As veterinary practitioners, our power to prescribe and supply medicines comes with profound responsibilities that extend beyond the immediate health of our patients.
The privilege of prescribing brings with it a duty to prescribe responsibly. Each time we reach for a bottle, we are not just making a clinical decision for that animal – we're participating in a complex web of One Health implications. The shadow of antimicrobial resistance looms over every antibiotic prescription, reminding us that today's treatment decision could affect both animal and human health outcomes for years to come. In addition, ensuring that there are appropriate safeguards to prevent medicine residues in the food our clients' animals produce is vital to both protecting human health and consumer confidence in the livestock industry.
As farm animal vets, we also have additional challenges over our small animal colleagues in deciding if and when to allow farmers to make treatment decisions themselves. This is a difficult exercise in trust and judgement; this week I reviewed large numbers of medicines books as part of an annual medicine use appraisal, and came across many, many treatments which I am confident would not have been under the direction of my veterinary colleagues.
Perhaps the most challenging aspect of responsible prescribing is maintaining the discipline to ask ‘why?’ before asking ‘what?’ When faced with disease, it is tempting to immediately reach for familiar pharmaceutical solutions. However, our primary role as veterinarians should be to understand and address the root causes of health issues. Often, the most effective interventions lie not in our medicine stores but in adjustments to nutrition, housing, or management practices.
Take, for example, the recurring challenge of neonatal diarrhoea in calves. While vaccines, NSAIDs and, occasionally, antimicrobials play a vital role in treatment and prevention, lasting solutions often stem from reducing stocking density, enhancing resilience through improved nutrition, or implementing better hygiene practices. In this issue of Livestock, Tim Potter provides an excellent review of practical approaches to assessing hygiene in calf-rearing enterprises. He explores techniques and tools—such as bacteriology and ATP testing—that can help engage clients in taking action.
While many farmers recognise that treating sick animals rather than preventing disease is akin to shutting the stable door after the horse has bolted from a productivity perspective, many struggle to implement management changes that improve animal health—often due to limited human and financial resources. The revised Veterinary Medicines Regulations (gov.uk, 2024) may provide an opportunity to revisit these discussions, as antibiotics can now only be prescribed when they are not used routinely and do not compensate for poor hygiene, inadequate animal husbandry or poor farm management. Long-term or repeated use of paromomycin—a European Medicines Agency Category C antibiotic—to control Cryptosporidium parvum in calves is clearly inconsistent with this legal obligation.
The art of veterinary medicine lies in finding the sweet spot between over-cautious prescribing that might compromise animal welfare, and overzealous use of medicines that could contribute to broader health challenges. As practitioners, we need the humility to acknowledge that sometimes the best medicine isn't a medicine at all.