**4.2 Governance of antimicrobial use**

Antimicrobial use in human and veterinary practice requires holistic approach in order to improve drug governance. There is need to list the critical or essential drugs in human and veterinary practice with requirement for prescription and guidelines such as banning the use of medically important antibiotics in agricultural practice and off-label use of antimicrobials as well as monitoring antimicrobial use and resistance. Not much success has been recorded in this regard in developing countries especially in livestock production and aquaculture due to little investments. According to OIE, better governance of veterinary antimicrobials comes from empowering veterinarians and limiting prescription to them. Most of the private veterinary service providers in developing countries are not operating at a significant scale and as such are often employed directly by agriculture and agro-allied companies making them to be less independent. The few that are successful are not operating with the guidelines of current OIE policy [81]. The community animal health workers (CAHWs), that have proven to be effective, are very expensive to train and may not be politically acceptable [82]. This is because there is lack of resources to support them by public veterinary services, and the private veterinarians often see them as potential competitors. A study investigated rational drug use by farmers and found that farmers in West Africa were mainly responsible for buying and using antimicrobials, and providing simple information on correct drug use could lead to improved drug usage as well as reduced amount of underdosages, which is an important factor for the development of AMR [83].

## **4.3 Antimicrobial alternatives in veterinary practice**

As previously mentioned, developed countries banned the use of medically important antibiotics as well as growth promoters in animal production, which has led to better farming practices as well as reduction in AMR of medically important microbes found in farm animals. With this natural experiment, it demonstrated that routine antimicrobial usage is not a precondition for healthy animals as long as there is better hygiene and sanitation with good housing condition, and the use of antibiotics is only limited to clinical condition. The benefit of antimicrobials as growth promoters may sound reasonable only under poor management and hygiene situations [71]. Although the type of intensive livestock production in developing countries makes them rely more on nontherapeutic use of antimicrobials, there are many other promising innovations that could support profitable and productive agriculture with less reliance on antimicrobials use such as:


*Veterinary Pharmaceuticals and Antimicrobial Resistance in Developing Countries DOI: http://dx.doi.org/10.5772/intechopen.84888*


All these intervention strategies will improve animal welfare as well as reducing environmental externalities of animal agriculture. A more radical suggestion is to decrease the amount of consumption of animal source food or shift from intensive to organic animal production.

### **5. Veterinary antimicrobial stewardship in developing countries**

The safeguarding of antimicrobial agents for future generations is of utmost priority as AMR threatens the very core of modern medicines and the sustainability of an effective, global public health response to the enduring threats from infectious diseases [72]. In many developing countries of the world, gaps exist among health care professionals on the current status of antibiotic resistance in their area due to lack of a systematic surveillance at country, provincial, and district level [88]. There is a paucity of clinical data on antibiotic resistance, and this is particularly the case in resource-poor settings. Tons of antibiotics are used annually in clinical and agricultural settings worldwide. The estimates of the total annual global consumption of antimicrobials in animal production vary considerably due to poor surveillance and data collection in many countries [89]. In 2013, food animals alone consumed over 130,000 tons of antibiotics [90]. It cannot be ignored that two-thirds of the estimated future growth of usage of antimicrobials is estimated to be within the animal production sector, with use in pig and poultry production predicted to double [89]. Nigeria, Pakistan, India, Bangladesh, China, and Egypt are the developing countries with massive consumption of antibiotics [88].

The implementation of rational and restricted use of antibiotics is lacking in most developing countries where you have the largest market of antimicrobial drugs and reports of the highest rate of antibiotic resistance [86, 87]. Due to these developments, antimicrobial stewardship programs have emerged as an essential means to attenuate the threat of a real possibility of the specter of a "postantibiotic era" [91, 92].

Antimicrobial stewardship is a harmonized program (the optimal selection, dosage, and drug regimen) that fosters the proper use of antimicrobials (including antibiotics) with the goal of optimizing clinical outcomes, reducing microbial resistance, and lessening the spread of infections produced by multidrug-resistant organisms. The main objectives of antimicrobial stewardship are to attain excellent patient outcomes associated with antimicrobial use while reducing toxicity and other unfavorable events, thereby curbing the discriminatory pressure on bacterial population that propels the emergence of multidrug-resistant strains [93, 94].

Antimicrobial stewardship programs (ASPs) are a cornerstone of the response to the AMR crisis in human medicine but are still largely underdeveloped in veterinary medicine [95]. Antimicrobial stewardship is important to both animal health and food safety. Just like humans, animals get infections that require treatment with antibiotics. The rise of antimicrobial resistance is a serious threat to public health [30]. It is imperative that antibiotic stewardship programs seeking to preserve the effectiveness of existing antibiotics in human health also consider strategies that reduce overuse of antibiotics in the agricultural sector as antimicrobials are used in terrestrial animal production practices to preserve animal and public health, but also as growth

promoters at a subtherapeutic level [89]. Other aspects to be considered with regard to antimicrobial use include the distinction between therapeutic and nontherapeutic use, between the diverse existing production systems and between specifics related to the different animal species and their eco-geographical location [72, 89].

According to the WHO, FAO, and OIE global tripartite database for antimicrobial resistance country self-assessment in 2016–2017, 42% of the countries on question regarding antimicrobial stewardship and regulation in animals and crop production responded that no national policy or legislation regarding the quality and efficacy of antimicrobials and their use in animals, and crops was available [101]. Responses to other veterinary-related questions showed a huge gap in the preparedness for combating AMR and also the lack of policy making and implementation of a successful antimicrobial stewardship program.

Various strategies have been shown to improve appropriateness of antimicrobial use and cure rates, decrease failure rates, and reduce healthcare-related costs in human hospitals [96–98]. According to Guardabassi & Prescott [95], the following successful strategies used in human hospitals can be adopted with focus on their implementation in veterinary practice.


It should be noted that one strategy does not exclude the other and that multiple strategies can be successfully used in combination.

A good antimicrobial stewardship program (ASP) needs remarkable input in research and training by all stakeholders including national and international veterinary organizations, funding concerns, and animal health industries [95]. At governmental levels, the growth and execution of ASPs need coordination of the task of national public health and veterinary authorities, veterinary clinics, organizations, and private practitioners. The concept of antimicrobial stewardship and of its continuous improvement is in its relative infancy in various sectors of veterinary practice in developing countries, but every veterinary component of the agricultural sector has the responsibility and access to a wide range of resources to develop an ASP.

Stewardship of antimicrobial drugs in human healthcare and veterinary settings is essential to slow the emergence of resistance and extending the useful life of effective antimicrobials according to FDA Center for Veterinary Medicine [99]. All developing countries should be committed to advancing efforts to implement good antimicrobial stewardship practices in veterinary settings as part of their role to protect human and animal health. Each program must be region-specific and constantly under review given that resistance patterns change, requiring changes to local policy of, for example, empirical antibiotic choice [100].

Therefore, the goals in all countries should be to align antimicrobial drug product use with the principles of antimicrobial stewardship, foster antimicrobial stewardship in veterinary settings, and enhance monitoring of antimicrobial resistance and use in animals to further preserve antimicrobial drugs to ensure human and animal health [99].

*Veterinary Pharmaceuticals and Antimicrobial Resistance in Developing Countries DOI: http://dx.doi.org/10.5772/intechopen.84888*
