J. vet. Pharmacol. Therap. 37, 1. doi: 10.1111/jvp.12105.
Antimicrobial Agents in Veterinary Medicine Dear Colleagues, The challenge of combating microbial infections has been a critical issue since the beginning of time. Therefore, it is not surprising that the biosynthesis of antimicrobial substances is inherent to all forms of life, ranging from soil micro-organisms such as Streptomyces to mammalian species where the synthesis of cationic peptides and other defensins with antimicrobial or anti-adhesive properties are an essential part of innate immunity. In turn, resistance mechanisms are ancient and have been developed in bacterial populations as a tool to combat adverse or hostile environmental conditions and to compete with other micro-organisms for nutrient resources. Antimicrobial resistance (AMR) is of increasing concern, reflecting one of the major non-economic challenges to the global mobility of people and goods (including feed materials and food). For more than five decades, the solution to emerging resistance included the development of modified antimicrobials and/or the introduction of new antimicrobial agents affecting different features of the bacterial life cycle. However, as the number of potential targets in a bacterial cell is limited, the identification of new targets is approaching a saturation point. This roadblock began to occur in the early 1990s. However, this problem was temporarily concealed by innovations that resulted in effective drug modifications such as the rapid expansion of the macrolides. In addition, an increasing insight into the time- and concentration-dependent effects of antibiotics led to a refinement of the dosing regimens, offering new avenues for constraining the decline in therapeutic efficacy. Nevertheless, despite these achievements, concerns regarding a global increase in antimicrobial resistance remain and therefore demand reflections on our current strategy of antimicrobial use. This point is underscored by the ever increasing number of the fatal infections in human patients that carry a bacterial population that is resistant to all known classes of antibiotics. Given the transmission of resistant bacteria between animals and humans (and vice versa!), and the potential persistence of antimicrobials, pathogens and resistance genes in the environment, it is essential that the agricultural industry and the veterinary profession reflect on the current use of antimicrobial agents. The environmental burden of non-human use of antibiotics, and the identification of (often less invasive) resistant bacterial communities on farm and companion animals, has resulted in the urgent request to reconsider the use of antibiotics that are used in animal and human health care and to develop strategies for limiting the amounts of antimicrobials that reach the environment. With the aim to stimulate the scientific discussion related to the use of antibiotics in veterinary medicine, our colleague Stefan Soback initiated the 1st AAVM (Antimicrobial Agents in Veterinary Medicine) meeting more than 10 years ago in Helsinki, Finland. This biannual event, which is held alterna© 2014 John Wiley & Sons Ltd
tively in the USA or in Europe, serves as a platform for discussions between colleagues across a range of disciplines, active in academia, regulatory authorities, industry and veterinary practice. In November 2012, the 6th AAVM meeting was held in Rockville, MD, with the invaluable engagement of Marilyn Martinez and her colleagues from the US/FDA. Marilyn and many of the conference speakers have developed a comprehensive summary of all issues discussed during that meeting. This document is available on the website of JVPT and free for downloading for all interested colleagues. The reference and abstract read as follows: Workshop Report: The 2012 Antimicrobial Agents in Veterinary Medicine (AAVM): Exploring the Consequences of Antimicrobial Drug Use: A 3D Approach* Marilyn Martinez,1,* Joseph Blondeau,2 Carl E. Cerniglia,3 Johanna Fink-Gremmels,4 Sebastian G€ unther,5 Robert P. Hunter,6 7 8 Xian-Zhi Li, Mark Papich, Peter Silley,9 Stefan Soback,10 PierreLouis Toutain,11 Qijing Zhang12 ABSTRACT: Antimicrobial resistance is a global challenge that impacts both human and veterinary health care. The resilience of microbes is reflected in their ability to adapt and survive in spite of our best efforts to constrain their infectious capabilities. As science advances, many of the mechanisms for microbial survival and resistance element transfer have been identified. During the 2012 meeting of Antimicrobial Agents in Veterinary Medicine (AAVM), experts provided insights on such issues as use versus resistance, the available tools for supporting appropriate drug use, the importance of meeting the therapeutic needs within the domestic animal health care and the requirements associated with food safety and food security. This report aims to provide a summary of the presentations and discussions occurring during the 2012 AAVM with the goal of stimulating future discussions and enhancing the opportunity to establish creative and sustainable solutions that will guarantee the availability of an effective therapeutic arsenal for veterinary species. Please consider this document as a crystallization point for further discussions. It is an initiative to inform our colleague and the public about antimicrobial stewardship in veterinary medicine, its objectives and achievements, but also identifying the challenges our profession is facing in the future. As Editors of JVPT, we invite you not only to take notice of this document, but to actively contribute to these discussions with letters, research notes and full articles. We will give this subject priority! Finally, we would like to announce the next AAVM meeting, which will be held in Berlin, Germany, in November 2014 (see www.aavmconferences.com).
J.E. RIVIERE & J. FINK-GREMMELS