During a presentation devoted to responsible antimicrobial use and selection at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11 in Orlando, Florida, Lucas Pantaleon, DVM, MS, Dipl. ACVIM, MBA, a veterinarian advisor at DVM One Health, in Versailles, Kentucky, referred to antimicrobial resistance (AMR) as a “silent pandemic” that we must address with a One Health framework approach.

“Antimicrobial-resistant bacteria can develop, disseminate, and have impacts on human, animal, and environmental health, incurring a huge economic burden,” he said.  

Pantaleon said we will never be able to completely defeat AMR because bacteria have an innate capacity to acquire resistance to drugs that were once effective. Instead, he urged veterinarians to be judicious with their use of antimicrobials to delay the onset of AMR and preserve the drugs we have today.

Pantaleon shared data from a systematic review published in the journal Lancet in 2022 stating that in 2019 there were 1.3 million human deaths attributed to AMR infection and almost 5 million deaths associated with AMR globally. Researchers on a study by the Centers for Disease Control (CDC) relayed that about 3 million people per year are affected by AMR infections, and an estimated 35,000 deaths annually are due to multidrug-resistant bacterial infections. If ignored, by 2050 AMR could cause 10 million deaths globally, with a $100 trillion price tag.

“Today, in the U.S., equine practitioners have the freedom and great responsibility to use any antibiotic to treat patients, because there is no regulatory body guiding antibiotic use in this sector,” he said. “AMR is a wicked problem where the solution requires a large number of people to change their behaviors.”

Pantaleon recommended including behavioral sciences and communication experts to transmit messages regarding AMR to the public.

Even using a One Health approach working across all disciplines in animal, human, and environmental health, Pantaleon warned equine practitioners, “We have monumental challenges ahead of us.”

In equine practice, he said, we must better address how to keep animals healthy, so we don’t need to use antibiotics in the first place. We need better, faster, and ­economical stallside diagnostic testing; improved biosecurity and infection prevention; and regulatory framework to guide us on how to be better with our drugs.

“Antibiotic use must not be a ‘cover-up’ for poor management or suboptimal infection prevention practices,” Pantaleon stressed.

For example, should veterinarians be using an aminoglycoside with every joint injection given the low risk of intra­articular infection? Do we need to infuse every mare post-breeding with antibiotics? Pantaleon said equine vets have many opportunities to improve antibiotic use.

In closing, Pantaleon acknowledge that equine veterinarians have many opportunities to improve our use of antibiotics to combat antimicrobial resistance.