Judicious Use and Antimicrobial Stewardship in Veterinary Medicine

Event Details

JUDICIOUS USE AND ANTIMICROBIAL STEWARDSHIP PRESENTED BY: Dr. Lauren Forsythe, PharmD, MBA, DICVP, FSVHP DATE: September 9, 2025 DURATION: 60 minutes AUDIENCE: Veterinarians, Veterinary pharmacists, Practice leadership and QA professionals FORMAT: Live lecture with integrated case-based discussion CE CREDIT: Eligible for 1 hour of CE. Meets antimicrobial-stewardship CE mandates in California and Oregon; counts toward general CE in other U.S. jurisdictions and Canadian provinces. Licensees should verify acceptance with their board.

DESCRIPTION This session examines the principles and application of antimicrobial stewardship in veterinary medicine through a One Health lens. It addresses antimicrobial resistance (AMR) as a complex challenge with implications for animal health, human health, and environmental sustainability. The lecture integrates current science, regulatory frameworks, and practical strategies to support judicious antimicrobial use in both food-producing and companion animals.

LEARNING OUTCOMES

Define and contextualize antimicrobial resistance (AMR) within veterinary medicine and its One Health implications.

Apply diagnostic and susceptibility data to select appropriate antimicrobial therapy using a structured framework.

Differentiate labeled versus extra-label drug use in accordance with AMDUCA and related regulations.

Interpret and comply with Veterinary Feed Directive (VFD) requirements.

Develop and implement practice-level antimicrobial stewardship plans.

Evaluate case scenarios to justify empirical therapy, de-escalation, and client communication strategies.

AGENDA OUTLINE

AMR overview and One Health context

Stewardship definition and core principles

Treatment decision framework

Regulatory environment

Case discussion: Canine sporadic bacterial cystitis (UTI)

Practice implementation: protocols, documentation, QA, monitoring

Resources and next steps

CONTINUING EDUCATION APPLICABILITY

UNITED STATES:

California: Requires 1 hour on judicious use of medically important antimicrobials every 4 years.

Oregon: Requires 1 hour on judicious antibiotic use each 2-year renewal cycle.

Note: All other U.S. states and territories accept antimicrobial topics as general CE.

CANADA:

Note: Provincial colleges generally require CPD/CE hours but do not mandate antimicrobial-specific hours.

CASE STUDY: EMPIRICAL VS. CULTURE-GUIDED THERAPY IN A CANINE UTI

OBJECTIVES:

Distinguish sporadic bacterial cystitis from recurrent disease.

Select appropriate empirical therapy while planning for de-escalation.

Document rationale, duration, and follow-up.

SCENARIO: A 4-year-old mixed-breed dog presents with signs of a UTI. The owner requests enrofloxacin based on a prior episode. Learners will weigh empirical options (e.g., amoxicillin) versus broad-spectrum use, plan de-escalation after culture results, and craft clear client communication.

DEBRIEF POINTS:

Value of diagnostic confirmation and CNS.

Risk of selective pressure from unnecessary broad-spectrum use.

Documentation elements: diagnosis, drug, dose, duration, rationale, monitoring.

ABBREVIATIONS

AMR: Antimicrobial Resistance

AMDUCA: Animal Medicinal Drug Use Clarification Act

CNS: Culture and Susceptibility

ELDU: Extra-Label Drug Use

FDA CVM: U.S. FDA Center for Veterinary Medicine

GFI: Guidance for Industry

ISCAID: International Society for Companion Animal Infectious Diseases

PK/PD: Pharmacokinetics/Pharmacodynamics

VCPR: Veterinarian-Client-Patient Relationship

VFD: Veterinary Feed Directive

PRACTICE IMPLEMENTATION CHECKLIST

Confirm infection; avoid 'just-in-case' prescribing.

Obtain culture and susceptibility when feasible.

Choose the narrowest effective agent.

Document diagnosis, drug, dose, duration, route, and rationale.

Plan monitoring and de-escalation based on CNS.

Educate clients on adherence and resistance risks.

Review use patterns quarterly.

REGULATORY REFERENCES

AMDUCA (Animal Medicinal Drug Use Clarification Act)

FDA GFI #213 (Judicious Use in Food Animals)

FDA GFI #152 (Microbial Food Safety Risk Assessment)

Veterinary Feed Directive (VFD) Rule

NARMS (National Antimicrobial Resistance Monitoring System)

California VMB – Antimicrobial CE Requirement

Oregon OAR 875‑010‑0090 – CE Requirements

GUIDELINES AND RESOURCES

AVMA: Antimicrobial Stewardship: Definition and Core Principles

AAHA: Antimicrobial Stewardship Guidelines (Small Animal)

CDC: One Health Antimicrobial Resistance (AMR) Resources

USDA APHIS: National Veterinary Accreditation Program (NVAP)

WOAH (OIE): Responsible and Prudent Use of Antimicrobials

WHO: Antimicrobial Stewardship Interventions: A Practical Guide

WSAVA: Key Documents on Responsible Antimicrobial Use

FVE (Europe): Antimicrobial Resistance and Stewardship Resources

University of Minnesota: Antimicrobial Resistance and Stewardship Initiative (ARSI)

Peer-Reviewed Overview: Antimicrobial Stewardship in Veterinary Medicine (Microbiology Spectrum)

ASSESSMENT PROMPT

List two situations in which culture and susceptibility testing should be prioritized, and explain how results would change your antimicrobial selection and duration.

DISCLAIMER

Regulatory requirements and guidelines are subject to change. Verify CE acceptance with your licensing board prior to claiming credit.

Learning Objectives

• Define antimicrobial stewardship and judicious use: the right antibiotic, time, dose and duration
• Explain how antimicrobial resistance develops and which antibiotics to reserve
• Describe medically important antibiotics and veterinary feed directive status
• Use culture and susceptibility testing and antibiograms to select and de-escalate therapy
• Apply extra-label drug use rules under AMDUCA, including food animal prohibitions and withdrawal times
• Document treatment rationale under a valid VCPR