What Constitutes Critically Important Antimicrobials?

What Constitutes Critically Important Antimicrobials?

Author: Michael Priestley
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There is growing agreement in animal agriculture that antimicrobials that are Critically Important to human medicine – or CIAs - should be treated as a special category when finding ways to tackle the threat of antimicrobial resistance. However, there are some differences in the current categorisation of CIAs between the World Health Organisation (WHO), the World Organisation for Animal Health (OIE) and the US Food and Drug Administration (FDA), which can lead to confusion over the exact meaning of the term ‘critically important.’

To help with the challenge of agreeing a common understanding of the term ‘Critically Important Antimicrobials (CIA)’ for the industry, agricultural research and science group FAI Farms have developed a diagram showing the breakdown of the classes of antibiotics ranked as ‘critically important’ by WHO, OIE and the FDA. The diagram also includes WHO sub-group categorization of CIAs as ‘highest priority critically important’ agents. There are three classes of antimicrobial agents that all the groups place at highest priority: fluoroquinolones, 3rd and 4th generation cephalosporins and macrolides.

Classes of Antibiotics

FAI Farms promotes the “3Rs framework” of Replace, Reduce, Refine, to help drive responsible use of antimicrobials in animal agriculture. Laura Higham, Veterinary Surgeon at FAI Farms said, “The 3Rs framework offers an opportunity for farmers and producers to take leadership in shaping the direction of what constitutes responsible use and stewardship of antibiotics in the context of food-producing animals. We must take responsibility to preserve the effectiveness of all antibiotics for the benefit of people, animals and the environment, but CIAs may warrant particular scrutiny as the vital medicines that are used in both human and animal healthcare."

Some argue that CIAs should be banned from use in food-producing animals, while others are concerned that a complete ban would significantly limit options for some disease treatments and that potential consequences could include treatment failures with associated welfare and productivity costs. A compromise may need to be made to make use of CIAs the last resort treatment option, with the inclusion of additional steps to ensure their responsible use.

Please see the complete lists of critical antibiotics at the links below:

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