Mass Medications: Prophylaxis and Metaphylaxis, Cascade and Off-label Use, Treatment Guidelines and Antimicrobial Stewardship

Abstract

Antimicrobials are used in animals not only for treatment, but as recognized by the European Surveillance of Veterinary Antimicrobial Consumption report (data 2016), more than 90% are used for mass medication of groups of animals, including healthy animals, mostly orally, especially in pigs and poultry and can reasonably be expected as used for either prophylaxis or metaphylaxis. It is unclear if this annual tonnage of consumption of antimicrobials for prophylaxis/metaphylaxis is necessary. There can be a need to use prophylaxis in just exceptional cases, for individual animals or for a well-defined restricted group of animals where it is known that the risk of development or spread of infectious disease is very high or the consequences of the infection are likely to be severe. Prophylactic use should always be under the responsibility of the attending veterinarian and based on epidemiological and clinical knowledge as well as the justification for such use should be documented. Also, metaphylactic use should be minimized. Growth promotion utilizing antimicrobials should remain banned in EU, and other countries.

Exceptionally when authorized veterinary medicinal products are not available, off-label use which fits the needs of the treatment and to avoid suffering of animals can be used based on the responsible decision of veterinarians. Treatment according to approved veterinary medicinal product texts (on the label) as well as exceptional off-label use should be evidence based. Proper and timely diagnosis, knowledge of pharmacokinetic and pharmacodynamic data and setting the appropriate route of administration and dosing schedule (frequency, duration, and dose) seem key factors for effective treatment. Principles of antimicrobial stewardship should be promoted and become standard for everyday practices.