Hello, it's Anthony Chadbury from the webinar vetting, this is Vet Chat, the number one UK veterinary podcast. I'm so pleased today to have two people on our episode today. We have Ian Battersby and Margo Mosher, who both work for Mars.
Margo is the global sustainability director, and Ian is the responsible pharmaceutical stewardship lead. We're wanting to talk today all about antibiotic stewardship. It's an incredibly important area.
I remember several years ago being at a conference in Dublin. Where one of my mentors, Professor David Lloyd from the Royal Veterinary College, was talking about antibiotic stewardship, and it was in a small room. And there weren't that many people in there, but of course we know that.
Our usage and our our stewardship of antibiotics and and all products is really, really important and I'm so pleased, Ian, to see that this is something that's really moving up the agenda as as something that we've really got to take seriously, isn't it? Oh, absolutely. I mean, pharmaceutical stewardship, it's a bit of a tongue twister to say.
You're not the first one to have difficulties pronouncing my job title, but, you know, pharmaceutical stewardship is really, you break it down into two arms. The first one is, you know, promoting good use of the drugs to get good clinical outcomes. So, you know, it's using the right drug at the right time by the right route.
You know, in optimising all the non-pharmaceutical aspects, you know, so, you know, I guess when you're resolving an infection, making sure there's good drainage, you know, removal of necrotic tissue. So that's the first part of it. The second part is making sure that when we use these pharmaceuticals, we don't cause harm to the patient.
You know, so that can be either an acute side effect, you know, some of which we're familiar with, or chronic effects, and then also for future patients. So when we're talking about future patients, that's focusing on the environmental impact of some of these resources that we use. Are we using them too much or not enough, you know, and, and are we disposing of them in the right way?
And then also making sure that the The efficacy is still available for future patients, so we will still have these drugs available to use on patients in the future when we need them. And it's, you know, I can certainly reflect on, you know, 10 years ago, you know, when I first started getting focused on antibiotics, you know, it like similar experience to you. I was, you know, almost like a lone wolf in certain lecture theatres and stuff, and it was a very new topic, but it's, it's pleasing to see now that this is, you know, this is gaining momentum.
It's really important that it gains momentum. And but it's really pleasing that we're getting a lot of engagement now across the profession. And I think it's also interesting, Margo, you know, there's a real sustainability element to this as well, because.
The antibiotics can be disposed of incorrectly, that can cause contamination of the environment and damage other ecosystems as well, can't it? Exactly, you know, the use of pharmaceuticals, their production, their shipping, their disposal, every aspect of the, the life cycle of pharmaceuticals has impacts, both environmentally and socially, but thinking about the environment, yes, you know, the impacts through waste on water, on greenhouse gas emissions, really overall creating our drugs and then using. Them, has impacts and, and so managing those carefully and being really good stewards is critical.
And one example just to give a sense of some of those environmental impacts, to create 1 kilogramme of vancomycin, an antibiotic that isn't used as much lately, but, has been historically, to create that 1 kilogramme, you need over 500 kilogrammes of inputs, largely water. But, but other inputs as well, and that that production of the drug emits greenhouse gas emissions over 50 kilogrammes for 1 kilogramme of the drug. So just to give a sense of the creation of these drugs does have those impacts, and so using them unnecessarily causes all of those impacts in that footprint.
So if we can be really judicious about their use and use them only when needed. We can not only help animal health, human health, but also that environmental side and really looking at this issue as, as a one health issue that has impacts across all of those different areas. I think it's really important, and for me the key word is that responsible usage because certainly, you know, I've been a vet for 32 years and when I went into practise, sometimes I would see practises using antibiotics in a cavalier way, .
A cat had been castrated, that operation was done in as clean a fashion as possible, but there was still a feeling that we had to give 0.5 mL of something white and milky, which was usually a penicillin type product. And there really is no need for that.
I, we did a webinar recently with somebody else and they were talking about use of antibiotics in diarrhoea. Often we don't need to use antibiotics, but maybe because we've not been taught well or we've learnt bad habits once we've got into practise, it can be very easy to fall into those. In those traps and I suppose sometimes also clients kind of expect something more than just a chat with the vet and an examination, they want to go home with something, don't they Ian?
Yeah, and it's You know, it's, it's, it's a complex matrix really of all the different factors that go into when we're actually in the consult room prescribing a medication, you know, there, there's all the information and guidelines. There's previous experiences that may be good or bad, you know, we, I, I can remember when I was a younger vet developing habits from one case going bad. So then I started using a pharmacy of drugs because of that one case, but that was an unusual event.
But it moulds your experiences and You know, one of the biggest challenges is, you know, with, with this particular type of, of conversation is, you know, if I talk to a vet about adding in a drug that might help them, you know, and maybe minimise the risk, you know, that's one thing that's easier to do. Taking away a drug because it's not necessary, that's a, that's a different psychological challenge and You know, so it's, it's really, you know, you know, we've got to, you know, we, we know this is, you know, we know this is an issue for antibiotics. We know there's areas, for example, where antibiotics aren't indicated.
You've used acute diarrhoea as a very good example. And so it's really about, you know, as vets, we need to make sure there's a culture within the hospital that's supportive, that there's consensus. You know, I, I get vets talking to me all the time saying I'd like to do this, but then if I don't do it, I don't get the support, you know, the, you know, I, I get put on the, you know, they'll go and see another vet and then they'll prescribe.
So it's all about getting consensus in the hospital really. And, and, and, you know, and, and also, I think, you know, one thing we touched on another podcast is, is that, you know, a lot of the course durations that we prescribe as vets have been arbitrary, allocated to multiples of 5 or 7, you know. And I can't believe that, you know, a bacteria is going to respond to a multiple of a calendar week.
So we really need to, you know, there's a lot of research in human medicine on shortening courses of antibiotics, and, you know, we, we need vets really to submit clinical cases to studies, you know, that that are that are starting to, to, to be initiated across the profession and looking at shortening these courses really, you know, so that we can. Only use these drugs when necessary, but also only for as long as needed. And I think it's interesting for those people perhaps not aware listening.
Obviously, Ian, you, you work in the UK for Linnaeus as well, which is, which is the big veterinary group that Mars own and then obviously there's veterinary groups in, in America, obviously also owned by Mars. That's a real power for good because there's so many practises, you're obviously taking this area so seriously that you can get that good information out and it becomes something that's a, a policy. You know, if there's there's an acute diarrhoea, we shouldn't give antibiotics.
But, you know, it's always been very difficult, as you said, even within practises, and again, to use a derm example, I would often be looking at as a referral vet at a case that had come from a practise, and there'd been 5 different approaches to it. And, you know, some of them were obviously better than others. So trying to get that standard of saying, you know, we shouldn't use this antibiotic.
Unless there are these 2 or 3 reasons, I think is, is really important to, you know, we can be quite prescriptive, I think, within. Use of products like this that that obviously are ones that we want to save for future generations, we're not only, as you said before, treating the animal, we're treating future animals as well by our behaviours aren't we. Yeah, and you're quite right.
I mean, the exciting thing about my role is that you know, Mars, I think we have about 2700 practises. Is that right, Margot? I think it's around about that number, and you know it's over a number of continents.
So collectively the impact we can have as a group is, it's hard to put into words really. But also you're right about the challenges on, you know, on, you know, getting agreement within the practise. And one measure that, we put in place in Linnaeus is, the PTE scheme, which I was involved with.
Part of the BSAVA Protect scheme is that they give you a number, we give you a number of different options for each condition. So, you know, you can be involved in the choice of antibiotic or not to use an antibiotic in a list of situations. It's a simple measure that we put in place at Linnaeus is that each practise had to discuss sections of the of the poster at the practise meetings.
So you, you talk about tea and coffee rotas, things that, you know, and all the other bits and bobs, insurance forms, and then you know 10 minutes at the end of each each practise meeting, right, we're going to talk about this section of the poster, and we're going to, you know, that might be the GI section, and we're all going to agree on what we're going to use. And then the next meeting they moved on to the next section and that. You know, generates, you know, conversations between colleagues, you know, and consensus really.
Yeah, I think it's really important, the conversations, isn't it, because. You know, there's certainly practises that very rarely held meetings and actually meetings and coms are very important because if you're all in separate consult rooms or even in separate buildings. Actually communicating as a team can be incredibly difficult, can't it?
Yeah. No, absolutely. You know, it's, it's all, you know, lots of change can be made, but if you're on your own and you're not, you know, you've not got that, that collaboration, and supportive culture, it's really hard, you know, really hard.
How do you see Linnaeus and you know, the larger Mars group across continents? Do, do you see that you have an obligation towards research, you know, because things like how long should we give a course of antibiotics is, you know, you're quite right, we, we still don't actually know, some of it is a bit of empirical guesswork, isn't it? Is there some work going on at some of your referral centres and, and so on, maybe working with universities to try and get further into this?
So I mean one of the first things we're trying to do is understand our baseline usage. So you know we're collaborating, you know, with all the different business units, getting, you know, benchmarking on the amounts that each hospital is using, and that piece of work is being done with Dr. Scott Wies who hopefully some of your listeners are familiar with world authority on infectious disease, really nice guy, incredibly bright and intelligent.
So he's been a, you know, incredible asset in this. So we're, you know, within that, we're doing some analysis at the moment. We're understanding our usage patterns, and then, you know, certainly that will steer us towards different initiatives that we, we, you know, we, we want to put in place.
And certainly what we'll want to do with that is assess the impact, you know, you know, try different ways of delivering because essentially a large part of this work is communication. You know, as, as we talked about, so, you know, if we can put intervention, interventions, you know, education platforms and things like that in place and look at the changes in prescribing behaviours, well, that, that information, you know, will be incredibly powerful for the profession so we can distribute that information when we get it. So there's certainly a number of, you know, we're just completing that analysis at the moment, and then, you know, the next couple of months we'll start working on areas that we want to focus on.
And then start putting those plans in place and you know it's not a quick process but you know with the number of practises that we've got, you know, the You know, it's potentially very powerful information because of the number of animals. You know, a lot of veterinary studies have a very small number of animals, whereas if we can look at, you know, 100,000 animals, wow, yeah. Just for those listening, Scott is a is a lecturer up in Ontario in Guelph, and he has done some webinars for us, so do go and have a little nose if you want to catch up on, on more sort of information about that.
You're absolutely right though, you know, with anything, and I know Margo, you've done a lot of work. You know, looking at carbon and sustainability, the, the first thing you have to do is measure your carbon, isn't it, or measure whatever, in any study you have to know what your baseline is. Exactly that that's the very first step and and something we've been working on in our other topic areas climate change and our greenhouse gas emissions also hospital waste so doing those footprints or baselines is is critical to be able to not only measure and and you know, track your progress annually but just to know where to be focusing and really looking at where are the biggest impacts coming from, where are their anomaly cases happening so across all three of these topics that that we've touched on.
Yeah, starting with your measurements, so that you can build the right plan and have really a strategy that's based on the evidence of, of where the impacts are. So, what I described as these first baselines that we're doing are just critical first step to understanding, OK, what is our picture when it comes to our. Usage and where and how can we focus to, to optimise and really be using these drugs wisely.
So, yeah, key first step for us. I remember a number of years ago, the Dutch government just mandated that vets had to reduce their antibiotics. I think it was by 50%.
You know, so that these sort of things are possible and I know that that the Dutch vets came together and did an amazing job. Sometimes there's a danger that vets can be blamed for, you know, antibiotic resistance and things because of antibiotic usage, but this really is this is the true, true one health issue, isn't it, because this is, use of antibiotics by humans, you know, by animals or for animals as well. How do you think that government can get involved and sort of help with this as well?
I'm sure you. Sorry, I'm taking the lead there, aren't I? Sorry.
All right, OK, so I mean, certainly from a UK point of view, we know the UK is taking this issue very, very seriously. Doctor Sally Davies is a very prominent advocate of responsible antibiotic use. And there's a, I think there's a 25 year plan and also within that there's a 5 year plan that's annually reviewed and there are touch points within that that impact on the, on the, veterinary sector, predominantly farm animal, but you know, those kind of initiatives will obviously cascade into companion animal as well.
And, but we also know that there are, you know, discussions on a, on a higher level than that occurring, you know, a quadripartite between the WHO, OIE, FAA, you know, bringing governments together to develop a consensus on approach because this is a, you know, it's a true on health, but it's also a global issue as well, you know. And, you know, you look at this, the studies, you know, this presentations I saw years ago where they show, you know, backpackers have picked up bugs with resistant genes in other countries, you know, from a dodgy, you know, dodgy tummy, you know, and they can, the world's more mobile now, so, well, COVID's a great example of that, isn't it? You know, the movement we all have.
So it is a real true collaborative effort across the world, and I guess, you know, we've all got a part to play in it really. I was very excited. Sorry, Margo, do you, do you have a point you want to bring up on that?
I, I would just add that you know I think it, it to the point about this being global, that we need to be collaborating across this, similar to other global issues climate change, pandemics, etc. We need everyone to be doing their part because otherwise, we just won't make the progress we need, and when looking at, you know, the potential restrictions. On drug use, here in the US, the FDA had an open comment period recently on this topic and so, being responsible users of pharmaceuticals is is just critical for us having the the licence to use them and and showing that we are using them in in the right ways so that piece from a regulatory and and government perspective is also important for us.
I think it, you, you're really right, Margo, it, you know, I often talk about this 3 constituents to pretty much all of our problems, and that is, you know, government, it's business and it's individual, and we all have responsibilities as individuals, you know, if I go to the doctor's with a little snuffle and I'm demanding antibiotics, then that's not appropriate. Similarly, if I take, My cat to the vets and want antibiotics for, for diarrhoea, it's not appropriate and and it's great to see Mars taking this so seriously, you know, across all of their, across all of their groups as well. What I was really excited about recently, and I know it it started last year, but I think it's hopefully going to be even bigger and better this year, is that collaboration coming together of certainly in the UK of, of the pharmacists and the vets with the antibiotic amnesty.
I'm sure that not everybody is compliant enough to take all of their course. They're left with antibiotics, they then decide what can they do with them. Sometimes they get flushed down the toilet, sometimes they get donated to other people for their, little tickle or whatever.
I think it's really important that that this is happening and perhaps Ian, you can explain a little bit about the amnesty and how it's gonna work, particularly for those people, perhaps as vets who are listening who can get involved in their practise. But also individuals who perhaps then find out about it and can start taking either their pet's antibiotics or their own antibiotics. Presumably back to vet or pharmacy.
I doubt if, if we'll see everybody separating things. Maybe they just got piled into one place. Yeah.
So, it's a fantastic initiative. It's, a coordinated effort between a number of, organisations, the VMD, BSAVA, and also a number of veterinary groups as well, and REMA, are also involved. Both, I think it's RUMA and, RCVS Knowledge, I think, have got the resources for everybody who wants to get involved in this.
And essentially it's, it's. It's trying to put a real promotion drive on, like you say, making owners and members of the public aware that when you have drugs left over, it's not in the bin or in the toilet, you know, that I think it's about a third of people admit to flushing old drugs down the toilet and our You know, our water cleaning systems can remove, you know, bacteria and things like that, but they can't remove pharmaceuticals. So inevitably they end up in the environment and have effects, you know, they can affect acidity of water, you know, obviously effects on organisms as well, so.
The amnesty really is to really push and promote for, you know, owners to find those old, you know, leftover courses of antibiotics and bring them back to your your practise. And there's a whole series of information packs. I think, I think there's details on how to, you know, how they're collected on on the websites as well.
And then we want, practises that participate to record all the conversations they have about this, but also record the amount of drugs that they've got, submit that to BSAVA. And that's going to be really interesting for, for lots of reasons. Firstly, you know, you know, what are people, how, how long, you know, what kind of drugs are they, you know, what kind of antibiotics are they holding onto and not using?
But also, you know, if we can track back to what kind of courses they're using, you know, if you've got a, you know, if you commonly, if we find that, say, You know, with cystitis is commonly getting given two weeks of antibiotics and the owners are stopping after 4 days, and that's, that's really powerful information that we can get from this. So, you know, certainly anybody who is aware of it, I would, you know, listening now, I would really encourage them to get involved. It's, it's a collaboration as well between the Midlands NHS as well.
So human pharmacies are doing it at the same time. So, you know, but this is, you know, for the, for the veterinary, you know, for the veterinary profession, it's The whole of the UK will want people to get involved. So, you know, please get involved, all the information on the, on the websites and, you know, they'll be if you're not sure about any of the details, there'll be contact details there for you to ask questions.
I just say to people listening, if you are a vet who's not in the UK or or er or a nurse, not in the UK, then this is something that maybe you can put forward to your governing bodies as something that is really important to encourage your societies to, to get involved with it, because, you know, you were saying before, when they get flushed down the toilet, we know that there's . Antimicrobial resistance in some of the bugs within the sewage isn't there, which then, you know, can cause all sorts of issues and problems and I was shocked by the number of deaths across the world that are basically caused by antibiotic resistance. So this is a huge problem and if we don't get a handle on it, it will only get bigger, it won't get smaller, will it, Margo.
Exactly it, it, it is really an urgent issue and, and I think the connection to human health is what, really lights a fire under it for, for me certainly, but I think for many that you know how we use these pharmaceuticals with our pets can directly impact how they work for us as humans in our own health care so. And yes, looking at, the trajectory and the potential harm that that is predicted, is, is quite concerning, so it, it's really right up there with climate change and some of the other really urgent crises that that we're facing both as humans but as as other species as well. Margo, thank you so much for coming to speak to us.
I know it's it's early in the morning in in America and Ian. Thank you all for coming. It's great to see the work that Mars is doing in this area, you know, I just continue to encourage you to do more and do pass on those learnings to us cos we all need to, to learn from each other, so.
Thank you so much and this has been Anthony Chadwick from the webinar vet, this has been that chat. Take care.
