Antimicrobial Stewardship in Livestock: Welfare and Resistance

The Dual Imperative: Animal Welfare and Antibiotic Stewardship

Antimicrobial stewardship — the responsible use of antibiotics to preserve their effectiveness — sits at the intersection of animal welfare and public health. Used appropriately, antibiotics save animal lives and reduce suffering from bacterial disease. Used inappropriately — routinely, prophylactically, or as substitutes for good management — they contribute to antimicrobial resistance (AMR), threatening both animal and human medicine. Responsible stewardship is not about withholding treatment from sick animals; it is about ensuring antibiotics are used when genuinely needed, with the right drug, at the right dose, for the right duration.

The Animal Welfare Case for Stewardship

A common misperception frames stewardship as being in tension with animal welfare — that using fewer antibiotics means treating fewer sick animals. In reality, good stewardship and good welfare are strongly aligned:

Reducing disease incidence (through better biosecurity, housing, nutrition, and management) reduces both suffering and antibiotic need simultaneously
Appropriate use means treating sick animals promptly and effectively — not withholding treatment
AMR means antibiotics failing when animals genuinely need them — this is a welfare catastrophe
Proactive health planning (VHPs, vaccination, disease prevention) reduces the disease burden that drives antibiotic use

UK Antibiotic Use in Livestock: Current Context

The UK has achieved significant reductions in veterinary antibiotic use since 2014:

Total antibiotic sales for food-producing animals fell by 55% between 2014 and 2022
Critically important antibiotic use reduced dramatically — colistin use fell by >95%
UK is one of the lowest users of antibiotics in food-producing animals in Europe
RUMA Targets Task Force coordinates sector-specific reduction targets across pig, poultry, cattle, and sheep sectors

Responsible Use Principles (RUMA Framework)

Diagnose before treating: Use antibiotics only when bacterial infection is confirmed or strongly suspected
Choose the right antibiotic: Narrow-spectrum agents preferred where appropriate; critically important antibiotics reserved for cases where no alternative exists
Use the right dose and duration: Underdosing promotes resistance; overdosing wastes resources and increases residue risk
Record all use: NOAH Compendium and Medicine Book recording requirements; essential for benchmarking and audit
Address root causes: Recurring disease requiring repeated antibiotic treatment signals a management problem, not just an antibiotic need

Critically Important Antibiotics: Priority Restrictions

Some antibiotics are designated as Critically Important Antibiotics (CIAs) for human medicine (WHO categorisation). These require particular stewardship discipline in veterinary use:

Fluoroquinolones: Should only be used based on sensitivity testing where other options have failed
Third and fourth generation cephalosporins: Reserved for life-threatening infections; not for routine use
Colistin: UK use now extremely restricted; only under veterinary prescription for specific indications
Macrolides: Use with care; sensitivity testing recommended before use

Disease Prevention as Stewardship

The most effective stewardship strategy is reducing disease incidence:

Vaccination programmes reducing disease pressure and antibiotic demand
Biosecurity preventing disease introduction
Nutrition and housing improvements reducing metabolic and respiratory disease
Early diagnosis tools (pen-side diagnostics) enabling targeted treatment
Targeted selective treatment (TST) in parasite management — treating only animals that need it