Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
IHAP, Université de Toulouse, INRA, ENVT, Toulouse, France.
J Antimicrob Chemother. 2020 Jul 1;75(7):1671-1680. doi: 10.1093/jac/dkaa104.
Among the measures taken to preserve the clinical efficacy of highest priority critically important antimicrobials (HP-CIAs), the WHO has recommended avoiding their use in food-producing animals. Little is known regarding the indications for which different antimicrobial classes are used in animals, even in countries where data on antimicrobial use are available.
To outline, in a narrative review, the diseases for which HP-CIAs are used in veterinary medicine, highlighting incongruences with international guidelines and disease conditions where effective alternatives to HP-CIAs are missing.
Scientific literature, national reports and expert opinion were used to describe the indications for the use of HP-CIAs in the main food-producing (pigs, cattle and poultry) and companion (horses, dogs and cats) animal species.
The most common indications for use of HP-CIAs are enteric and respiratory infections in pigs, cattle and poultry, urogenital infections in dogs and cats and respiratory infections in horses. In some instances, no valid and convenient alternatives to colistin and macrolides are available against certain porcine enteric and bovine respiratory pathogens. Effective, legal and convenient alternatives to HP-CIAs are also lacking for managing common infections in cats, for which oral administration is difficult, Rhodococcus equi infections in horses, some enteric and respiratory infections in poultry and MDR infections in all companion animal species.
Future research and stewardship programmes should focus on the disease conditions identified by this review to reduce the use of HP-CIAs in the veterinary sector.
为了保持高度优先的关键抗菌药物（HP-CIAs）的临床疗效，世界卫生组织（WHO）建议避免在食用动物中使用这些药物。即使在有抗菌药物使用数据的国家，对于不同抗菌药物类别在动物中使用的适应症也知之甚少。
通过叙述性综述概述 HP-CIAs 在兽医中的用途，重点介绍与国际指南的不一致之处，以及缺乏有效替代 HP-CIAs 的疾病情况。
使用科学文献、国家报告和专家意见，描述 HP-CIAs 在主要食用（猪、牛和家禽）和伴侣（马、狗和猫）动物物种中的使用适应症。
HP-CIAs 最常见的使用适应症是猪、牛和家禽的肠内和呼吸道感染、犬和猫的泌尿生殖道感染以及马的呼吸道感染。在某些情况下，针对某些猪肠内和牛呼吸道病原体，没有有效的、方便的多粘菌素和大环内酯类替代品。对于管理猫的常见感染，口服给药困难，马的罗霍氏球菌感染，家禽的某些肠内和呼吸道感染以及所有伴侣动物物种的多药耐药感染，也缺乏有效的、合法的和方便的 HP-CIAs 替代品。
未来的研究和管理计划应重点关注本综述确定的疾病情况，以减少兽医部门对 HP-CIAs 的使用。
