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13 pages, 240 KiB

Open AccessArticle

Development and Pilot of an Interactive Online Course on Antimicrobial Stewardship in Companion Animals

by Nonke E. M. Hopman, Jaap A. Wagenaar, Ingeborg M. van Geijlswijk and Els M. Broens

Antibiotics 2021, 10(5), 610; https://doi.org/10.3390/antibiotics10050610 - 20 May 2021

Cited by 1 | Viewed by 2955

Abstract

A holistic approach to antimicrobial use (AMU) and prescribing is needed to combat the problem of antimicrobial resistance (AMR). Previously, an antimicrobial stewardship programme (ASP) was developed, introduced, and evaluated in 44 Dutch companion animal clinics, which resulted in an optimization of AMU. [...] Read more.

A holistic approach to antimicrobial use (AMU) and prescribing is needed to combat the problem of antimicrobial resistance (AMR). Previously, an antimicrobial stewardship programme (ASP) was developed, introduced, and evaluated in 44 Dutch companion animal clinics, which resulted in an optimization of AMU. As a follow-up to this, an online course was developed to promote awareness of AMU, AMR, and responsible antimicrobial prescribing. The aim of this paper is to describe the development and pilot, including evaluation, of this course, which will be disseminated more widely among Dutch companion animal veterinarians. The interactive programme consists of a major e-learning component and two online, face-to-face meetings. The course comprises five different parts corresponding with five consecutive weeks. Theory on several topics is offered, for example on AMU and AMR in general, Dutch regulations and guidelines on veterinary AMU, behavioural change, and possible methods to quantify AMU. Additionally, several assignments are offered, for example to reflect upon one’s own current antimicrobial prescribing behaviour. Interactive discussion and peer-to-peer learning are promoted. Since September 2020, the course has been offered in a pilot phase, and the feedback is promising. Evaluation of the pilot phase will result in recommendations for further optimization and dissemination. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

14 pages, 1241 KiB

Open AccessArticle

Coaching Belgian and Dutch Broiler Farmers Aimed at Antimicrobial Stewardship and Disease Prevention

by Nele Caekebeke, Moniek Ringenier, Franca J. Jonquiere, Tijs J. Tobias, Merel Postma, Angelique van den Hoogen, Manon A. M. Houben, Francisca C. Velkers, Nathalie Sleeckx, Arjan Stegeman, Jeroen Dewulf and on behalf of the i-4-1-Health Study Group

Antibiotics 2021, 10(5), 590; https://doi.org/10.3390/antibiotics10050590 - 17 May 2021

Cited by 16 | Viewed by 3361

Abstract

A reduction in antimicrobial use (AMU) is needed to curb the increase in antimicrobial resistance in broiler production. Improvements in biosecurity can contribute to a lower incidence of disease and thereby lower the need for AMU. However, veterinary advice related to AMU reduction [...] Read more.

A reduction in antimicrobial use (AMU) is needed to curb the increase in antimicrobial resistance in broiler production. Improvements in biosecurity can contribute to a lower incidence of disease and thereby lower the need for AMU. However, veterinary advice related to AMU reduction or biosecurity is often not complied with, and this has been linked to the attitudes of farmers. Behavior change promoted by coaching may facilitate uptake and compliance regarding veterinary advice. Thirty broiler farms in Belgium and the Netherlands with high AMU were included in this study for 13 months. For each farmer, the attitude towards AMU reduction was quantified using an adjusted Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR^®) change management model, and farm biosecurity was assessed with the Biocheck.UGent^™ tool. Subsequently, farmers were coached to improve disease prevention and antimicrobial stewardship. After the individual coaching of farmers, there was a change in their attitudes regarding AMU, reflected by an increase in ADKAR^® scores. Biosecurity levels improved by around 6% on average, and AMU was reduced by 7% on average without negative effects on performance parameters. Despite these improvements, no significant association could be found between higher ADKAR^® scores and lower AMU. Further investigation into sociological models is needed as a tool to reduce AMU in livestock production. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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10 pages, 922 KiB

Open AccessArticle

The Use of Colistin in Food-Producing Animals in Estonia—Vaccination as an Effective Alternative to Consumption of Critically Important Antimicrobials in Pigs

by Marju Sammul, Kerli Mõtus and Piret Kalmus

Antibiotics 2021, 10(5), 499; https://doi.org/10.3390/antibiotics10050499 - 28 Apr 2021

Cited by 4 | Viewed by 3020

Abstract

Reducing the use of critically important antimicrobials in veterinary medicine is increasingly important to avoid the development and spread of antimicrobial resistance. The aim of this study was to analyse ten-year trends of colistin consumption in Estonia and to ascertain the possible association [...] Read more.

Reducing the use of critically important antimicrobials in veterinary medicine is increasingly important to avoid the development and spread of antimicrobial resistance. The aim of this study was to analyse ten-year trends of colistin consumption in Estonia and to ascertain the possible association between Escherichia (E.) coli vaccination and colistin consumption in pig production. Colistin sales data (2010–2019) were collected from the wholesalers, allowing differentiation of target species. In Estonia, the amount of sold colistin increased constantly and almost doubled from 2010 to 2013, and decreased from 2013 to 2019 by 92.5% in total. On average across a ten-year study period, 89.7% of colistin was used in pig production. The number of sold doses of E. coli vaccines for pigs was very low before 2014 (<2000) and increased drastically to 2019 (362,000). According to linear time-series model with autoregressive integrated moving average (ARIMA) the consumption of colistin in pigs decreased on average by 0.23 mg/PCU for every 10,000 E. coli vaccine doses (95% CI −0.39, −0.06; p = 0.006) over ten years. This study revealed that in pig production, vaccination against E. coli strains contributes to the expected downward trend in colistin consumption. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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29 pages, 1246 KiB

Open AccessArticle

Examining the Effect of Context, Beliefs, and Values on UK Farm Veterinarians’ Antimicrobial Prescribing: A Randomized Experimental Vignette and Cross-Sectional Survey

by Sarah E. Golding, Jane Ogden and Helen M. Higgins

Antibiotics 2021, 10(4), 445; https://doi.org/10.3390/antibiotics10040445 - 15 Apr 2021

Cited by 8 | Viewed by 3234

Abstract

Antimicrobial resistance (AMR) is a pressing threat to public and animal health. There is evidence that antimicrobial prescribing and stewardship behaviors by veterinarians (vets) are influenced by non-clinical factors, such as psychological, social, and environmental factors. This study explored the role of context, [...] Read more.

Antimicrobial resistance (AMR) is a pressing threat to public and animal health. There is evidence that antimicrobial prescribing and stewardship behaviors by veterinarians (vets) are influenced by non-clinical factors, such as psychological, social, and environmental factors. This study explored the role of context, beliefs, and values on vets’ antimicrobial prescribing decisions. UK-based practicing farm vets (n = 97) were recruited to an online study. Using an experimental vignette methodology, vets were randomly assigned across four conditions, to examine the effects of different contexts (pressure on farm economics, the farmer, or the vet-farmer relationship, compared to a control condition) on vets’ likelihood of prescribing antibiotics. Vets’ beliefs about different groups’ responsibility for causing and preventing AMR and vets’ values were also measured. Key findings were that context alone, values, and beliefs about groups’ responsibilities for causing AMR were not predictive of vets’ likelihood of prescribing antibiotics. However, vets’ beliefs about groups’ responsibilities for preventing AMR were predictive of an increased likelihood of prescribing antibiotics, when vets were exposed to the experimental condition of the vignette in which the vet–farmer relationship was under pressure. Farm vets also believed that different groups have different levels of responsibility for causing and preventing AMR. Results should be interpreted cautiously, given the smaller than planned for sample size, and the possibility for both false negatives and false positives. Further research is needed to explore how these findings could inform antimicrobial stewardship interventions in veterinary medicine. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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16 pages, 1781 KiB

Open AccessEditor’s ChoiceArticle

Overview and Evaluation of Existing Guidelines for Rational Antimicrobial Use in Small-Animal Veterinary Practice in Europe

by Fergus Allerton, Cameron Prior, Arzu Funda Bagcigil, Els Broens, Bénédicte Callens, Peter Damborg, Jeroen Dewulf, Maria-Eleni Filippitzi, Luís Pedro Carmo, Jonathan Gómez-Raja, Erez Harpaz, Ana Mateus, Mirja Nolff, Clare J. Phythian, Dorina Timofte, Flavia Zendri and Lisbeth Rem Jessen

Antibiotics 2021, 10(4), 409; https://doi.org/10.3390/antibiotics10040409 - 9 Apr 2021

Cited by 36 | Viewed by 8907

Abstract

Antimicrobial stewardship guidelines (ASGs) represent an important tool to help veterinarians optimize their antimicrobial use with the objective of decreasing antimicrobial resistance. The aim of this study was to map and qualitatively assess the ASGs for antimicrobial use in cats and dogs in [...] Read more.

Antimicrobial stewardship guidelines (ASGs) represent an important tool to help veterinarians optimize their antimicrobial use with the objective of decreasing antimicrobial resistance. The aim of this study was to map and qualitatively assess the ASGs for antimicrobial use in cats and dogs in Europe. Country representatives of the European Network for Optimization of Veterinary Antimicrobial Treatment (ENOVAT) were asked to identify ASGs published in their countries. All collated ASGs updated since January 2010 containing recommendations on antimicrobial therapy for at least three conditions affecting different organ systems in cats and dogs underwent detailed review including AGREE II analysis. Out of forty countries investigated, fifteen ASGs from eleven countries met the inclusion criteria. Several critical principles of antimicrobial use were identified, providing a framework that should assist development of stewardship guidance. The AGREE II analysis highlighted several methodological limitations of the currently available ASGs. This study sheds light on the lack of national ASGs for dogs and cats in multiple European countries and should encourage national bodies to prioritize guideline development in small animals. A greater awareness of the need to use a structured approach to guideline development could improve the quality of ASGs in the future. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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16 pages, 4462 KiB

Open AccessArticle

Towards a Better and Harmonized Education in Antimicrobial Stewardship in European Veterinary Curricula

by Carmen Espinosa-Gongora, Lisbeth Rem Jessen, Oliver James Dyar, Alain Bousquet-Melou, Bruno González-Zorn, Céline Pulcini, Giovanni Re, Stefan Schwarz, Dorina Timofte, Pierre-Louis Toutain, Luca Guardabassi, The PREPARE-VET Working Group, ESCMID Study Group for Veterinary Microbiology (ESGVM) and ESCMID Study Group for Antimicrobial stewardshiP (ESGAP)

Antibiotics 2021, 10(4), 364; https://doi.org/10.3390/antibiotics10040364 - 30 Mar 2021

Cited by 19 | Viewed by 5039

Abstract

Education in antimicrobial stewardship (AMS) in veterinary medicine is essential to foster responsible antimicrobial use and control of antimicrobial resistance (AMR) in animals. AMS is listed by the EU and international organizations among the basic ‘Day One Competences’ required of veterinary students upon [...] Read more.

Education in antimicrobial stewardship (AMS) in veterinary medicine is essential to foster responsible antimicrobial use and control of antimicrobial resistance (AMR) in animals. AMS is listed by the EU and international organizations among the basic ‘Day One Competences’ required of veterinary students upon graduation. Our aim was to evaluate the quality of education of European veterinary students in AMS. We distributed a 27-item survey addressing the perceptions of preparedness and acquired skills on key topics related to AMS to final-year veterinary students in Europe. We collected 3423 complete answers from 89 veterinary schools in 30 countries. Selection of treatment strategies and awareness of emerging AMR problems were markedly different between countries. Overall, only one in four students was familiar with guidelines for antimicrobial use. The students perceived a medium-high impact of veterinary antimicrobial use on AMR in humans. Notably, 75% of the students felt the need for improved teaching on AMS, half of which also demanded more teaching on general antimicrobial therapy. Our results highlight several possible strategies to improve the quality of education, ranging from a better link between clinical rotations and the theory taught in pre-clinical modules, to a more effective introduction into best practices for antimicrobial use. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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16 pages, 307 KiB

Open AccessArticle

Knowledge, Attitudes and Practices Regarding Antibiotic Use and Resistance among Veterinary Students in Bangladesh

by Lorraine Chapot, Md Samun Sarker, Ruhena Begum, Delower Hossain, Rahima Akter, Md Mehedi Hasan, Zamila Bueaza Bupasha, Md Bayzid, Md Salauddin, Md Shafiullah Parvej, AHM Musleh Uddin, Fazlul Hoque, Joya Chowdhury, Md Niyamat Ullah, Md Kaisar Rahman, Nure Alam Siddiky, Guillaume Fournié and Mohammed A. Samad

Antibiotics 2021, 10(3), 332; https://doi.org/10.3390/antibiotics10030332 - 22 Mar 2021

Cited by 15 | Viewed by 6799

Abstract

The use of antibiotics in animals for both therapeutic and non-therapeutic purposes is a major driver of the emergence and spread of antimicrobial resistance (AMR). While several studies have investigated prescription and consumption patterns in humans, little attention has been paid to the [...] Read more.

The use of antibiotics in animals for both therapeutic and non-therapeutic purposes is a major driver of the emergence and spread of antimicrobial resistance (AMR). While several studies have investigated prescription and consumption patterns in humans, little attention has been paid to the veterinary sector. A cross-sectional study was conducted in 3002 veterinary students (VS) and non-medical students (NMS) from 12 universities in Bangladesh to explore their knowledge, attitudes and practices (KAP) about antibiotics and AMR using a self-administered questionnaire, and assess the influence of the veterinary curriculum. KAP regarding antibiotic use and AMR was significantly higher in veterinary than non-medical students, and in first-year than final-year students. However, gaps in knowledge and practices were highlighted, suggesting deficiencies in training. Moreover, final-year veterinary students were found to be more likely than first-year students to use antibiotics without instructions, which could indicate deficiencies in their curriculum. Although the study suggested a positive impact of the veterinary curriculum on KAP about antibiotics and AMR in Bangladesh, critical gaps remain that are likely to contribute to inadequate use in their future practice. Therefore, there is scope for improving educational programs on AMR in professional curricula. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

20 pages, 614 KiB

Open AccessArticle

Non-Clinical Factors Determining the Prescription of Antibiotics by Veterinarians: A Systematic Review

by Miguel Servia-Dopazo, Margarita Taracido-Trunk and Adolfo Figueiras

Antibiotics 2021, 10(2), 133; https://doi.org/10.3390/antibiotics10020133 - 30 Jan 2021

Cited by 27 | Viewed by 3698

Abstract

The misuse of antibiotics in humans, animals, and plants is related to the spread of resistant antibiotic strains among humans and animals. In this paper, we carry out a bibliographic search of Medline, Web of Knowledge, and Cab Abstracts with the main objective [...] Read more.

The misuse of antibiotics in humans, animals, and plants is related to the spread of resistant antibiotic strains among humans and animals. In this paper, we carry out a bibliographic search of Medline, Web of Knowledge, and Cab Abstracts with the main objective of ascertaining the available evidence on non-clinical factors and attitudes that could influence the prescription of antibiotics by veterinarians. A total of 34 studies fulfilled the inclusion criteria. Whereas, veterinary health professionals’ prescribing habits did not appear to be influenced by their socio-demographic characteristics, they were influenced by different attitudes, such as fear (identified in 19 out of 34 studies), self-confidence (19/34), business factors (19/34), and by complacency (16/34). Certain owner-related factors, such as lack of awareness (16/34) and demand for antibiotics (12/34), were also important, as were concurrent factors, ranging from a lack of appropriate regulations (10/34) to the expense and delays involved in performing culture and sensitivity tests (10/34) and inadequate farm hygiene (8/34). Our results appear to indicate that the non-clinical factors are potentially modifiable. This may be useful for designing interventions targeted at improving antibiotic use in animals, as part of an overall strategy to reduce the global spread of multi-resistant strains. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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12 pages, 836 KiB

Open AccessArticle

The Use of Antimicrobials in Italian Heavy Pig Fattening Farms

by Federico Scali, Giovanni Santucci, Antonio M. Maisano, Francesca Giudici, Federica Guadagno, Matteo Tonni, Alberto Amicabile, Nicoletta Formenti, Enrico Giacomini, Massimiliano Lazzaro, Giorgio Bontempi, Nicoletta Vitale, Lis Alban, Jeroen Dewulf, Adriana Ianieri, Sergio Ghidini, Giancarlo Belluzzi, Loredana Candela, Angelica Maggio, Paolo Pasquali, Silvio Borrello and Giovanni L. Alborali Show full author list Hide full author list

Antibiotics 2020, 9(12), 892; https://doi.org/10.3390/antibiotics9120892 - 10 Dec 2020

Cited by 15 | Viewed by 3498

Abstract

Data on antimicrobial use (AMU) in heavy pig production (>150 kg) are limited. The aim of this study was to investigate the AMU in this production. Data from 2015 were collected for 143 fattening farms. The AMU was estimated through a treatment index [...] Read more.

Data on antimicrobial use (AMU) in heavy pig production (>150 kg) are limited. The aim of this study was to investigate the AMU in this production. Data from 2015 were collected for 143 fattening farms. The AMU was estimated through a treatment index per 100 days (TI₁₀₀) using the defined daily dose animal for Italy (DDDAit). When possible, a comparison with the European Medicines Agency’s defined daily doses for animals (DDDvet) was performed. The median TI₁₀₀ was 10.7 (range, 0.2–49.5). Group treatments represented 94.6% of overall consumption. The AMU calculated using DDDAit and DDDvet were strongly correlated (ρ = 0.976; p < 0.001). The AMU was negatively correlated with injectables use (ρ = −0.46, p < 0.001) and positively correlated with oral products (ρ = 0.21, p = 0.014), premixes (ρ = 0.26, p = 0.002), and mortality (ρ = 0.18; p = 0.027). Farm size was negatively correlated with AMU (ρ = −0.29, p < 0.001). Smaller farms were more frequently above the median TI₁₀₀ (odds ratio = 2.3, 95% confidence interval = 1.2–4.7), suggesting that they may have lower biosecurity and management standards. The results of this study should provide useful insights for the development of an Italian monitoring system. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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11 pages, 1622 KiB

Open AccessArticle

Antimicrobial Stewardship for Respiratory Pathogens in Swine

by Anna Vilaró, Elena Novell, Vicens Enrique-Tarancón, Jordi Balielles, Eduard Allué and Lorenzo Fraile

Antibiotics 2020, 9(11), 727; https://doi.org/10.3390/antibiotics9110727 - 22 Oct 2020

Cited by 6 | Viewed by 2604

Abstract

The aim of this study was to set up antimicrobial stewardship for swine respiratory pathogens following the recommendation from the European Medicine Agency. The obtained antimicrobial susceptibility pattern recommended using antimicrobial stewardship for each clinical case instead of treatment guidelines focused on pathogens. [...] Read more.

The aim of this study was to set up antimicrobial stewardship for swine respiratory pathogens following the recommendation from the European Medicine Agency. The obtained antimicrobial susceptibility pattern recommended using antimicrobial stewardship for each clinical case instead of treatment guidelines focused on pathogens. Thus, the bacteria are isolated and the MIC values, the clinical interpretation for each antimicrobial (susceptible or resistant), additional information about the distance between the MIC obtained and the clinical breakpoint, and set up for each drug, are represented in the report provided for veterinarians. A graph from green (susceptible) to red (resistant) is enclosed for each antimicrobial and microorganism in the report. The greener, the more susceptible is the strain, and the redder, the less susceptible is the strain for each particular antimicrobial. This information could help veterinarians to select the most suitable antimicrobial from first, second, or last option antimicrobials. Thus, veterinarians should choose the antimicrobial, inside each option, with the best antimicrobial susceptibility pattern that corresponds with the greener status in the report. The information provided in the report could be useful for all clinical cases, caused by a certain bacterium within the same pig production system, if an epidemiological link could be established. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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10 pages, 693 KiB

Open AccessArticle

Antimicrobial Resistance in Escherichia coli and Resistance Genes in Coliphages from a Small Animal Clinic and in a Patient Dog with Chronic Urinary Tract Infection

by Veronika Zechner, Dmitrij Sofka, Peter Paulsen and Friederike Hilbert

Antibiotics 2020, 9(10), 652; https://doi.org/10.3390/antibiotics9100652 - 29 Sep 2020

Cited by 8 | Viewed by 2755

Abstract

Antimicrobial resistance is on the rise in certain pathogens that infect pets and their owners. This has raised concerns about the use of antibiotics and the transfer of resistance elements in small animal clinics. We sampled a surgery unit, diagnostic rooms after disinfection, [...] Read more.

Antimicrobial resistance is on the rise in certain pathogens that infect pets and their owners. This has raised concerns about the use of antibiotics and the transfer of resistance elements in small animal clinics. We sampled a surgery unit, diagnostic rooms after disinfection, and a dog with chronic urinary tract infection (UTI), in a small animal clinic in Austria, and isolated/characterized phages and Escherichia (E.) coli for antimicrobial resistance, resistance genes and transduction ability. Neither the coliphages nor E. coli were isolated in the 20 samples of the surgery units and diagnostic rooms. From the urinary tract of the dog, we recovered 57 E. coli isolates and 60 coliphages. All of the E. coli isolates were determined as resistant against nalidixic acid, 47 against ampicillin, 34 against sulfonamides, and 33 against streptomycin. No isolate held resistance against tetracycline, trimethoprim, kanamycin, or chloramphenicol. Among the 60 phages, 29 tested positive for one or more resistance gene(s) by PCR, but none was able to transduce it to a laboratory strain or to an E. coli isolated from samples. Nevertheless, six phages out of 60 were able to transduce ampicillin resistance (bla gene) after being grown on a puc19 harboring E. coli strain. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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1 pages, 153 KiB

Open AccessErratum

Erratum: Callaway et al. Alternatives to Antibiotics: A Symposium on the Challenges and Solutions for Animal Health and Production. Antibiotics 2021, 10, 471

by Todd R. Callaway, Hyun Lillehoj, Rungtip Chuanchuen and Cyril G. Gay

Antibiotics 2021, 10(8), 1024; https://doi.org/10.3390/antibiotics10081024 - 23 Aug 2021

Cited by 7 | Viewed by 1764

Abstract

The authors would like to make the following corrections to the published paper [...] Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

15 pages, 305 KiB

Open AccessConference Report

Alternatives to Antibiotics: A Symposium on the Challenges and Solutions for Animal Health and Production

by Todd R. Callaway, Hyun Lillehoj, Rungtip Chuanchuen and Cyril G. Gay

Antibiotics 2021, 10(5), 471; https://doi.org/10.3390/antibiotics10050471 - 21 Apr 2021

Cited by 47 | Viewed by 6808

Abstract

Antibiotics have improved the length and quality of life of people worldwide and have had an immeasurable influence on agricultural animal health and the efficiency of animal production over the last 60 years. The increased affordability of animal protein for a greater proportion [...] Read more.

Antibiotics have improved the length and quality of life of people worldwide and have had an immeasurable influence on agricultural animal health and the efficiency of animal production over the last 60 years. The increased affordability of animal protein for a greater proportion of the global population, in which antibiotic use has played a crucial part, has resulted in a substantial improvement in human quality of life. However, these benefits have come with major unintended consequences, including antibiotic resistance. Despite the inherent benefits of restricting antibiotic use in animal production, antibiotics remain essential to ensuring animal health, necessitating the development of novel approaches to replace the prophylactic and growth-promoting benefits of antibiotics. The third International Symposium on “Alternatives to Antibiotics: Challenges and Solutions in Animal Health and Production” in Bangkok, Thailand was organized by the USDA Agricultural Research Service, Faculty of Veterinary Science, Chulalongkorn University and Department of Livestock Development-Thailand Ministry of Agriculture and Cooperative; supported by OIE World Organization for Animal Health; and attended by more than 500 scientists from academia, industry, and government from 32 nations across 6 continents. The focus of the symposium was on ensuring human and animal health, food safety, and improving food animal production efficiency as well as quality. Attendees explored six subject areas in detail through scientific presentations and panel discussions with experts, and the major conclusions were as follows: (1) defining the mechanisms of action of antibiotic alternatives is paramount to enable their effective use, whether they are used for prevention, treatment, or to enhance health and production; (2) there is a need to integrate nutrition, health, and disease research, and host genetics needs to be considered in this regard; (3) a combination of alternatives to antibiotics may need to be considered to achieve optimum health and disease management in different animal production systems; (4) hypothesis-driven field trials with proper controls are needed to validate the safety, efficacy, and return of investment (ROI) of antibiotic alternatives. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Veterinary Medicine)

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