Understanding current practice in the use of antimicrobials in livestock farming and informing interventions to reduce antimicrobial resistance

bjectives: This research sought to:
 provide evidence-based analysis of how and why antimicrobials (AMs) are prescribed and used in livestock systems,
 explore the extent to which farmers, veterinarians and key actors are aware of the issue of antimicrobial resistance (AMR),
 identify how awareness becomes embedded in and through social positions and social practice,
 inform future AM interventions in the livestock sector.
Current AM uses in livestock were investigated, focusing upon the interfaces between farming, food production, veterinary and advisory practices as a basis for understanding how changes to these practices might be achieved.
Materials and Methods: A combination of three different yet inter-linked methodological approaches were used:
 A Rapid Evidence Assessment (REA) was undertaken, drawing upon an initial database search of over 4,500 published and unpublished works, narrowed down to 31 papers from which a detailed comparative assessment was generated. The REA also served to contextualise the subsequent empirical research.
 AQ-sortandanalysiswasdevelopedasameanstointerrogateview points and value positions with respect to AM use and related issues (such as animal welfare, public health and governance).
 Qualitative, semi-structured interviews with selected farmers, veterinarians and key actors across the poultry, pig and dairy livestock sectors were undertaken. For each sector, five farmers (at least one of which in each sector was organic) and three vets were interviewed (on farm or in practice). Additionally, interviews were held with a number of key actors from the professional bodies, the food sector and assurance/certification bodies. In total, 32 individual interviews were undertaken. The transcribed interviews were subsequently analysed for common and contradictory themes, for specific examples of practice, for relevant statements that would support identified common positions and for an understanding of the range of practices within which the use and prescription of AMs constituted a regular (or irregular) component.
The REA, Q-sort and qualitative research were then bought together to draw up a series of specific policy-informing messages.
Results: Four evidence categories emerged from the REA: on the volumes/dosage and application of AMs in farming systems, on vet prescription practice in different countries, on farmer attitudes towards AM use and on questions of data and recording of AM use.
The Q-sort suggested there were significant shared values as well as differences across the livestock sectors and across personnel and professions. Shared positions included a relative disdain for the risks posed by farming to AMR in the wider environment and a tendency to underplay the importance of the livestock sector’s contribution to AMR as a human health issue. There were three broad positions that vets and farmers tended to take:
 The Modern Business approach - antibiotics are already being phased out through modern farming methods which prioritise hygiene, health planning and herd management; AM use is already appropriate and under control.
 The Interventionist - changes in AM use can be brought about through better farmer education and a veterinary-led understanding of the issue. This position is most amenable to making changes in AM use in livestock.
The Autonomist - there is a fear that over-zealous regulation or outside influence will lead to inappropriate restrictions and further erode the viability of farming.
These responses suggest the best hope for behavioural change towards more appropriate use is to work with farmers and vets rather than regulate in a top-down fashion.
The qualitative research, by focusing on key actors and allowing them to drive the discussion, enabled deeper insight into these positions.
Conclusions: AMs are seen as a tool in maintaining health of farm animals - the key issue is their inappropriate use. Principal areas of concern:
 prophylactic and metaphylactic use
 use to treat conditions not caused by sensitive microorganisms
 unnecessary use of later generation AMs
 over-dependence on medicines as a replacement for health management, and
 incorrect dosage
Targeting these areas is a priority, though achieving change requires more than awareness. Changes can be both facilitated and constrained by existing social and practical relationships. Governance of AMs will require a mixture of regulation and responsible action by the industry.