Categorisation of antibiotics for use in animals for prudent and responsible use

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Categorisation of antibiotics for use in animals for prudent and responsible use

Prudent and responsible use of antibiotics in both animals and humans can lower the risk of bacteria becoming resistant. This is particularly important for antibiotics that are used to treat both people and animals and for antibiotics that are the last line of treatment for critical infections in people.
The Antimicrobial Advice Ad Hoc Expert Group (AMEG) has categorised antibiotics based on the potential consequences to public health of increased antimicrobial resistance when used in animals and the need for their use in veterinary medicine.The categorisation is intended as a tool to support decision-making by veterinarians on which antibiotic to use.
Veterinarians are encouraged to check the AMEG categorisation before prescribing any antibiotic for animals in their care.The AMEG categorisation does not replace treatment guidelines, which also need to take account of other factors such as supporting information in the Summary of Product Characteristics for available medicines, constraints around use in food-producing species, regional variations in diseases and antibiotic resistance, and national prescribing policies.

Category A: Avoid
• antibiotics in this category are not authorised as veterinary medicines in the EU
• should not be used in food-producing animals
• may be given to companion animals under exceptional circumstances

Category B: Restrict
• antibiotics in this category are critically important in human medicine and use in animals should be restricted to mitigate the risk to public health
• should be considered only when there are no antibiotics in Categories C or  D that could be clinically effective
• use should be based on antimicrobial susceptibility testing, wherever possible

Category C: Caution
• for antibiotics in this category there are alternatives in human medicine
• for some veterinary indications, there are no alternatives belonging to Category D
• should be considered only when there are no antibiotics in Category D that could be clinically effective

Category D: Prudence
• should be used as first line treatments, whenever possible
• as always, should be used prudently, only when medically needed

For antibiotics in all categories
• unnecessary use, overly long treatment periods, and under-dosing should be avoided
• group treatment should be restricted to situations where individual treatment is not feasible

Categorisation of antibiotic classes for veterinary use

Category- A: AVOID

Amdinopenicillins

   Mecillinam
   Pivmecillinam

Carbapenems

   Meropenem
   doripenem

Carboxypenicillin and ureidopenicillin, including combinations with beta lactamase inhibitors

   piperacillin-tazobactam

Drugs used solely to treat tuberculosis or other mycobacterial diseases

   Isoniazid
   Ethambutol
   Pyrazinamide
   Ethionamide

Glycopeptides

   Ancomyci

Glycylcyclines

   Igecycline

Phosphonic acid derivates

   Fosfomycin

Pseudomonic acids

   Mupirocin

Ketolides

   Telithromycin

Monobactams

   Aztreonam

Lipopeptides

   Daptomycin

Oxazolidinones

   Linezolid

Other cephalosporins and penems (ATC code J01DI), including combinations of 3rd-generation cephalosporins with beta lactamase inhibitors

   Ceftobiprole
   Ceftaroline
   ceftolozane-tazobactam
   faropenem

Rifamycins (except rifaximin)

   Rifampicin

Riminofenazines

   Clofazimine

Sulfones

   dapson

Streptogramin

   Pristinamycin
   virginiamycin

Substances newly authorised in human medicine following publication of the AMEG

   Categorisationto be determined

Category- B: RESTRICT

Cephalosporins, 3rd- and 4th-generation, with the exception of combinations with β-lactamase inhibitors

   Cefoperazone
   Cefovecin
   Cefquinome
   Ceftiofur

Polymyxins

   Colistin
   polymyxin B

Quinolones: fluoroquinolones and other quinolones

   Cinoxacin
   Danofloxacin
   Difloxacin
   Enrofloxacin
   Flumequine
   Ibafloxacin
   Marbofloxacin
   Norfloxacin
   Orbifloxacin
   oxolinic acid
   pradofloxacin


Category- C: CAUTION

Aminoglycosides (except spectinomycin)

   Amikacin
   apramycin
   dihydrostreptomycin
   framycetin
   gentamicin
   kanamycin
   neomycin
   paromomycin
   streptomycin
   tobramycin

Aminopenicillins, in combination with beta lactamase inhibitors
   amoxicillin + clavulanic
   acidampicillin + sulbactam

Amphenicols
   chloramphenicol
   florfenicol
   thiamphenicol

Cephalosporins, 1st- and 2nd-generation, and cephamycins
   Cefacetrile
   Cefadroxil
   Cefalexin
   Cefalonium
   Cefalotin
   Cefapirin
   Cefazolin

Lincosamides
   Clindamycin
   Lincomycin
   Pirlimycin

Macrolides
   Erythromycin
   Gamithromycin
   Oleandomycin
   Spiramycin
   Tildipirosin
   Tilmicosin
   Tulathromycin
   Tylosin
   Tylvalosin

Pleuromutilins
   Tiamulin
   Valnemulin

Rifamycins: rifaximin only
   Rifaximin


Category- D: PRUDENCE

Aminopenicillins, without beta-lactamase inhibitors
   Amoxicillin
   Ampicillin
   Metampicilli

Aminoglycosides: spectinomycin only
   Spectinomycin

Anti-staphylococcal penicillins (beta-lactamase-resistant penicillins)
   Cloxacillin
   Dicloxacillin
   Nafcillin
   Oxacillin

Cyclic polypeptides
   Bacitracin

Nitroimidazoles
   Metronidazole

Nitrofuran derivatives
   Furaltadone
   Furazolidone

Natural, narrow-spectrum penicillins (beta lactamase-sensitive penicillins)
   benzathine benzylpenicillin
   benzathine phenoxymethylpenicillin
   benzylpenicillin
   penethamate hydriodide
   pheneticillin
   phenoxymethylpenicillin
   procaine benzylpenicillin

Steroid antibacterials
   fusidic acid

Sulfonamides, dihydrofolate reductase inhibitors and combinations
   Formosulfathiazole
   Phthalylsulfathiazole
   Sulfacetamide
   Sulfachlorpyridazine
   Sulfaclozine
   Sulfadiazine
   Sulfadimethoxine
   Sulfadimidine
   Sulfadoxine
   Sulfafurazole
   Sulfaguanidine
   Sulfalene
   Sulfamerazine
   Sulfamethizole
   Sulfamethoxazole
   Sulfamethoxypyridazine
   Sulfamonomethoxine
   Sulfanilamide
   Sulfapyridine
   Sulfaquinoxaline
   Sulfathiazole
   Trimethoprim

Tetracyclines
   Chlortetracycline
   Doxycycline
   Oxytetracycline
   Tetracycline

Other factors to consider

The route of administration should be taken into account alongside the categorisation when prescribing antibiotics. The list below suggests routes of administration and types of formulation ranked from the lowest to the highest estimated impact on antibiotic resistance.

•Local individual treatment (e.g. udder injector, eye or ear drops)
•Parenteral individual treatment (intravenously, intramuscularly, subcutaneously)
•Oral individual treatment (i.e. tablets, oral bolus)
•Injectable group medication (metaphylaxis), only if appropriately justified
•Oral group medication via drinking water/milk replacer (metaphylaxis), only if appropriately justified
•Oral group medication via feed or premixes (metaphylaxis), only if appropriately justified

Source: EUROPEAN MEDICINES AGENCY