Treating E. coli in the era of prudent use

In a world where antibiotics use in livestock is increasingly under scrutiny, it is becoming vital to exactly understand the mode of action of each antibiotic. That will allow swine veterinarians to know in detail when to apply them and in which manner – making sure the best outcome is guaranteed for both the pigs and their environments.


Apramycin* (8mg/kg bw) feed medication

Paromomycin** (25mg/kg bw) water medication

scherichia coli is a gram-negative bacterium which is the causative agent of pig neonatal diarrhoea and post-weaning diarrhoea. Both diseases are life- threatening and are important causes of economic

losses for the pig industry due to mortality, morbidity and de- creased growth rate. Antimicrobial therapy in cases of enteric colibacillosis infec- tions is still based on the use of various classes of anti- biotics. New regulations limit the use of different antibiotic classes for E. coli treatment. Implementation of an antibiotic

Table 1 - Apramycin* and paromomycin** concentrations in small and large intestine content during feed and water medication and after medication cessation.

Day of treatment/ hours post treatment

Day 21 of treatment

12 hours after treatment stop

Day 5 of treatment

24 hours after treatment stop

* Apravet, Huvepharma ** Parofor, Huvepharma

10 ▶ PIG PROGRESS | Volume 37, No. 7, 2021

Small intestine (μg/g)

45.0 33.2 760.3 17.6

Large intestine (μg/g)

88.2 54.0 640.5 71.0

categorisation system in the EU in February 2023 will re- strict the use of several antibiotics that are considered criti- cally important for human medicine; think of colistin, dano- floxacin and enrofloxacin. Zinc oxide as a therapeutic drug (2,000–3,000 ppm) will be banned for medical use in June 2022 and already is not mark- eted anymore in a range of European countries: Belgium, France, the Netherlands and Germany. Missing cross-protec- tion and a narrow activity spectrum impede the effective use of vaccines as a preventive approach to manage colibacillosis infections. That necessitates the use of other effective coli- bacillosis antibiotic treatment options – ideally those which are not classed as critically important for humans.

Antibiotic stewardship and requirements Antibiotic stewardship requires professional veterinarians to abide by certain requirements. A vet should sustain the effi- cacy of antibiotics and prevent resistance development. In addition, a veterinarian should optimise dosing based on im- proved understanding of the mode of action of antimicrobial products. Thirdly, a vet should use the most effective anti- biotic for treatment purposes. Successful treatment of E. coli infections can only be achieved by the administration of an antibiotic that reaches therapeu- tic concentrations at the intestinal infection site, where E. coli is present. The antimicrobial susceptibility of E. coli strains is fundamental to combat the emergence and expansion of antibacterial resistance. When choosing antibiotics, a veterinarian should consider: • Antibiotic therapeutic concentrations in the intestine; and • The sensitivity of E. coli strains, which is why susceptibility testing is fundamental for correct therapy. Responsible use of antibiotics in animals lowers the risk of bacteria becoming resistant. A key element in veterinary practice is prudent antibiotic use based on pharmacokinetic (PK) and pharmacodynamic (PD) data. The decision to treat and the choice of antibiotics is ideally based on PK/PD knowledge, which is in line with global treatment guidelines in place on antibiotic usage.

E. coli treatment options Apravet (apramycin) and Parofor (paromomycin), both marketed by Huvepharma, belong to the group of

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