1. Appropriate Use of Antibiotics A Veterinary Curriculum and Other Educational Activities Jennifer Nunnery, DVM ATPM Fellow FoodNet/NARMS Unit Foodborne and Diarrheal Diseases Branch Centers for Disease Control and Prevention

2. CDC Educational Activities to Combat Antimicrobial Resistance 1. Activities to Prevent Antibiotic Resistance in Foodborne Pathogens 2. Campaign for Appropriate Antibiotic Use in Healthcare Settings 3. Campaign for Appropriate Antibiotic Use in the Community

3. Activities to Prevent Antibiotic Resistance in Foodborne Pathogens A. Veterinary School Curriculum promoting appropriate use of antibiotics. B. Co-operative agreements with 4 colleges of veterinary medicine – projects demonstrating appropriate use of antibiotics. C. State based intervention in Michigan to promote the appropriate use of antibiotics.

4. Why a veterinary curriculum?

5. An Emerging Threat “The emergence and spread of antimicrobial resistance increasingly threatens the success of infectious disease treatment and prevention in the 21 st century.” -- WHO Global Strategy for Containment of Antimicrobial Resistance “The emergence and spread of antimicrobial resistance increasingly threatens the success of infectious disease treatment and prevention in the 21 st century.” -- WHO Global Strategy for Containment of Antimicrobial Resistance

7. WHO Global Strategy for Containment of Antimicrobial Resistance Several strategies, including: Several strategies, including: WHO Global Principles for the Containment of Antimicrobial Resistance in Animals Intended for Food - Geneva Switzerland – June 5-9, 2000 - http://www.who.int/emc http://www.who.int/emc INTERNATIONAL

8. WHO Global Principles for the Containment of Antimicrobial Resistance in Animals Intended for Food “Purpose “Purpose To minimize the negative public health impact of the use of antimicrobial agents in food-producing animals whilst at the same time providing for their safe and effective use in veterinary medicine.”

9. Education and Training – WHO “Veterinary…education should be evaluated to ensure that preventive medicine, prudent antimicrobial use and antimicrobial resistance are given high priority.” “Veterinary…education should be evaluated to ensure that preventive medicine, prudent antimicrobial use and antimicrobial resistance are given high priority.” WHO Global Principles for the Containment of Antimicrobial Resistance in Animals Intended for Food

10. Veterinary School Curriculum CDC funded coordinator. CDC funded coordinator. Subject matter experts from the academic veterinary community. Subject matter experts from the academic veterinary community. Web based technology for case-based individual or group study. Web based technology for case-based individual or group study. Pre/post test evaluation. Pre/post test evaluation.

11. Topics To Be Addressed Overview of antimicrobial resistance as an emerging and global problem Overview of antimicrobial resistance as an emerging and global problem Human health consequences of agricultural use of antimicrobial agents Human health consequences of agricultural use of antimicrobial agents Antibiotic classes, mechanisms of resistance Antibiotic classes, mechanisms of resistance Epidemiology and control strategies Epidemiology and control strategies Tools: antibiograms, culture&sensitivity, etc. Tools: antibiograms, culture&sensitivity, etc.

12. Topics cont. Species specific judicious use principles Species specific judicious use principles Client education Client education Prophylactic and disease prevention antimicrobial use Prophylactic and disease prevention antimicrobial use Growth promotion antimicrobial use Growth promotion antimicrobial use

13. Veterinary Community Consultation American Association of Veterinary Medical Colleges – Lawrence Heider American Association of Veterinary Medical Colleges – Lawrence Heider Deans – Lonnie King, Michigan State; Michael Blackwell, Tennessee Deans – Lonnie King, Michigan State; Michael Blackwell, Tennessee American Association of Veterinary Teachers for Public Health and Preventive Medicine (Now AVEPH) American Association of Veterinary Teachers for Public Health and Preventive Medicine (Now AVEPH)

14. Consultation cont. American Association of Bovine Practitioners American Association of Bovine Practitioners American Veterinary Medical Association- Steering Committee on Antimicrobial Resistance American Veterinary Medical Association- Steering Committee on Antimicrobial Resistance Deans/Academicians at AAVMC Agenda For Action Meeting Deans/Academicians at AAVMC Agenda For Action Meeting Pork Board Pork Board AVMA Leadership and CVM Deans at CDC meeting AVMA Leadership and CVM Deans at CDC meeting

15. Other Activities to Prevent Antibiotic Resistance in Foodborne Pathogens A. Co-operative agreements with 4 colleges of veterinary medicine – projects demonstrating appropriate use of antibiotics. B. State based intervention in Michigan to promote the appropriate use of antibiotics.

16. A.Co-operative agreements with four colleges of veterinary medicine Projects demonstrating appropriate use of antibiotics. Projects demonstrating appropriate use of antibiotics. Michigan State University, University of California, Davis – Dairy cow/calf operations Michigan State University, University of California, Davis – Dairy cow/calf operations Tufts, Ohio State – Swine production Tufts, Ohio State – Swine production

17. B. State based intervention in Michigan to promote the appropriate use of antibiotics. ELC Grant through Michigan Department of Health supporting PhD student at Michigan State University CVM. ELC Grant through Michigan Department of Health supporting PhD student at Michigan State University CVM. James Averill, DVM James Averill, DVM