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Who Guidelines on Use of Medically Important Antimicrobials in Food-Producing Animals

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Who Guidelines on Use of Medically Important Antimicrobials in Food-Producing Animals WHO GUIDELINES ON USE OF MEDICALLY IMPORTANT ANTIMICROBIALS IN FOOD-PRODUCING ANIMALS WHO GUIDELINES ON USE OF MEDICALLY IMPORTANT ANTIMICROBIALS IN FOOD-PRODUCING ANIMALS WHO guidelines on use of medically important antimicrobials in food-producing animals ISBN 978-92-4-155013-0 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. WHO guidelines on use of medically important antimicrobials in food-producing animals. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design and layout: Blossoming.it CONTENTS Acknowledgements v Overall coordination vi Funding vi Acronyms and abbreviations vii Glossary of terms ix Executive summary xi Background 1 Methods 9 Recommendations and best practice statements 13 Recommendation 1: Overall antimicrobial use 14 Recommendation 2: Growth promotion use 16 Recommendation 3: Prevention use (in the absence of disease) 18 Recommendation(s) 4: Control and treatment use (in the presence of disease) 20 Best practice statement 1 22 Best practice statement 2 22 Contributors and their role in the development of these guidelines 23 Dissemination and implementation of these guidelines 27 Research gaps 29 Updating these guidelines 31 References 33 Contents iii Annex 1. External experts and WHO staff involved in development of these guidelines 37 Annex 2. Summary and management of declared interests 43 Annex 3. Critical and important outcomes for decision-making 47 Annex 4. Summaries of systematic reviews including supplementary report 53 Annex 5. Summaries of the narrative literature reviews 59 Annex 6. Recommendations and summary of the judgments of the guideline development group of the criteria related to the strength of the recommendations for each intervention 65 Web Annex A. Evidence base (WHO/NMH/FOS/FZD/17.2; available at: http://apps.who.int/iris/bitstream/10665/259241/1/WHO-NMH-FOS- FZD-17.2-eng.pdf) Web Annex B. From evidence to recommendations (WHO/NHM/FOS/FZD/17.3; available at: http://apps.who.int/iris/bitstream/10665/259242/1/WHO-NMH-FOS- FZD-17.3-eng.pdf) iv WHO guidelines on use of medically important antimicrobials in food-producing animals ACKNOWLEDGEMENTS The World Health Organization (WHO) would like provided a narrative literature review on to thank the many individuals who contributed to biological plausibility for associations between these guidelines,1 especially Hanan Balkhy, Peter antimicrobial use in food-producing animals Collignon, John Conly, Cindy Friedman, Aidan Hollis, and increased risks of human exposures to, Samuel Kariuki, Hyo-Sun Kwak, Scott McEwen, and infections by, antimicrobial-resistant Gérard Moulin, Antoinette Ngandjio, Bernard zoonotic pathogens. John Conly and Mauricio Rollin, Flavia Rossi, and David Wallinga who served Ferri served as Grading of Recommendations as members of the Guideline Development Group Assessment, Development and Evaluation (GDG); Peter Collignon for serving as Chair at the (GRADE) methodologists, and prepared the first GDG meeting in October 2016; and to both evidence profiles tables, summary-of-findings Scott McEwen and Peter Collignon for serving tables, narrative evidence summaries, and the as Co-Chairs at the second GDG meeting in outcomes and ratings questionnaire. Special March 2017. WHO appreciates the contribution thanks go to Frederick Angulo for providing of participants at the February 2016 guidelines technical supports to WHO secretariat scoping meeting, including members of the WHO throughout the development of these Advisory Group of Integrated Surveillance for guidelines. Antimicrobial Resistance (AGISAR). Additional thanks go to the external review Several groups and individuals gathered and group, which included Saeed Murie Al-Shahrani, presented evidence that the GDG considered Casey Barton Behravesh, Delia Grace, Dik in the development of these guidelines. Two Mevius, Paturkar Ashish Motiram, Hnin Thidar research teams, one at Bond University in Myint, Langelihle Simela, Linda Tollefson, Jan Australia, led by Chris Del Mar, and the other L. M. Vaarten, Haruo Watanabe, and Khadija Id at the University of Calgary in Canada, led by Sidi Yahia. William Ghali, conducted systematic reviews on the effects of restrictions on the use in WHO also acknowledges the contributions of food-producing animals of medically important WHO Steering Group as well as contributions of antimicrobials on antimicrobial resistance Henk Jan Ormel from the Food and Agriculture in bacteria isolated from food-producing Organization of the United Nations (FAO) animals and humans. Hattie Webb conducted and Elisabeth Erlacher-Vindel of the World a narrative literature review on transfer of Organisation for Animal Health (OIE), who served antimicrobial resistance determinants from as special members of the WHO Steering Group. food-producing animals to humans. Scott McEwen led a narrative literature review Assistance and guidance was provided by on the potential unintended consequences Susan Norris of the secretariat of the WHO associated with restrictions on antimicrobial Guidelines Review Committee throughout the use in food-producing animals. Ellen Silbergeld development and finalization of the guidelines. 1 A full list of contributors is included as Annex 1. Annex 2 includes a summary of the declared interests and thier management. Acknowledgements v Overall coordination The work to develop these guidelines coordination of Awa Aidara-Kane, with the was initiated by the Department of Food support of Yuki Minato. Safety and Zoonoses of the WHO under the Funding The Governments of Japan and the not influence the development or content of Netherlands provided financial support for these guidelines. this work. The views of the funding bodies did vi WHO guidelines on use of medically important antimicrobials in food-producing animals ACRONYMS AND ABBREVIATIONS AFRO WHO Regional Office for Africa AGISAR WHO Advisory Group on Integrated Surveillance for Antimicrobial Resistance AMRO WHO Regional Office for the Americas CINAHL Cumulative Index to Nursing and Allied Health Literature COI Conflict of Interest DOI Declaration of Interest EMBASE Excerpta Medica database EMRO WHO Regional Office for the Eastern Mediterranean ERG External Review Group EURO WHO Regional Office for Europe FAO Food and Agriculture Organization of the United Nations FERG Foodborne Diseases Epidemiology Reference Group GDG Guideline Development Group GRADE Grading of Recommendations Assessment, Development and Evaluation GREAT Guideline-driven Research Priorities Evidence Synthesis Application of Evidence Transfer of Knowledge IndMED Indexing
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