step in making appropriate treatment decisions. To get good results it’s important to:

a. take good samples, and

b. use a laboratory that has a proven performance record i.e. a CellCheck Partner Laboratory. Any commercial laboratory that successfully participates in the DAFM Proficiency Test scheme is recognised as a ‘CellCheck Partner Lab’, delivering milk sample services to an agreed standard and undergoing continual evaluation in this area. For more information on taking milk samples in an aseptic fashion, and contact details for CellCheck Partner Labs see http://animalhealthireland.ie/?page_id=8731

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What products do these guidelines relate to?

Highest Priority Critically Important Antibiotics licensed in Ireland for use in cattle: (April 2019)

EXAMPLES OF PRODUCTS

ANTIMICROBIAL CLASS

ACTIVE SUBSTANCE

HP-CIA CATEGORY

INJECTABLE

INTRAMAMMARY

3rd & 4th generation cephalosporins

ceftiofur

Alfacef, Cefavex, Cefinil, Cefokel, Ceftiocyl, Cemay, Cevaxel, Curacef, Eficur, Excenel, Naxcel

Category 2: • Not for prophylactic use. • Not for first line of treatment. • Should not be used without first having culture/sensitivity results showing no effective alternative. • In exceptional circumstances, treatment can commence before laboratory results return. • Records of all relevant laboratory results must be kept.

cefquinome

Ceffect LC, Cefimam DC/LC, Cefquinome DC/LC, Cephaguard DC, Cobactan LC, Penix LC, Qivitan LC

Ceffect, Cobactan, Qivitan

INJECTABLE

ORAL

Fluoroquinolones

enrofloxacin

Baytril, Doraflox, Enrocare, Enrodexil, Enrotril, Enrotron, Enroxil, Fenoflox, Floxibac, Quinoflox, Roxacin, Unisol Boflox, Forcyl, Kelacyl, Marbim, Marbocare, Marbocyl, Marbonor, Marbosyva, Marbox, Marfloxin

Baytril, Colmyc, Enrotron, Kariflox, Unisol

marbofloxacin

Marbocyl

Product names sourced from Health Products Regulatory Authority and European Medicines Agency websites. Correct as of April 2019.

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What products do these guidelines relate to?

Highest Priority Critically Important Antibiotics licensed in Ireland for use in cattle: (April 2019)

EXAMPLES OF PRODUCTS

ANTIMICROBIAL CLASS

ACTIVE SUBSTANCE

HP-CIA CATEGORY

INJECTABLE

ORAL

Macrolides

Category 1: • Not for prophylactic use. • Not for first line of treatment. • Not to be used more than once in a 3-month period to the same animal(s). • If a second treatment within 3 months is necessary, then guidelines are as for Category 2 products i.e.: - Should not be used without first having culture/sensitivity results showing no effective alternative. - In exceptional circumstances, treatment can commence before laboratory results return. - Records of all relevant laboratory results must be kept.

Zactran

gamithromycin

Zuprevo

tildipirosin

Hymatil, Micotil, Milbotyl, Tilmodil

Pulmotil, Pulmovet, Tilmovet

tilmicosin

Draxxin

tulathromycin

Bilovet, Pharmasin, Tylan, Tylo, Tylosin, Tylovet, Tylucyl

Pharmasin, Tylan

tylosin

Product names sourced from Health Products Regulatory Authority and European Medicines Agency websites. Correct as of April 2019.

References:

More, S.J., Clegg, T.A., McCoy, F., 2017. The use of national-level data to describe trends in intramammary antimicrobial usage on Irish dairy farms from 2003 to 2015. J Dairy Sci 100, 6400–6413. doi:10.3168/jds.2016-12068

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