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21 JULY/AUGUST 2017 ■ TVPJOURNAL.COM VET REPORT VITALS IMPLICATIONS FOR VETERINARIANS A large-scale implication of an increase in the incidence of antimicrobial-resistant infections is the potential for heightened scrutiny of antibiotic use in veterinary medicine, resulting from increased public awareness of AMR. Situations coming under particularly close inspection might include the use of antimicrobial drugs where not indicated; the administration of inappropriate drugs for a given condition; and prescription of antimicrobial drugs with inappropriate dosages, frequencies, or treatment durations. 2 As evidenced by regulations on antimicrobial use in human and food animal medicine, it is also conceivable that companion animal veterinarians could be subject to restrictions on the types of antimicrobial drugs available for use in their patients, regulations around the use of specific drugs, and/or the requirement for approval to use certain drugs. 3 Although directed primarily at drug manufacturers and distributors, legislation to ensure medicines are safe, effective, and of assured quality could certainly have consequences in the veterinary clinic, including changes in pricing, accessibility, and availability that would affect the use of certain drugs in treatment protocols. 1 Additionally, the World Health Organization (WHO) has suggested optimizing the use of antimicrobial medicines in animal health through training or accreditation of health professionals to align with national legislation. This could include the creation of regulations around the licensing, distribution, and use of antimicrobial drugs and regulatory actions to preserve new antibiotics. 1 It also implies that regulated use of antimicrobials in companion animal medicine, including greater control over dispensing rights, could become a reality. In the face of the rise of AMR, advancement in the development of new drugs has been minimal. No major new class of antibiotics has been discovered since 1987, and few antibacterial agents are in development. As antimicrobial-resistant infections become more prevalent in companion animal practice, the consequences of infection with resistant microorganisms may include 1 : • Longer duration of illness (refractory to normal treatments) • Increased mortality • Prolonged treatment or hospitalization • Higher costs of care Evidence of the threat of AMR to veterinary and public health can be found in the recent discovery of a multidrug-resistant strain of Salmonella species infecting a cat presented to an Australian veterinary clinic for an upper respiratory tract infection. 4 The strain was resistant to approximately 9 classes of antimicrobials, including carbapenems, which are frequently a last line of defense against multidrug- resistant bacterial infections in humans. The infected cat was ultimately euthanized, and 3 of 8 other cats being treated at the clinic for unrelated illnesses subsequently tested positive for the bacterium, indicating that it was highly transferable. This is just a single example; the WHO reports that AMR is present worldwide, and drug-resistant bacterial strains include Escherichia coli , Staphylococcus aureus, and Mycobacterium tuberculosis. 5 Last, but certainly of crucial importance, is the risk for transmission of antimicrobial-resistant infections from animals to their owners and caretakers, whether by zoonotic spread of transmissible disease or through transference of resistance among bacterial FIGURE 1. The implications of antimicrobial resistance. THE IMPLICATIONS WHAT DOES A RISE IN AMR MEAN? Clients Less effective treatments for sick pets Increased veterinary bills Risk of AMR transmission from their pets Veterinarians Decreasing efficacy of available drugs Threatens freedom to practice as we choose Zoonotic spread of AMR