Dr. Katie Hope - What Do We Do With The Numbers?
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What Do We Do With The Numbers? - Dr. Katie Hope, Graduate Research Assistant, Kansas State University, College of Veterinary Medicine, from the 2018 NIAA Antibiotic Symposium: New Science & Technology Tools for Antibiotic Stewardship, November 13-15, 2018, Overland Park, KS, USA. More presentations at https://www.youtube.com/playlist?list=PL8ZKJKD9cmEffjOrjbBvQZeN2_SZB_Skc
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Dr. Katie Hope - What Do We Do With The Numbers?
- 1. WHAT DO WE DO WITH THE NUMBERS? KATIE HOPE, DVM
- 2. FDA COOPERATIVE AGREEMENTS Michael Apley DVM, PhD, DACVCP Sandra Godden DVM, DVSc Peter Davies BVSc, PhD Randall Singer DVM, PhD, MPVM
- 3. PROJECT OVERVIEW No requirements on size (number of cattle fed out/year) No requirements on record system types Types of Systems Sales data On farm management software Data from an intermediary management group
- 4. Capturing Use Data Granular Coupled to cause Accurate Current Historical Not coupled to cause Approximate Aggregate What we would like… We would really rather not… Easy Resource intensive Enables benchmarking Unable to benchmark
- 5. Capturing Use Data Granular Coupled to cause Accurate Current Historical Not coupled to cause Approximate Aggregate Reality… Easy Resource intensive Enables benchmarking Unable to benchmark
- 6. Individual Animal or Herd/Flock Records Individual Animal or Herd/Flock Records What would you like to know? Amount used…. Duration used…. Number of animals exposed…. Sales Data Individual Animal or Herd/Flock Records Regimen Estimates and sales data Regimen Estimates and sales data
- 7. OPTIMIZATION OF DISEASE PREVENTION Best way to optimize disease treatment…. Not having to use the antimicrobial in the first place
- 8. 2. Non – Antibiotic Alternative? 4. How can we prevent this disease? 1. Disease Diagnosis 5. Do we still need this drug? While asking . . . Enter … Thenask.. . Yes . . . 3. Choose appropriate drug STOP STOP YES?
- 10. Live Weight Number Treated Number At Risk Meat or Milk (kg) Calendar Day/Year Production Cycles DRUG MEASUREMENT OPTIONS Animals Treated (# Regimens or #CD) Days Therapy (# daily doses) Drug Cost Drug (mg or mol) Live Weight Number Treated Number At Risk
- 11. DESCRIBE REGIMENS Drug Product Amount Administrations Interval Route
- 12. Drug Product Amount per Administrations Number of Administrations Interval of Administrations Route Tulathromyci n 800 mg One 0 hours SQ Ceftiofur 700 mg Three 24 hours SQ Ceftiofur 700 mg Two 72 hours SQ Total: 800 Mg
- 13. Drug Product Amount per Administrations Number of Administrations Interval of Administrations Route Tulathromyci n 800 mg One 0 hours SQ Ceftiofur 700 mg Three 24 hours SQ Ceftiofur 700 mg Two 72 hours SQ Total: 2100 Mg
- 14. Drug Product Amount per Administrations Number of Administrations Interval of Administrations Route Tulathromyci n 800 mg One 0 hours SQ Ceftiofur 700 mg Three 24 hours SQ Ceftiofur 700 mg Two 72 hours SQ Total: 1400 Mg
- 15. fruit What does “Total mg” mean?
- 16. SELECTION PRESSURE Drug Substance, class, number of molecules Amount Dose (high vs low) Total dose given (multiple low doses, a few high doses) Interval Total time Number of exposures Route Oral, injectable, dermal
- 17. “If you think you understand antimicrobial resistance, it has not been adequately explained to you.”
- 18. Individual Animal or Herd/Flock Records Individual Animal or Herd/Flock Records What would you like to know? Amount used…. Duration used…. Number of animals exposed…. Sales Data Individual Animal or Herd/Flock Records Regimen Estimates and sales data Regimen Estimates and sales data
- 19. OTHER CONCERNS What question is being asked? Resistance development Animals and humans Improving management, nutrition, genetics, education, etc Decrease need for antimicrobial use
- 20. Antimicrobial use monitoring without considering animal health is nonsensical If truly concerned about animal health, these are tied together
Editor's Notes
- Exists for all major proteins Collaboration between working groups.
- Have solid case definitions – especially for producers treating their own animals Are there non-AM alternatives that are efficacious and (for a lot of ppl, affordable) -- if so, stop. Choose an drug appropriate for disease But at the same time, look at why the disease occurred in the first place – source of animals, weather, nutrition, genetics Always evaluate need for continued use of drug – if disease is gone, then stop.
- DADD : Defined animal daily dose DAPD : DADD per 1,000 animals per day ; estimate of the proportion of animals treated daily with a particular antimicrobial agent DCD : Number of DDD per 1000 physician contacts per day DCDvet : Defined Course Dose for Animals DDD: Defined Daily Dose DDDvet : Defined Daily Dose for Animals UDDvet : Used Daily Doses PCU : Population Correction Unit ACD: Animal Course Dose DOT: Days of therapy assigned to a specific AM – good for short acting multi-dose drugs. Falls apart with single injection LA medications.
- Here are specific parameters commonly used Answer – Resistance pressure put on by exposure time.
- We don’t know what combination/combinations are better….or worse Have to consider the bacterial population that is exposed – are resistance genes already present, spontaneous mutations, etc
- Data granularity Outcomes Only use one or one type of DDD/DCD – inappropriate benchmarking
- Number of yards, size of yards, record systems available ???
- Is IMM exposure better or worse than systemic Duration vs total mg vs efficacy