Today (Friday 9 December 2022) has seen the launch of the first Annual Progress Report from the Responsible use of Medicines Alliance – Companion Animal and Equine (RUMA CA&E) . The Alliance was established in 2020 to define the principles of responsible use of medicines in the companion animal and equine sectors with a view to contributing positively to the One Health agenda.
The Alliance was created from the leadership and vision of the Responsible use of Medicines in Agriculture (RUMA) Alliance, which over the past decade has helped focus activity across the livestock sectors to achieve a 55% reduction in antibiotic sales for food-producing animals since 2014, and has seen the use of Highest Priority Critically Important Antibiotics in animals reduce by 79% since 2014.
The newly published RUMA CA&E Annual Progress Report details the work undertaken over the past 12 months by the newly established RUMA CA&E Targets and Measures Working Group (T&MWG) – a small working group of companion animal experts and stakeholders who have been working together to formulate a set of realistic metrics, published for the first time today, for measuring antibiotic use at a national level for dogs and cats (with equine metrics to follow next year).
Steve Howard, RUMA CA&E Secretary General, says: “The T&MWG group quickly concluded that multiple metrics are needed to communicate the wider story of antimicrobial use in the companion animal sectors. Over the past year through collaboration from many stakeholders, work has been undertaken to develop metrics for monitoring and benchmarking use in dogs and cats in the first instance, with equine to follow, as well as identifying key areas where antibiotic stewardship can be improved, including how to reduce the use of HP-CIAs. The group has also considered the challenges that exist, which includes the difficulty in collecting data, differences and inconsistencies in data recording, off licence and specials use, the varying practice models across the country – for example, charity versus private first opinion, versus referral. And there are even greater complexities in the exotic and equine sectors, which we will explore further in 2023.”
The T&MWG identified three focus areas:
- Reducing the inappropriate use of antibiotics in the companion animal sector
- National and practice level targets
- Data collection and protocols at practice level
- Determining standardised methodology for benchmarking
- Promoting best practice and knowledge exchange
- Training and potential gaps. Monitoring of uptake and impact of training
National monitoring is a core focus for RUMA CA&E. The T&MWG group has explored the challenges in collecting veterinary practice prescribing data for national monitoring and will be working to promote more standardisation and working with the organisations who collect practice data (SAVSNET/VetCompass) to interpret the data collected. In the meantime, antibiotic sales data will be used as an estimate of antibiotic use in dogs and cats. This is collected by the Veterinary Medicines Directorate (VMD) and represents what is reported as sold by the Marketing Authorisation Holders (MAH’s).
Benchmarking use at practice level is not the remit of RUMA CA&E, but the Alliance recognises the importance of this to inform antimicrobial stewardship activities, so it is within the Alliances remit to help improve standardisation of medicine recording and amplify tools and techniques available to help practices with benchmarking.
The Companion Animal (Dog and Cat) National Metrics :
Steve adds: “This is an ongoing journey of refinement, and once all measures become embedded, realistic benchmarks or targets can then be set which will take into consideration that the CA&E sectors are complex, with many different factors at play.
“I am delighted with the progress that has been made so far to both establish the Alliance and in defining, through effective consultation with stakeholders, the areas to establish specific measures, activities and research, which will form the basis of agreed sector targets in the near future. These targets will ensure specific goals are set and efforts focused in the appropriate areas to demonstrate progress.”
RUMA CA&E acknowledges that there will be benefits and disadvantages to the chosen metrics, but it is committed to continually reviewing the targets and measures; those presented in the report are a starting point on the journey for the sectors, and they are likely to evolve over time.
Through input from RUMA CA&E stakeholders including the T&MWG and attendees at the roundtable that was held earlier in 2022, the following clinical scenarios have also been identified as those to prioritise, based on where it is considered there is the greatest scope to improve antibiotic stewardship, including HP-CIA use, and demonstrate some of the tools and techniques that can be employed across other scenarios:
- Cat bite abscess
- Kennel Cough
- Acute diarrhoea
- Cat Flu
Gwyn Jones, RUMA CA&E Chair and the former Chair of RUMA Agriculture, says: “These are important building blocks we are putting in place which will provide benchmarks and baselines, and in time, evidence of progress towards achieving the Government’s 20-year vision and five-year national plan for how the UK will contribute to containing and controlling AMR.
“Whilst we acknowledge there are many complex challenges to take into account across the companion animal and equine sectors when it comes to antibiotic stewardship, what is recognised is the opportunity that exists to make a positive impact on AMR and protect the role of antibiotics in both human and animal health for the future.
“Antibiotic use in the pet and equine sectors is very different to agriculture. One notable difference is the close bond and living proximity which exists between pet and owner which increases the potential for micro-organisms and bacteria to transfer from pets to humans (and vice, versa). This means that even low use of antimicrobials in these sectors could lead to resistance to key medicines, through the transfer between owners and pets or horses. In the interests of One Health, this is why the CA&E sectors are a very important consideration when we are thinking about antimicrobial stewardship and AMR.
“Ultimately, we want RUMA CA&E to become a hub for antimicrobial stewardship – the place where research and guidance exists in one place and the great work being done within the sectors can be recognised and signposted to. In the immediate future, our focus turns next to the creation of an Independent Scientific Group (ISG) to help further our understanding of opportunities and risks, understanding the capabilities for standardising data and reporting, drug availability and prevalence data on conditions that need antibiotics.”