**5. Synchronized efforts by stakeholders to reduce the pace of spread of antimicrobial resistance**

All the stakeholders including veterinarians, paravets, farmers, and pharmaceutical companies should be made aware about their interacting roles from antimicrobial prescription to use, in which decision made by one stakeholders affects the worth and value of choices and decision for other stakeholder [42]. These aspects can be highlighted under following sub-heads.

#### **5.1 One Health approach to combat antimicrobial resistance**

One Health approach recognizes that human, animals, and ecosystem health are inextricably linked to each other. It came in to light because many factors have changed the interaction between humans, animals, and environment. Thus, for achieving the mutual optimal health outcomes, it needs the cooperation of human health, livestock, and environment health. Resistance to infectious diseases increase the cost of treatment as well as serious biosecurity concerns due to spread of antibiotic resistance. Thus, the animal production is hampered due to rise in incidence of infections.

#### **5.2 Antimicrobial stewardship**

The primary focus of an antimicrobial stewardship program is to optimize the use of antimicrobials to achieve the best treatment outcomes, reduce the risk of infections, reduce or stabilize levels of antibiotic resistance, and promote

*Livestock Health and Farming*

**4.1 Use of antimicrobials by farmers**

cally sick, and high-risk feedlot cattle [37].

**4.2 Understanding the antimicrobials overuse in small dairy farms**

The incidence of death of farm workers due to treatment failure attributed by antimicrobial resistance is likely much higher in developing countries where more

with standards for its export. The level of antibiotic residues found was not high enough to cause an adverse effect in consumers, but it appealed for regulation and monitoring of antibiotic residues in honey because continuous long-term exposure to low levels of antibiotics could increase antibiotic resistance in pathogenic bacteria making their treatment difficult [32]. The National Policy for Containment of Antimicrobial Resistance—India was documented in years 2007, 2011, and 2017, which covers a range of topics, including reduction of antibiotic use in animals, particularly domesticated animals; provision of infection surveillance in hospitals; improving hospital surveillance for monitoring antibiotic resistance; promoting rational and judicious use of drug through education, monitoring, and supervision; researching new drugs; and developing and implementing a more restrictive and participatory antibiotic policy by including various stakeholders 65. Under the new

Schedule H1, selling of antibiotics over-the-counter will be banned [20].

**4. Delineating the use of antibiotics by farmers from farm-to-fork**

Low income countries should follow the approaches of World Health

Organization, World Organization for Animal Health, and the Food and Agriculture Organization of the United Nations, which recommends to implement national action plans encircling human, food animal, dairy animals, and environmental sectors to formulate appropriate policies, interventions, and activities that could address the prevention and containment of antimicrobial resistance from farm-to-fork. Suitable interventions should be designed, which include the following fields and coverage.

In strong sense, there is dependence among piggery farmers on antimicrobials to sustain production, improve farm performance, and maintain health status. Lack of concern about the harmful effects of antimicrobial use on their own and public health was identified among pig producers as a result of a reduction in the curative ability of antimicrobials and the selection of antimicrobial resistance bacteria [33]. A study conducted in Danish system revealed that 82% of antimicrobials sold by pharmacies were direct to individuals on prescription with specifications for use, 78% of antimicrobials sold by pharmacies used for pigs, and 20% for cattle [34]. The overuse of antibiotic has exploited this miracle drug to such an extent that a study in the Netherlands revealed that 79% of farmers used antibiotics routinely and 18% occasionally extended antibiotic treatment. The choice of progressive farmers for adopting prudent use of antibiotics by avoiding routine use of antibiotics was perceived as good practice by fellow farmers. This was followed by repeating the initial label treatments [35]. There are certain specific antibiotics which are used by farmers to treat animals without veterinary consultation (e.g., gentamicin in Ohio). Thus, improving information flow from Veterinarians to farmers may be the most effective means of promoting prudent use of antibiotics on dairy farms [36]. Subjective norms and moral obligations together, in which perceived moral obligations to peers, clients, and the regulatory norm setting sector associated with the feedlot industry increase social pressures to use antibiotics in acutely sick, chroni-

**16**

livestock safety. Creating an antimicrobial stewardship program needs baseline information, including institutional use of antimicrobial [43]. This would help to identify recurrent problems with antimicrobial use at the institution and frames the problems that need to be addressed [44]. The antimicrobial stewardship efforts should focus on improving adherence to documentation standards, optimizing the use of antimicrobials, appropriateness of drug dosing, halting treatment of asymptomatic bacteria and microbes, and minimizing the length of surgical prophylaxis [45].

#### **5.3 Recommendations to control antibiotic overuse**

Recognizing that antibiotic resistance is a reality crossing the geographical boundaries of the world, in developing countries, the prevalence of resistant microbes will rise over time, which demands urgent action. Vaccinations to prevent various disease falls into this category of recommendation, but their "antibioticsparing" effects are often overlooked because these are of secondary importance. Restricting the use of antimicrobials in livestock and poultry for non-therapeutic use, particularly growth promotion, could be beneficial. There is a need to eliminate irrational or inappropriate use, enforce prescription only laws, and eliminate overthe-counter antibiotic purchases, surveillance, distribution of Standard Treatment Guidelines (STGs), antibiotic sensitivity testing, checklists for surgical procedures, educating farmers and other stakeholders about appropriate use of antibiotics, and improving antibiotic supply chain and quality (Global Antibiotic Resistance Partnership (GARP)-India Working Group 2011). For gaining better understanding and subsequent action toward antimicrobial resistance, detailed social science research is needed to gather information on the processes of diagnosis, prescription, use of antimicrobials, the application of treatments besides antimicrobials, and the processes of data generation. Thus, sub-optimal use, potential users, and food chain pinch points could be identified. There is a general scantiness of data on on-farm application and use of antimicrobials. The tools for recording on-farm medicine use, such as paper spread sheets and computerized entries, may be of practical use to farmers in the health management of their animals/birds or to veterinarians in providing an accurate picture of how prescribed medicines are actually used [46].

#### **5.4 Prescription of antimicrobials**

Prescription of antibiotics are strongly influenced by the demand of farmers for antibiotics, fear of veterinarians blamed if antimicrobials later prove unnecessary, the expectation of farmers to be prescribed antimicrobials, confidence of veterinarians in diagnosis. Thus, prescription decisions are strongly influenced by multifactorial non-clinical influences such as farmer pressure and cost of drug, etc., to some extent [47]. Also, variations are present in beliefs of veterinarians regarding efficacy of systemic antibiotics for dry-cow therapy results in very different decisions being taken on farm and considerable discrepancies in treatment. Thus, it raises concern of the consistency and appropriateness of antibiotic prescription by them [48]. Antibiotic sensitivity testing should be preferred before prescribing the antibiotics [49].

#### **6. Conclusion**

The overuse of antimicrobials in livestock is leading to decline in antimicrobial effectiveness against infections in animals and eventually in humans. Use of antimicrobials purely as growth promoters and prophylactic purposes should be

**19**

**Author details**

Hans Ram Meena\* and Vikash Kumar

provided the original work is properly cited.

\*Address all correspondence to: drhrms@gmail.com

*Antimicrobial Resistance and Rational Use of Antimicrobials in Livestock: Developing Countries'…*

avoided and initiatives should be taken to phase out the sub-therapeutic use of antimicrobials. Injudicious use, overuse, and indiscriminate use of antimicrobials should be avoided. The obtaining of antibiotics from over—the counter sales should be checked and antimicrobial conservation practices should be encouraged to control the indiscriminate prescription and use of antimicrobials. Suitable strategies and policies should be formulated in line with the World Organisation for Animal Health and World Health Organization initiatives which call for harmonious efforts among stakeholders of different countries. Suitable extension outreach and continuing programmes should be devised to promote awareness among stakeholders about judicious use of antimicrobials and educate farmers, veterinarians, and consumers on the potential risk of antimicrobial resistance. There is need for surveillance and monitoring to track rates of antimicrobial use in veterinary sector,

increase in resistance, and spread of antimicrobial residues in food chain.

Division of Dairy Extension, ICAR-National Dairy Research Institute, Karnal, India

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*DOI: http://dx.doi.org/10.5772/intechopen.88458*

#### *Antimicrobial Resistance and Rational Use of Antimicrobials in Livestock: Developing Countries'… DOI: http://dx.doi.org/10.5772/intechopen.88458*

avoided and initiatives should be taken to phase out the sub-therapeutic use of antimicrobials. Injudicious use, overuse, and indiscriminate use of antimicrobials should be avoided. The obtaining of antibiotics from over—the counter sales should be checked and antimicrobial conservation practices should be encouraged to control the indiscriminate prescription and use of antimicrobials. Suitable strategies and policies should be formulated in line with the World Organisation for Animal Health and World Health Organization initiatives which call for harmonious efforts among stakeholders of different countries. Suitable extension outreach and continuing programmes should be devised to promote awareness among stakeholders about judicious use of antimicrobials and educate farmers, veterinarians, and consumers on the potential risk of antimicrobial resistance. There is need for surveillance and monitoring to track rates of antimicrobial use in veterinary sector, increase in resistance, and spread of antimicrobial residues in food chain.
