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Responsible Use of Medicines - Fifth Sustainability Tip for Practices

News Sustainability in Equine Practice
08 Jul 2021 BEVA

Sustainability encompasses much more than just CO2 emissions, from upholding biodiversity to maintaining the efficacy of the medicines available to us. True sustainable practice means meeting the needs of our clients and the animals under our care without compromising the ability of future generations to do the same.

Responsible use of medicines is essential for sustainable practice. Here is why, and what YOU can do to use medicines responsibly:

- Antimicrobial resistance (AMR)

• The issue: A recent study showed a prevalence of multi-drug resistant bacteria of >25% in various infections2 with the concerning finding that there was no readily available treatment for 30.2% of Enterococcus-positive submissions. Not only does AMR impact on patient outcomes, it also has implications for the duration of treatment and quantity of pharmaceuticals and other resources required.

• Practising responsible use:

• Perform an audit – Evidence from human healthcare suggests that auditing antimicrobial use is one of the most effective methods of reducing use of critically-important antibiotics. The BEVA PROTECT ME toolkit provides an excellent first step.

• Make use of further PROTECT ME resources including the ‘no antibiotic prescription’ form and practice posters.

• Get informed – Whilst a full discussion of AMR is beyond the scope of this post, a huge array of resources is available. For a start, take a look at the EVJ Antimicrobial Resistance Virtual Issue.

- Anthelmintics and antiparasitics

• The issue: Similarly to AMR, anthelmintic resistance is an increasing problem in equine and farm practice. Studies have demonstrated increasing anthelmintic resistance in strongyles, notably to benzamidazoles, together with a shortening of the egg reappearance period3. Unchecked, this resistance will likely lead to an increase in incidence of clinical disease. The other problem with these drugs is the impact they have on wildlife such as coprophagic insects. So far, little research has been performed in horses; however, we know that anthelmintics such as ivermectin can significantly disrupt dung beetle functioning4, and other off-target effects are likely.

• Practising responsible use:

• Avoid blanket use of anthelmintics and antiparasitics

• Make best use of faecal egg counts and targeted treatment

• Combine pharmaceutical methods with alternative strategies such as grazing management and co-grazing with other species

• Educate clients on the need to use anthelmintics appropriately

-  Drug wastage:

• The issue: Pharmaceuticals are estimated to account for a whopping 20% of the NHS’s carbon footprint1, and the carbon footprint associated with manufacture of drugs can be considerable, often hundreds or even thousands of kg CO2e per kg active substance. A life cycle analysis of morphine suggested the carbon footprint of 100mg morphine is equivalent to driving an average car 1km5

• Practising responsible use:

• Reduce drug wastage by broaching as few bottles as possible

• Perform frequent stock takes to identify short-dated products

• Only order what you need – avoid stockpiling

1.  Hawkes, N. Cutting emissions by drug industry is crucial to reducing NHS’s carbon footprint. BMJ 345, e8243 (2012).

2.  Isgren, C. M. et al. Antimicrobial resistance in clinical bacterial isolates from horses in the UK. Equine Veterinary Journal n/a,.

3.  Relf, V. E., Lester, H. E., Morgan, E. R., Hodgkinson, J. E. & Matthews, J. B. Anthelmintic efficacy on UK Thoroughbred stud farms. Int J Parasitol 44, 507–514 (2014).

4.  VerdĂș, J. R. et al. Ivermectin residues disrupt dung beetle diversity, soil properties and ecosystem functioning: An interdisciplinary field study. Science of The Total Environment 618, 219–228 (2018).

5.  McAlister, S. et al. The Environmental footprint of morphine: a life cycle assessment from opium poppy farming to the packaged drug. BMJ Open 6, e013302 (2016).