A review of the expected effects of antimicrobials in bovine respiratory disease treatment and control using outcomes from published randomized clinical trials with negative controls

Antimicrobial Metaphylaxis and its Impact on Health, Performance, Antimicrobial Resistance, and Contextual Antimicrobial Use in High-Risk Beef Stocker Calves

The objective of this blinded, cluster-randomized, complete block trial was to evaluate the impact of metaphylaxis on health, performance, antimicrobial resistance, and contextual antimicrobial use (AMU) in high-risk beef stocker calves. Calves (n = 155) were randomly assigned to receive either saline or tulathromycin at the time of arrival processing. Deep nasopharyngeal swabs were collected from each calf at arrival and 14 d later. Calves were monitored for bovine respiratory disease (BRD) for 42 d. Body weights were obtained at arrival, days 14, 28, and 42. Contextual antimicrobial use (AMU) was calculated using dose and mass-based metrics. Calves given tulathromycin had a greater average daily gain (0.96 ± 0.07 kg vs. 0.82 ± 0.07 kg; P = 0.034) and lower prevalence of BRD than controls (17% vs. 40%; P = 0.008). Proportions of calves with BRD pathogens identified at arrival were similar between treatment groups [17%; P = 0.94]. Proportions of calves with BRD pathogens identified at day 14 were lower for calves receiving tulathromycin compared to controls (15% vs. 60%, P < 0.001). Overall, 81% of Pastuerella multocida isolates and 47% of Mannheimia haemolytica isolates were pansusceptible. When measured as regimens per head in, AMU in calves receiving tulathromycin was higher than calves receiving saline (P = 0.01). Under the conditions of this study, metaphylaxis had positive impacts on the health and performance of high-risk beef stocker calves, did not contribute to the selection of resistant bacterial isolates in the nasopharynx of treated cattle, and increased AMU.

Tulathromycin metaphylaxis increases nasopharyngeal isolation of multidrug resistant Mannheimia haemolytica in stocker heifers

Bovine respiratory disease (BRD) is a leading cause of disease in feedlot and stocker calves with Mannheimia haemolytica (MH) as one of the most common etiologies. One of the most effective means of controlling BRD is through metaphylaxis, which involves administering antimicrobials to all animals at high risk of developing BRD. However, increasing prevalence of multidrug resistant (MDR) MH may reduce efficacy of metaphylaxis due to decreased susceptibility to drugs used for metaphylaxis. Primarily, this study aimed to determine the effect of tulathromycin metaphylaxis and subsequent BRD treatment on antimicrobial resistance (AMR) in MH isolated from stocker calves. Secondary objectives included evaluating the effect of metaphylaxis and treatment for BRD on animal health and comparing the genetic relationship of MH isolated. Crossbred beef heifers (n = 331, mean weight = 232, SD = 17.8 kg) at high risk for BRD were randomly assigned to receive tulathromycin metaphylaxis (META, n = 167) or not (NO META, n = 164). Nasopharyngeal swabs were collected for MH isolation, antimicrobial susceptibility testing and whole genome sequencing at arrival and 3 (WK3) and 10 (WK10) weeks later. Mixed-effects logistic regression was used to identify risk factors for isolation of MH and MDR MH (resistant to ≥3 antimicrobial drug classes) at 3 and 10 weeks, BRD morbidity, and crude mortality. Animals in the META group had higher odds of isolation of MDR MH at 3 weeks [OR (95% CI) = 13.08 (5-30.9), p < 0.0001] and 10 weeks [OR (95% CI) = 5.92 (1.34-26.14), p = 0.019] after arrival. There was no difference in risk of isolation of any MH (resistant or susceptible) between META and NO META groups at all timepoints. Animals in the NO META group had 3 times higher odds of being treated for BRD [WK3: OR (95% CI) = 3.07 (1.70-5.52), p = 0.0002; WK10: OR (95% CI) = 2.76 (1.59-4.80), p = 0.0002]. Antimicrobial resistance genes found within isolates were associated with integrative conjugative element (ICE) genes. Tulathromycin metaphylaxis increased risk of isolation of MDR MH and in this population, the increase in MDR MH appeared to be associated with ICE containing antimicrobial resistance genes for multiple antimicrobial classes. This may have important implications for future efficacy of antimicrobials for control and treatment of BRD.

Antimicrobial use in 20 U.S. beef feedyards: 2018-2019

The objective of this study was to report antimicrobial use in a convenience sample of U.S. beef feedyards for the years 2018 and 2019. In addition to antimicrobial use metrics, also reported are the indications for antimicrobial use and outcomes related to these indications. Antimicrobial use is characterized at the study and feedyard levels for a total of 1,141,846 head of cattle in 20 U.S. feedyards. Antimicrobial use is reported as milligrams of active antimicrobial ingredient per kilogram of liveweight sold (mg/kg-LW) and regimens of antimicrobials per animal year (Reg/AY). Regimens are described by antimicrobial class within use category as characterized by mg of active antimicrobial product per regimen (mg/Reg) and calendar days of administration per regimen (CDoA/Reg). A total of 1,128,515 regimens of medically important antimicrobials were captured from records. The number of regimens/100 head-in (Reg/100 head-in) are described in a subset of 10 feedyards with adequate data granularity to directly determine indications for antimicrobial administration. For the indications of bovine respiratory disease (BRD), Lameness (Lame), Liver Abscess Control (LAC), and Other (e.g., central nervous system disease, cellulitis) the Reg/100 head-in study-level values are 37.1, 0.8, 98.4, and 0.7, respectively, for 2018, with similar values for 2019. The regimens for BRD are further categorized in these 10 feedyards by the use categories in-feed, control of BRD, and individual animal therapy, yielding study level values of 4.6, 19.6, and 12.9 Reg/100 head-in, respectively, for 2018, with similar values for 2019. Outcomes of therapy for individual animal treatment of BRD, Lame, and Other are reported as treatment success, retreatment, or mortality by 30 days after the initial therapy of an animal for a disease. Treatment success rates (no treatment or mortality in the next 30 days) for 2018 in the 10 feedyards with sufficient data granularity are 76.5, 86.5, and 83.0% for BRD, Lame, and Other, respectively. The comparison of these results with other reports of antimicrobial use in North American feedyards highlights how differing approaches in calculating metric values may result in substantially different conclusions regarding antimicrobial use, especially in relation to long-duration uses.

Long-Term Effects of Single-Dose Cephalosporin or Macrolide Use on the Prevalence of AmpC and Extended-Spectrum β-Lactamase Producing Escherichia coli in the Feces of Beef Cattle

Extended-spectrum-β-lactamase (ESBL) and AmpC-lactamase-producing Enterobacteriaceae are serious public health threats. Due to an increasing number of reports of ESBL and AmpC producing Escherichia coli in agricultural settings, it is critical to understand the relationship between the use of two of the highest priority critically important human antibiotics (e.g., third generation cephalosporins [3GC] and macrolides) in food animals and their potential contribution to the selection of ESBL/AmpC E. coli. The objective of our randomized controlled feedlot trial was to measure the effects of ceftiofur crystalline-free acid and tulathromycin on 3GC resistant fecal E. coli populations in cattle before and at various time points after treatment up to and including at slaughter. Multi-level mixed-effects linear regression showed no effect of ceftiofur and tulathromycin on 3GC E. coli CFU counts at slaughter (Day 99); however, a significant (p < 0.05) population shift was observed from susceptible to 3GC resistant E. coli immediately after ceftiofur administration (Day 7). Among 799 fecal samples screened using selective media, 17.7% were ESBL/AmpC E. coli positive, which were further tested for phenotypic antibiotic susceptibility. The majority of the isolates from these plates were multidrug-resistant (94.3%) and expressed either AmpC (78.1%) or ESBL (28.1%) phenotype. A subset of isolates was whole-genome sequenced (n = 20) and identified to harbor chromosomal and/or plasmidal bla genes such as CMY-2, CTX-M, and TEM. Our findings show a time-dependent selection of antibiotics on 3GC-resistant E. coli. High prevalence of multidrug-resistant ESBL/AmpC E. coli found in cattle feces highlights the importance of prudent use of antibiotics in livestock.

Cross-sectional study of primary antimicrobial treatment and vaccination coverage in outbreaks of bovine respiratory disease on dairy and beef farms in northern Belgium

BACKGROUND

To what extent veterinarians active in the dairy or beef sector follow the antimicrobial therapy guidelines made available in different European countries for bovine respiratory disease (BRD) outbreaks, and whether differences in therapeutic or preventive preferences for BRD management exist, is currently unknown. Therefore, the objectives of this cross-sectional study were to compare vaccination coverage and primary antimicrobial and anti-inflammatory treatment on dairy, beef and mixed-breed farms in northern Belgium, and determine their compliance with the recommendations made by the Belgian formulary.

METHODS

Information on antimicrobial and anti-inflammatory drug use and vaccination coverage from 190 BRD outbreaks in 180 herds, submitted by 101 veterinarians, was analysed. Multivariable linear probability models, adjusted for clustering at the veterinarian level, were used to determine differences between dairy and beef farms.

RESULTS

Antimicrobials and non-steroidal anti-inflammatory drugs (NSAIDs) were used in 93.5% and 81.7% of the BRD outbreaks, respectively. First-line antimicrobials were used as primary treatment in only 42.3%, 50.9% and 38.6% of dairy, beef and mixed-breed farms, respectively. Significant differences (p < 0.05) were observed between dairy and beef farms in terms of use of long-acting macrolides (-17.2 percentage points [pp]; 95% confidence interval [CI]: -31.9, -2.5), steroidal anti-inflammatory drugs (15.2 pp; CI: 0.5, 29.8) and vaccination coverage (bovine respiratory syncytial virus, parainfluenza virus type 3 [33.1 pp; Cl: 15.7-50.6] and Mannheimia haemolytica [23.1 pp; Cl: 3.4-39.8]).

LIMITATIONS

The herds that participated in this study were likely among the more motivated regarding BRD control. As such, the information on vaccination coverage is likely not entirely representative of herds in the study area. Interpretation is further complicated by the fact that vaccinated herds were potentially less likely to face a BRD outbreak and therefore participate in the current study.

CONCLUSION

This study reveals differences in the primary use of (N)SAIDs, type of antimicrobials used and vaccination coverage on beef and dairy farms in the study region, and also differences in the appropriateness of antimicrobial selection based on the Belgian formulary.

Comparison of two distinct arrival and treatment programs for bovine respiratory disease in high-risk feeder cattle entering a feedlot

Antimicrobial metaphylaxis of high-risk cattle entering the feedlot is a common management strategy implemented against bovine respiratory disease (BRD). Typically, following a prescribed postmetaphylactic interval (PMI), animals displaying clinical signs of BRD are pulled from the feedlot pen and treated with antimicrobials when treatment criteria are met. The objective of this study was to compare 2 distinct sequential BRD treatment protocols each consisting of a metaphylactic antimicrobial plus 2 potential subsequent as-needed treatment antimicrobials. Heifers at high-risk for BRD (n = 1000; initial BW = 229 kg ± 1.6) purchased from sale barns in the southeastern U.S. were transported to a contract research feedlot in Nebraska and randomly assigned to 1 of 2 experimental groups (10 blocks of 100 animals each; 50 per treatment group). Experimental groups consisted of: (1) tulathromycin metaphylaxis (2.5 mg/kg) followed by ceftiofur crystalline free acid (6.6 mg/kg) and danofloxacin (8 mg/kg) for subsequent first and second as-needed BRD treatment, respectively (TCD) or (2) tildipirosin metaphylaxis (4 mg/kg) followed by florfenicol-flunixin meglumine (40 mg/kg florfenicol; 2.2 mg/kg flunixin meglumine) and enrofloxacin (12.5 mg/kg) for subsequent first and second as-needed BRD treatment, respectively (TFFE). Following expiration of the 7-d PMI, calves that showed signs of clinical BRD were pulled and examined to determine if treatment was necessary based on a clinical attitude score (CAS). Heifers with a CAS of 1 accompanied by ≥40°C rectal temperature, and all heifers with a CAS ≥ 2 regardless of rectal temperature, received the appropriate first-treatment antimicrobial. Upon relapse, following expiration of the post-treatment interval (PTI), heifers received the appropriate second-treatment antimicrobial. In the first 90 d, calves in the TFFE experimental group received more first-treatments than calves in the TCD experimental group (P = 0.054) and resulted in 50% greater mortality (P < 0.043) relative to the TCD heifers. From d 0 to closeout, first-treatment morbidity as well as mortality were greater in TFFE relative to TCD (P ≤ 0.032). Growth performance did not differ between treatments in the first 90 d; however, ADG was greater (P = 0.033) and G:F improved (P = 0.014) at closeout in TCD versus TFFE on a deads-in basis. Closeout economics revealed a $50.78/animal greater profit in the TCD experimental group relative to TFFE.

Bovine Respiratory Disease Considerations in Young Dairy Calves

Raising young dairy calves presents many challenges for producers and veterinarians including losses attributable to BRD. This article will discuss several key concepts for practitioners to consider when applying evidence-based medicine for the control and treatment of BRD in young dairy calves. The authors review BRD complex, provide considerations for diagnostic approaches, and discuss research associated with the control and treatment of BRD.

Randomized field trial comparing the efficacy of florfenicol and oxytetracycline in a natural outbreak of calf pneumonia using lung reaeration as a cure criterion

Background

Respiratory infections are the main indication for antimicrobial use in calves. Optimal treatment duration currently is unknown, but shorter duration would likely decrease selection for antimicrobial resistance.

Hypothesis/Objectives

Determine differences in cure rate and healing time between animals treated with florfenicol and oxytetracycline in a natural outbreak of respiratory disease using reaeration observed on thoracic ultrasound examination as healing criterion.

Animals

Commercial farm housing 130, 3 to 9 month old Belgian blue beef calves.

Methods

Randomized clinical trial during an outbreak of respiratory disease. Metaphylactic treatment was initiated, randomly treating animals with either florfenicol or oxytetracycline. Ultrasonographic follow‐up was done the first day and every other day for a 14‐day period. At the individual animal level, treatment was discontinued when reaeration of the lungs occurred. Differences in cure rate and healing time were determined.

Results

Of the 130 animals studied, 67.7% developed a lung consolidation ≥0.5 cm. The mean ultrasonographic healing time was 2.5 days in the florfenicol group compared to 3.1 days in the oxytetracycline group (P = .04). After single treatment, 80.6% and 60.3% had no consolidations in the florfenicol and oxytetracycline groups, respectively (P = .01). A Mycoplasma bovis strain was genetically and phenotypically determined to be susceptible to both antimicrobials.

Conclusions and Clinical Importance

Ultrasonographic lung reaeration shows potential as a cure criterion to rationalize antimicrobial use for outbreaks of pneumonia. In our study, florfenicol resulted in a faster cure and higher reduction in antimicrobial usage than did oxytetracycline.

Treatment of bovine respiratory disease with a single administration of tulathromycin and ketoprofen

BACKGROUND

The therapeutic strategy of bovine respiratory disease (BRD) often involves a combination of an antibiotic with an anti-inflammatory agent. Aim of this study was to evaluate the clinical effect of a new combination product containing tulathromycin and ketoprofen for the treatment of naturally occurring BRD.

METHODS

Two hundred and eighty animals were randomized upon diagnosis of BRD. One hundred forty animals each were treated once subcutaneously with tulathromycin-ketoprofen or tulathromycin. Rectal temperature of each animal was measured at 1, 2, 4, 6, 8, 10, 12 and 24 h post-treatment. Individual respiration and depression scores were determined at 6 h post-treatment. Daily rectal temperature, respiration and depression scores were recorded from day 2 to 14 and on day 21.

RESULTS

The tulathromycin-ketoprofen and tulathromycin treatment group demonstrated a treatment success rate of 94.2% and 95.0%, respectively and a relapse rate of 3.8% and 4.0%, respectively. Tulathromycin-ketoprofen demonstrated superior pyrexia control compared to tulathromycin within the first 24 h following treatment. Tulathromycin-ketoprofen-treated animals demonstrated faster improvement of their clinical symptoms (respiration and depression score).

CONCLUSION

Efficacy of tulathromycin-ketoprofen for the treatment of BRD was non-inferior to tulathromycin. The combination product clearly exhibited more pronounced fever control than tulathromycin which is considered beneficial for animal welfare.

BRD treatment failure: clinical and pathologic considerations

In cattle treated for respiratory disease, resolution of clinical signs has been the mainstay of determining treatment response and treatment efficacy. Through the use of calf lung ultrasound, we have found that pneumonia can persist or recur in the face of antibiotic therapy, despite improved clinical signs, leading to greater risk of clinical disease and more antibiotic use in the future. This review will discuss the pros and cons of using clinical signs to define resolution of disease and discuss how to implement lung ultrasound to improve our ability to accurately measure the impact of antibiotic therapy in cattle with respiratory disease.

Comparison of a traditional bovine respiratory disease control regimen with a targeted program based upon individualized risk predictions generated by the Whisper On Arrival technology

The study objective was to determine if cattle health and performance comparing a targeted bovine respiratory disease (BRD) control program based on individualized risk prediction generated by a novel technology (Whisper On Arrival) was superior to a negative control (no metaphylaxis) yet no different than a positive control (conventional BRD control; 100% application). Across four study sites, auction market-derived beef calves were randomly allocated to one of four BRD control treatment groups: 1) Negative control (Saline), 2) Positive control (Tildipirosin [TIL] to 100% of the group), 3) Whisper-high (±TIL based on conservative algorithm threshold), and 4) Whisper-low (±TIL based on aggressive algorithm threshold). Within either Whisper On Arrival group, only calves predicted to be above the algorithm threshold by the technology (determined a priori) were administered TIL leaving the remainder untreated. Cattle were followed to either a short-term timepoint (50 or 60 d; health outcomes, all sites; feed performance outcomes, two sites) or to closeout (two sites). Data were analyzed as a completely randomized block design separately at each site. Across all sites, BRD control antibiotic use was reduced by 11% to 43% between the two Whisper On Arrival treatment groups compared to the positive control. The positive control and both Whisper On Arrival groups reduced (P ≤ 0.05) BRD morbidity compared to negative controls at both the short-term timepoint at three of the four sites and at closeout at one of two sites. The positive control and both Whisper-managed groups had improved (P ≤ 0.05) average daily gain (ADG), dry-matter intake (DMI), and feed efficiency compared to negative controls at the short-term timepoint at one of two sites. At closeout, the positive control and both Whisper-managed groups improved (P ≤ 0.05) ADG (deads-in) compared to the negative control at one of the two sites. At one of two sites, the positive control and the Whisper-high group displayed an improvement (P ≤ 0.05) in hot carcass weight compared to the negative control. The Whisper On Arrival technology maintained the benefits of a conventional BRD control program yet reduced BRD control antibiotic use by 11% to 43%. This technology maintained the benefits of a conventional BRD control program while reducing antibiotic costs to the producer and supporting judicious antimicrobial use.

A Pilot Study in Sweden on Efficacy of Benzylpenicillin, Oxytetracycline, and Florfenicol in Treatment of Acute Undifferentiated Respiratory Disease in Calves

Bovine respiratory disease (BRD) is a major indication for antibiotic treatment of cattle worldwide and some of the antibiotics used belong to classes of highest priority among those listed by WHO as critically important for human medicine. To preserve the efficacy of “newer” antibiotics, it has been suggested that “older” drugs should be revisited and used when possible. In this pilot study, we evaluated the efficacy of benzylpenicillin (PEN), oxytetracycline (OTC), and florfenicol (FLO) for treatment of naturally occurring BRD on two farms raising calves for slaughter. Farm personnel selected calves for enrolment, assigned calves to one of the three regimens in a systematically random manner, treated the calves, and registered the results. Overall, 117 calves were enrolled in the study. Nineteen calves relapsed in BRD before slaughter and were retreated (16.2%) and three died (2.6%). For PEN, treatment response rates after 30 days, 60 days, and until slaughter were 90.2%, 87.8%, and 80.5%, respectively; for OTC, 90.0%, 85.0%, and 85.0%, respectively; and for FLO, 86.1%, 83.3%, and 77.8%, respectively. There were no statistically significant differences in relapse, mortality, or response rates between the three treatment regimens. This indicates that PEN, OTC, and FLO were equally effective for treatment of BRD but the results need to be confirmed in a more elaborate study with a higher statistical power. The findings support the current recommendations from the Swedish Veterinary Association and the Medical Products Agency to use benzylpenicillin as a first line antibiotic for treatment of calves with undifferentiated respiratory disease in Sweden. Due to differences in the panorama of infectious agents and presence of acquired antibiotic resistance, the findings might not be applicable in other geographical areas.

Randomized clinical trial to assess the effect of antibiotic therapy on health and growth of preweaned dairy calves diagnosed with respiratory disease using respiratory scoring and lung ultrasound

The primary objective of this randomized field study was to assess the effect of antibiotic therapy on health and growth of preweaned dairy calves diagnosed with naturally occurring respiratory disease, using respiratory scoring and portable lung ultrasound. A secondary objective was to determine whether treatment response depended on clinical presentation at the time of diagnosis. Holstein calves (n = 357) were enrolled at 3 to 6 d of age and followed until 52 d on 2 commercial dairies. Calves were examined twice weekly by blinded members of the research team. Clinical respiratory and ultrasonographic lung scores were assigned at each exam and used to classify the first detected respiratory disease event (BRD1) into upper respiratory tract disease (clinical, no significant consolidation); subclinical lobular pneumonia (not clinical, patchy consolidation ≥1 cm²); clinical lobular pneumonia (clinical, patchy consolidation ≥1 cm²); subclinical lobar pneumonia (not clinical, ≥1 lobe consolidated); and clinical lobar pneumonia (clinical, ≥1 lobe consolidated). At BRD1, calves were blocked by their respiratory disease status and randomized to receive an antibiotic (tulathromycin, 2.5 mg/kg subcutaneous) or placebo (sterile saline, equal volume subcutaneous). Multivariable linear and logistic regression analyses were used to model response to therapy. At BRD1 (n = 289), the distribution of diagnoses was 29% (upper respiratory tract disease), 43% (subclinical lobular pneumonia), 13% (clinical lobular pneumonia), 8% (subclinical lobar pneumonia), and 7% (clinical lobar pneumonia). Early antibiotic therapy limited progression of lung consolidation immediately following treatment, reduced the likelihood of requiring treatment within 7 d of BRD1, and improved growth and mortality before weaning. Despite receiving multiple doses of antibiotics after BRD1, calves treated with either antibiotic or placebo were equally likely to enter the weaning phase with pneumonia. Clinical presentation was associated with response to treatment for worsening of consolidation, early treatment failure, days to retreatment, and average daily gain. Overall, treatment was associated with short-term benefits, but more research is needed to develop treatment protocols that more effectively treat pneumonia and ensure that calves enter the weaning period with ultrasonographically clean lungs.

Economic effects of policy options restricting antimicrobial use for high risk cattle placed in U.S. feedlots

The rising public health threat of antimicrobial resistance, the influence of food service companies, as well as the overall lack of positive image of using medical products in intensive farming are major drivers curbing antimicrobial use. In the future, government policies may affect practices of antimicrobial use in beef production in feedlots, a prominent current user of antimicrobials in animal agriculture, but also the agricultural industry generating the highest cash receipt in the U.S. Our objective was to estimate the cost effect from the following policies in feedlots: 1) using antimicrobials for disease prevention, control, and treatment; 2) using antimicrobials only for treatment of disease; and 3) not using antimicrobials for any reason. We modelled a typical U.S. feedlot, where high risk cattle may be afflicted by diseases requiring antimicrobial therapy, namely respiratory diseases, liver abscesses and lameness. We calculated the net revenue loss under each policy of antimicrobial use restriction. With moderate disease incidence, the median net revenue loss was $66 and $96 per animal entering the feedlot, for not using antimicrobials for disease prevention and control, or not using any antimicrobials, respectively, compared to using antimicrobials for disease prevention, control, and treatment. Losses arose mainly from an increase of fatality and morbidity rates, almost doubling for respiratory diseases in the case of antimicrobial use restrictions. In the case of antimicrobial use prohibition, decreasing the feeder cattle price by 9%, or alternatively, increasing the slaughter cattle price by 6.3%, would offset the net revenue losses for the feedlot operator. If no alternatives to antimicrobial therapy for prevention, control and treatment of current infectious diseases are implemented, policies that economically incentivize adoption of non-antimicrobial prevention and control strategies for infectious diseases would be necessary to maintain animal welfare and the profitability of beef production while simultaneously curbing antimicrobial use.

Prevalence and temporal trends in antimicrobial resistance of bovine respiratory disease pathogen isolates submitted to the Wisconsin Veterinary Diagnostic Laboratory: 2008-2017

The objective of this study was to describe the prevalence and trends in antimicrobial resistance for bacterial pathogens associated with bovine respiratory disease (BRD) isolated from samples submitted to the Wisconsin Veterinary Diagnostic Laboratory (WVDL). Data were retrospectively collected from bovine respiratory isolates including Pasteurella multocida, Mannheimia haemolytica, Histophilus somni, and Bibersteinia trehalosi identified at the WVDL between January 2008 and December 2017. Antimicrobial susceptibility testing data were queried from antimicrobial resistance databases at the WVDL. A total of 4,261 isolates were identified. Pasteurella multocida was most frequently identified, accounting for 2,094 isolates (49% of total) over the study period. Mannheimia haemolytica was the second most frequently isolated bacterial respiratory pathogen (n = 1,267, 30%) followed by H. somni (n = 749, 18%) and B. trehalosi (n = 151, 4%). Over the 10-yr period, B. trehalosi had the highest median percentage of isolates that were resistant to at least one antibiotic at 33% (interquartile range: 24, 47) followed by M. haemolytica (13%; 8, 23). For P. multocida, 10% (4, 26) of isolates were classified as resistant to at least one antibiotic, whereas H. somni had the fewest resistant isolates (9%; 3, 15). When comparing 2013-2017 to 2008-2012, the overall percentage of resistant isolates for P. multocida and B. trehalosi decreased, whereas the percentage of resistant isolates for M. haemolytica and H. somni increased. Increased resistance against florfenicol, fluoroquinolones, gentamicin, tilmicosin, and tulathromycin was observed for M. haemolytica. These data show that antimicrobial susceptibility for BRD bacterial pathogens has changed in the population served by the WVDL over this 10-yr period. For P. multocida, resistance is relatively low and has either improved or at least remained constant for the majority of drugs labeled for treatment of respiratory disease in dairy cattle. Veterinarians and producers should be aware of the bacterial pathogens most commonly associated with BRD and work toward early disease detection, proper antibiotic administration, and monitoring lung lesions to ensure that their treatment protocols improve lung health.

Monitoring Mycoplasma bovis Diversity and Antimicrobial Susceptibility in Calf Feedlots Undergoing a Respiratory Disease Outbreak

Bovine respiratory diseases (BRD) are widespread in veal calf feedlots. Several pathogens are implicated, both viruses and bacteria, one of which, Mycoplasma bovis, is under-researched. This worldwide-distributed bacterium has been shown to be highly resistant in vitro to the main antimicrobials used to treat BRD. Our objective was to monitor the relative prevalence of M. bovis during BRD episodes, its diversity, and its resistance phenotype in relation to antimicrobial use. For this purpose, a two-year longitudinal follow-up of 25 feedlots was organized and 537 nasal swabs were collected on 358 veal calves at their arrival in the lot, at the BRD peak and 4 weeks after collective antimicrobial treatments. The presence of M. bovis was assessed by real-time PCR and culture. The clones isolated were then subtyped (polC subtyping and PFGE analysis), and their susceptibility to five antimicrobials was determined. The course of the disease and the antimicrobials used had no influence on the genetic diversity of the M. bovis strains: The subtype distribution was the same throughout the BRD episode and similar to that already described in France, with a major narrowly-variable subtype circulating, st2. The same conclusion holds for antimicrobial resistance (AMR) phenotypes: All the clones were already multiresistant to the main antimicrobials used (except for fluoroquinolones) prior to any treatments. By contrast, changes of AMR phenotypes could be suspected for Pasteurellaceae in two cases in relation to the treatments registered.

Bovine Respiratory Disease Diagnosis: What Progress Has Been Made in Clinical Diagnosis?

Bovine respiratory disease (BRD) complex is a worldwide health problem in cattle and is a major reason for antimicrobial use in young cattle. Several challenges may explain why it is difficult to make progress in the management of this disease. This article defines the limitation of BRD complex nomenclature, which may not easily distinguish upper versus lower respiratory tract infection and infectious bronchopneumonia versus other types of respiratory diseases. It then discusses the obstacles to clinical diagnosis and reviews the current knowledge of readily available diagnostic test to reach a diagnosis of infectious bronchopneumonia.

Net return distributions when metaphylaxis is used to control bovine respiratory disease in high health-risk cattle

This study’s objective was to estimate net returns and return risk for antimicrobial metaphylaxis options to manage bovine respiratory disease (BRD) in high health-risk feedlot cattle. The effectiveness of antimicrobials for metaphylaxis varies by cattle population. How differing antimicrobial effectiveness translates to net return profitability for heterogeneous cattle populations is less understood. Net returns and return risk were assessed using a net return simulation model adapted to allow for heterogeneity in high health-risk cattle placement characteristics and antimicrobial choice to control BRD. The net return model incorporated how antimicrobials modify BRD health and performance outcomes. Health and performance outcomes were calibrated from published literature and proprietary feedlot data. Proprietary data came from 10 Midwestern feedlots representing nearly 6 million animals and 50,000 cohorts. Twelve placement-by-metaphylaxis decision combinations were assessed: high health-risk steer placement demographics were 600 or 800 lb steers placed in Winter (Oct–Mar) or Summer (Apr–Sept) managed with one of three different health programs: “no metaphylaxis,” “Upper Tier” antimicrobial, or “Lower Tier” antimicrobial. Net return distributions were compared between “no metaphylaxis” and a specific antimicrobial tier within specific cattle populations. We found the expected incremental net return of administering an “Upper Tier” (“Lower Tier”) antimicrobial for metaphylaxis compared to “no metaphylaxis” for high health-risk steers was $122.55 per head ($65.72) for 600 lb and $148.65 per head ($79.65) for 800 lb winter placements. The incremental expected net return and risk mitigated by metaphylaxis varied by placement weight, season, and antimicrobial choice. The probability net returns would decline by at least $50 per head was significantly reduced (from approximately 4% to 40%) when any antimicrobial was used on high health-risk steers. Both tiers of antimicrobials used for metaphylaxis increased expected net returns and decreased net return variability relative to no metaphylaxis. Thus, feedlots were more certain and realize a greater profit on high health-risk pens of steers when metaphylaxis was used. This occurred because the reduction in cattle health and performance outcomes using any antimicrobial was sufficiently large to cover added initial and subsequent antimicrobial costs. Results aid in assessing metaphylaxis strategies in high health-risk cattle.

How do veterinarians influence sales of antimicrobials? A spatial-temporal analysis of the French prescribing-delivery complex in cattle

BACKGROUND

In animal agriculture, antimicrobials (AM) are used to control infectious diseases whose incidence and severity vary across production systems, but may contribute to select AM resistant bacteria, potentially disseminating in humans. Antimicrobial resistance (AMR) represents a public threat, leading policymakers to implement measures to reduce antimicrobial use (AMU). Investigating AMU patterns at prescriber's level, beyond national AMU trends, enables evaluation of substitutions between AM classes (occurring when one product is replaced by another), or average consumption per production system. Our aim was to identify the influence veterinarians would exert on AMU by quantifying substitution between AM products prescribed and delivered in similar therapeutic indications, in cattle production.

METHODS

Monthly sales data on four critically important AM in five French areas (representative of production systems) were analysed from 2008 to 2013. We calculated the animal live weight receiving a treatment course and evaluated substitutions between brand-name and generic products, and between products from different AM classes with similar indications.

RESULTS

Substitutions occurred, between products of the same class (macrolides) with similar indications, between generic and brand-name products (fluoroquinolones, ceftiofur, florfenicol) and between innovative and brand-name products (marbofloxacin, ceftiofur). Innovative products reaching the market represented between 2% and 40% of the yearly sales for a given molecule, depending on the active ingredient and the area. The introduction of generic products of fluoroquinolones and ceftiofur led to a moderate adoption of the generic product at the expense of the brand-name one, unlike in human health care where the adoption reaches up to 80%.

CONCLUSION

Veterinary prescription remains a strong regulating power of AMU; substitutions only occurred for products with similar indications.

Genetic relatedness and antimicrobial resistance in respiratory bacteria from beef calves sampled from spring processing to 40 days after feedlot entry

Recent studies have shown an increase in antimicrobial-resistant bovine respiratory disease (BRD) pathogens. To investigate the origin of antimicrobial resistance in the respiratory microbiota of beef cattle, three groups (A, B, or C) of 40 calves sourced from different calf-ranches were sampled by deep nasopharyngeal swab (DNS) at the time of first on-ranch vaccination (Time point 1, T1), feedlot entry (Time point 2, T2), and 40 days after feedlot entry (Time point 3, T3; feedlots differed by group). Pasteurella multocida, Mannheimia haemolytica, and Histophilus somni were isolated from DNS samples, tested for antimicrobial susceptibility, and subtyped by pulsed-field gel electrophoresis (PFGE). Antimicrobial resistance genes [tet(H), tet(W), and sul2] were also quantified in DNS metagenomic DNA using PCR. Prevalence of calves positive for BRD pathogens differed among groups and time-points but P. multocida was the most prevalent (61% of calves positive, at least, at one timepoint), followed by M. haemolytica (48%) and H. somni (26%). Most M. haemolytica were susceptible to all antimicrobials (88.6%; n = 70). For P. multocida, the dominant resistance phenotype was against oxytetracycline and neomycin (35.8%). Resistant P. multocida isolates were mainly detected in group C at T3 and had the same PFGE profile. For H. somni, the dominant resistance phenotype was against neomycin (63.3%) and was only observed at T3. The abundance of tet(W) did not change significantly over time (P >  0.05). Abundances of tet(H) and sul2 only increased for group C at T3 (P <  0.05). Overall, this study showed that resistance in the respiratory microbiota of beef calves can increase from calf-ranch to feedlot however, the results can vary by calf-ranch and feedlot.

Effect of antibiotic treatment in preweaned Holstein calves after experimental bacterial challenge with Pasteurella multocida

The primary objective of this randomized controlled challenge study was to investigate the effect of ampicillin on ultrasonographic (US) lung consolidation after experimental challenge with Pasteurella multocida in preweaned dairy calves. The secondary objectives were to determine whether ampicillin affected respiratory score, gross consolidation, or the detection of P. multocida in lung tissue at postmortem exam (PME). Holstein bull calves (n = 39) were transported to the University of Wisconsin-Madison School of Veterinary Medicine isolation facility at the mean (±SD) age of 52 ± 6 d. After a 7-d acclimation period, 30 calves were inoculated intratracheally with 10¹⁰ cfu of ampicillin-sensitive P. multocida. Lung US and respiratory scoring were performed 2, 6, 12, and 24 h post-challenge, then US once daily and respiratory scoring twice daily until d 14. Calves were randomized to receive ampicillin [n = 17, treatment (TX), 6.6 mg/kg i.m. once daily for 3 d] or placebo [n = 11, control (CON), saline, equal volume, i.m. once daily for 3 d] when ≥1 cm² of lung consolidation was observed and ≥6 h had elapsed since challenge. Lung lesions ≥1 cm² were considered positive for consolidation. Calves were respiratory score positive if ≥2 in 2 or more categories based on the Wisconsin respiratory health score chart. Area under the curve (AUC) was calculated for US score and respiratory score as a proxy for time with consolidation and clinical respiratory disease, respectively. Gross lung lesions and pathogens were quantified following PME. At the time of first treatment, consolidation had developed in 28/30 calves (TX, n = 17; CON, n = 11) and 6% (1 out of 17) of TX and 9% (1 out of 11) of CON calves had a positive respiratory score. The TX calves had a significantly lower median (interquartile range given in parentheses) AUC for US score [TX: 23 (20, 29), CON: 47 (33, 53)], whereas mean AUC for respiratory score was not different between groups (TX: 93 ± 28, CON: 96 ± 17). On d 14, 70% (12 out of 17) of TX and 100% (11 out of 11) of CON calves had lung consolidation, and 24% (4 out of 17) of TX and 27% (3 out of 11) of CON calves had clinical respiratory disease. On PME, median consolidation was 10% (6, 15) for TX and 10% (2, 28) for CON calves. Lung cultures were positive for P. multocida in 77% (13 out of 17) of TX and 91% (10 out of 11) of CON calves. Lung health benefited from a 3-d ampicillin therapy, but benefits were short-lived. Treatment failures might be due to incomplete resolution of the initial lung infection. Future studies are needed to optimize TX strategies to improve long-term lung health.

Antimicrobial Policies in United States Beef Production: Choosing the Right Instruments to Reduce Antimicrobial Use and Resistance Under Structural and Market Constraints

Antimicrobial use (AMU) in animal agriculture contributes to the selection of resistant bacteria, potentially constituting a public health threat. To address antimicrobial resistance, public policies set by governments, as well as intra-sectoral approaches, can be implemented. In this paper, we explore how common policy instruments such as regulations, economic incentives, and voluntary agreements could help reduce AMU in beef production. We first describe the structure of the beef supply chain which directly influences the choice of policy instruments. We describe how externalities and imperfect information affect this system. We then discuss how five policy instruments would each perform to achieve a reduction in AMU. Bovine respiratory disease complex (BRD) represents the major driver of AMU in beef production; consequently, reducing its incidence would decrease significantly the amounts of antimicrobials administered. We consider control options for BRD at different stages of the beef supply chain.

Semi-Mechanistic Modeling of Florfenicol Time-Kill Curves and in silico Dose Fractionation for Calf Respiratory Pathogens

An important application of time-kill curve (TKC) assays is determination of the nature of the best PK/PD index (fAUC/MIC or fT% > MIC) and its target value for predicting clinical efficacy in vivo. VetCAST (the veterinary subcommittee of EUCAST) herein presents semi-mechanistic TKC modeling for florfenicol, a long acting (96 h) veterinary antimicrobial drug licensed against calf pneumonia organisms (Pasteurella multocida and Mannheimia haemolytica) to support justification of its PK/PDbreakpoint and clinical breakpoint. Individual TKC assays were performed with 6 field strains of each pathogen (initial inoculum 107 CFU/mL with sampling at times at 0, 1, 2, 4, 8, and 24 h). Semi-mechanistic modeling (Phoenix NLME) allowed precise estimation of bacteria growth system (KGROWTH, natural growth rate; KDEATH, death rate; BMAX, maximum possible culture size) and florfenicol pharmacodynamic parameters (EMAX, efficacy additive to KDEATH; EC50, potency; Gamma, sensitivity). PK/PD simulations (using the present TKC model and parameters of a florfenicol population pharmacokinetic model) predicted the time-course of bacterial counts under different exposures. Of two licensed dosage regimens, 40 mg/kg administered once was predicted to be superior to 20 mg/kg administered at 48 h intervals. Furthermore, we performed in silico dose fractionation with doses 0 - 80 mg/kg administered in 1, 2 or 4 administrations over 96 h and for MICs of 0.5, 1, 2, 4 mg/L with 2 inoculum sizes 105 and 107 CFU/mL. Regression analysis (Imax model) demonstrated that i) fAUC/MIC outperformed fT% > MIC as PK/PD index and ii) maximum efficacy (IC90%) was obtained when the average free plasma concentration over 96 h was equal to 1.2 to 1.4 times the MIC of Pasteurella multocida and Mannheimia haemolytica, respectively.

Optimization of Antimicrobial Treatment to Minimize Resistance Selection

Optimization of antimicrobial treatment is a cornerstone in the fight against antimicrobial resistance. Various national and international authorities and professional veterinary and farming associations have released generic guidelines on prudent antimicrobial use in animals. However, these generic guidelines need to be translated into a set of animal species- and disease-specific practice recommendations. This article focuses on prevention of antimicrobial resistance and its complex relationship with treatment efficacy, highlighting key situations where the current antimicrobial drug products, treatment recommendations, and practices may be insufficient to minimize antimicrobial selection. The authors address this topic using a multidisciplinary approach involving microbiology, pharmacology, clinical medicine, and animal husbandry. In the first part of the article, we define four key targets for implementing the concept of optimal antimicrobial treatment in veterinary practice: (i) reduction of overall antimicrobial consumption, (ii) improved use of diagnostic testing, (iii) prudent use of second-line, critically important antimicrobials, and (iv) optimization of dosage regimens. In the second part, we provided practice recommendations for achieving these four targets, with reference to specific conditions that account for most antimicrobial use in pigs (intestinal and respiratory disease), cattle (respiratory disease and mastitis), dogs and cats (skin, intestinal, genitourinary, and respiratory disease), and horses (upper respiratory disease, neonatal foal care, and surgical infections). Lastly, we present perspectives on the education and research needs for improving antimicrobial use in the future.

The reporting characteristics of bovine respiratory disease clinical intervention trials published prior to and following publication of the REFLECT statement

The goal of the REFLECT Statement (Reporting guidElines For randomized controLled trials in livEstoCk and food safeTy) (published in 2010) was to provide the veterinary research community with reporting guidelines tailored for randomized controlled trials for livestock and food safety. Our objective was to determine the prevalence of REFLECT Statement reporting of items 1-19 in controlled trials published in journals between 1970 and 2017 examining the comparative efficacy of FDA-registered antimicrobials against naturally acquired BRD (bovine respiratory disease) in weaned beef calves in Canada or the USA, and to compare the prevalence of reporting before and after 2010, when REFLECT was published. We divided REFLECT Statement, items 3, 5, 10, and 11 into subitems, because each dealt with multiple elements requiring separate assessment. As a result, 28 different items or subitems were evaluated independently. We searched MEDLINE^® and CABI (CAB Abstracts^® and Global Health^®) (Web of Science™) in April 2017 and screened 2327 references. Two reviewers independently assessed the reporting of each item and subitem. Ninety-five references were eligible for the study. The reporting of the REFLECT items showed a point estimate for the prevalence ratio >1 (i.e. a higher proportion of studies published post-2010 reported this item compared to studies published pre-2010), apart from items 10.3, i.e., item 10, subitem 3 (who assigned study units to the interventions), 13 (the flow of study units through the study), 16 (number of study units in analysis), 18 (multiplicity), and 19 (adverse effects). Fifty-three (79%) of 67 studies published before 2010 and all 28 (100%) papers published after 2010 reported using a random allocation method in either the title, abstract, or methods (Prevalence ratio = 1.25; 95% CI (1.09,1.43)). However, 8 studies published prior to 2010 and 7 studies published post-2010 reported the term "systematic randomization" or variations of this term (which is not true randomization) to describe the allocation procedure. Fifty-five percent (37/67) of studies published pre-2010 reported blinding status (blinded/not blinded) of outcome assessors, compared to 24/28 (86%) of studies published post-2010 (Prevalence ratio = 1.5, 95% CI (1.19, 2.02)). The reporting of recommended items in journal articles in this body of work is generally improving; however, there is also evidence of confusion about what constitutes a random allocation procedure, and this suggests an educational need. As this study is observational, this precludes concluding that the publication of the REFLECT Statement was the cause of this trend.

Injectable antimicrobials in commercial feedlot cattle and their effect on the nasopharyngeal microbiota and antimicrobial resistance

Beef cattle in North America that are deemed to be at high risk of developing bovine respiratory disease (BRD) are frequently administered a metaphylactic antibiotic injection to control the disease. Cattle may also receive in-feed antimicrobials to prevent specific diseases and ionophores to improve growth and feed efficiency. Presently, attempts to evaluate the effects that these medications have on antibiotic resistance in the bovine nasopharyngeal microbiota have been focused on culturable bacteria that are associated with BRD. Therefore, we assessed the effects of injectable antibiotics on the nasopharyngeal microbiota of commercial feedlot cattle in Alberta, Canada, through the first 60 d on feed. Although all cattle in the study were also receiving in-feed chlortetracycline and monensin, the administration of a single injection of either oxytetracycline or tulathromycin at feedlot placement altered the nasopharyngeal microbiota in comparison with the cattle receiving only in-feed antibiotics. Oxytetracycline significantly (P < 0.05) reduced the relative abundance of Mannheimia spp. from feedlot entry to exit (≥60 d) and both oxytetracycline and tulathromycin treated cattle had a significantly lower relative abundance of Mycoplasma spp. at feedlot exit compared with the in-feed antibiotic only group. The proportion of the tetracycline resistance gene tet(H) was significantly increased following oxytetracycline injection (P < 0.05). Oxytetracycline also reduced both the number of OTUs and the Shannon diversity index in the nasopharyngeal microbiota (P < 0.05). These results demonstrate that in feedlot cattle receiving subtherapeutic in-feed antimicrobials, the administration of a single injection of either oxytetracycline or tulathromycin resulted in measurable changes to the nasopharyngeal microbiota during the first 60 d following feedlot placement.

A mixed treatment comparison meta-analysis of metaphylaxis treatments for bovine respiratory disease in beef cattle

The objective of this project was to evaluate the effects of antimicrobials approved for parenteral metaphylactic use in feeder and stocker calves on morbidity and mortality for bovine respiratory disease with the use of a mixed treatment comparison meta-analysis. An initial literature review was conducted in April 2016 through Pubmed, Agricola, and CAB (Commonwealth Agricultural Bureau) for randomized controlled trials for metaphylaxis antimicrobial administered parentally to incoming feedlot or stocker calves within 48 h of arrival. The final list of publications included 29 studies, with a total of 37 trials. There were 8 different metaphylactic antimicrobials. Final event outcomes were categorized into bovine respiratory disease (BRD) morbidity cumulative incidence d 1 to ≤ 60 of the feeding period, BRD morbidity cumulative incidence d 1 to closeout of the feeding period, BRD mortality cumulative incidence d 1 to closeout of the feeding period, and BRD retreatment cumulative incidence morbidity d 1 to closeout of the feeding period. Network meta-analysis combined direct and indirect evidence for all the event outcomes to determine mean odds ratio (OR) with 95% credibility intervals (CrIs) for all metaphylactic antimicrobial comparisons. The "upper tier" treatment arms for morbidity d 1 to ≤ 60 included tulathromycin, gamithromycin, and tilmicosin. For BRD mortality cumulative incidence d 1 to closeout and BRD retreatment morbidity d 1 to closeout, classifying the treatment arms into tiers was not possible due to overlapping 95% CrIs. The results of this project accurately identified differences between metaphylactic antimicrobials, and metaphylactic antimicrobial options appear to offer different outcomes on BRD morbidity and mortality odds in feedlot cattle.

Clinical disease and lung lesions in calves experimentally inoculated with Histophilus somni five days after metaphylactic administration of tildipirosin or tulathromycin

OBJECTIVE

To compare clinical disease and lung lesions in calves experimentally inoculated with Histophilus somni 5 days after metaphylactic administration of tildipirosin or tulathromycin. ANIMALS Twenty-four 3-month-old Holstein and Holstein-crossbreed steers.

PROCEDURES

Calves were randomly allocated to 3 groups of 8 calves. On day 0, calves in group 1 received tildipirosin (4 mg/kg, SC), calves in group 2 received tulathromycin (2.5 mg/kg, SC), and calves in group 3 received isotonic saline (0.9% NaCl) solution (1 mL/45 kg, SC; control). On day 5, calves were inoculated with 10 mL of a solution containing H somni strain 7735 (1.6 × 10(9) CFUs/mL, intrabronchially; challenge). Calves were clinically evaluated on days 5 through 8 and euthanized on day 8. The lungs were grossly evaluated for evidence of pneumonia, and bronchial secretion samples underwent bacteriologic culture.

RESULTS

The mean clinical score for each group was significantly increased 12 hours after challenge, compared with that immediately before challenge, and was significantly lower for tildipirosin-treated calves on days 6, 7, and 8, compared with those for tulathromycin-treated and control calves. The mean percentage of lung consolidation for tildipirosin-treated calves was significantly lower than those for tulathromycin-treated and control calves. Histophilus somni was isolated from the bronchial secretions of some tulathromycin-treated and control calves but was not isolated from tildipirosin-treated calves.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that metaphylactic administration of tildipirosin to calves 5 days prior to H somni challenge prevented subsequent culture of the pathogen from bronchial secretions and was more effective in minimizing clinical disease and lung lesions than was metaphylactic administration of tulathromycin.

A mixed treatment meta-analysis of antibiotic treatment options for bovine respiratory disease - An update

Bovine respiratory disease is the most economically important disease of feedlot cattle in North America. Choice of antibiotic is a critical factor for producers and veterinarians. We previously published a mixed-treatment comparison meta-analysis that combined evidence from published trials and published estimates of comparative efficacy for 12 antibiotics registered for use in the USA. Some of the comparative efficacy estimates were based only on indirect evidence. Since the original review was published, new studies that provide direct evidence of comparative efficacy have been published. We updated the original review to include the current evidence. We also compared the results from the indirect estimates from the prior model with the observed results from randomized control trials. We repeated the original search and found that five of the new studies met the criteria for inclusion in the updated review. Four of these studies provided new data on direct comparisons of active drugs. The results from one study (performed in 2002) that compared ceftiofur pinna and enrofloxacin were inconsistent with the network and were excluded from the analysis. Three new direct comparison studies examined gamithromycin compared with tulathromycin, florfenicol, and tilmicosin. The results of our analysis suggested that the indirect estimates from the prior model provided reasonable estimates of the risk ratios revealed by the primary studies. For example, for the comparison of gamithromycin (referent) with tulathromycin, the original model predicted a risk ratio of re-treatment of 0.54 (95% credible interval 0.27-0.87). The subsequent randomized controlled trial revealed that the observed risk ratio of re-treatment was 0.59 (95% confidence interval 0.45-0.78). The results of other comparisons were also similar. For the gamithromycin (referent) to florfenicol comparison, the observed randomized trial RR was 1.17 (95% confidence interval 0.83-1.64) and the indirect estimate of RR from the prior model was 0.84 (95% credibility interval 0.48-1.3). The gamithromycin to tilmicosin (referent) observed RR from the randomized trial was 0.99 (95% confidence interval 0.67-1.47) and the indirect estimate of RR from the prior model was 1.09 (95% credible interval 0.64-1.79). The results suggested that indirect estimates provided reasonable estimates of RR when direct data were not available.

Feedlot Pharmaceutical Documentation: Protocols, Prescriptions, and Veterinary Feed Directives

The days of oral treatment instructions and loosely associated authorizations for the use of drugs in food animals are gone. Treatment protocols should include case definitions for treatment eligibility, detailed regimens, case definitions for treatment success and failure, directions for animal disposition, and mechanisms to prevent animals entering the food chain with violative residues. Prescriptions and veterinary feed directives (VFDs) will soon be necessary for almost all uses of antimicrobials in food animals. Although VFDs have a regulatory format, prescriptions may vary, but there are basic inclusions that should be present in any prescription.