Improving the outcome of antimicrobial treatment

In swine production the use of antibiotics is an integral part of a swine health plan. For each farm unit a health plan is designed and includes health monitoring, disease diagnosis, disease prevention and disease treatment measures.


he most common and important enteric infections in the ileum and colon are the following: • Porcine Proliferative Enteropathy (PPE, ileitis), caused by Lawsonia intracellularis (L.i.). This is a com-

mon and widespread infection in the small intestine and also occurs infrequently in the large intestine of pigs. Often the disease progresses subclinically, causing poor pig perfor- mance. Acute and chronic forms of ileitis are treated by anti- biotics of several drug groups (pleuromutilins, macrolides, lincosamides, tetracyclines). •

Destruction of a bacterium by antibiotics.

Lawsonia vaccine and a live attenuated vaccine can be used for PPE prevention.

Swine Dysentery (SD), caused by Brachyspira hyodysenteri- ae (B.h.), is a serious diarrhoeal disease in the colon of grow-finish pigs with re-emerging character in many coun- tries (US/Canada/Brazil/Spain).

• Porcine Colonic Spirochaetosis (PCS, colitis), caused by Brachyspira pilosicoli (B.p.), is a mild to moderate non-fatal infection mainly in young weaned animals, mostly 20-40kg. Economic losses are due to reduced growth and the associated impact on pig flows and market uniformity. When pigs are challenged by PPE, SD or PCS the most impor- tant consideration must be to quickly control the disease with an appropriate treatment. Different antibiotics are licensed for therapeutic use against Lawsonia and Brachyspira infec- tions in pigs. No suitable protective vaccines against B.h. and B.p. are avail- able commercially. In the case of L.i. currently an inactivated

14 ▶PIG PROGRESS | Volume 36, No. 4, 2020

Responsible use of antibiotics and AMR Sustaining antibiotic efficacy in the long term is critical and demands the responsible use of antibiotic therapies. The tar- geted use of antibiotics aims to limit the development and the expansion of antimicrobial resistance (AMR). The animal health and production industries play a signifi- cant role in minimising AMR risk. Following internationally endorsed recommendations summarised in the “5Ds” of anti- biotic stewardship is the basis for AMR minimisation: • Diagnosis: Does the condition require antibiotic therapy? • Drug: Are the bacteria susceptible? • Dose: What is the recommended dose? • Duration: What is the recommended duration? • De-escalation: What is the appropriate treatment and route of administration?

Considerations when using antibiotics Selecting the best antibiotic depends on the therapeutically effective concentrations that the antibiotic achieves at the gut infection site and the susceptibility of L.i./B.h./B.p. strains to the antibiotics registered. Use of a drug with broader spec- trum can be beneficial based on different bacteria organisms possibly present in the ileum and colon based on polymicro- bial infections. When selecting the appropriate type of antibiotics for PPE, SD or PCS treatment, it is vital to look at two different antibiotic characteristics, both of which are essential for treatment justi- fication. They must have: 1. A favourable pharmacodynamic (PD) activity measured as minimum inhibitory concentrations (MICs);


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