Mickaël Cargnel

Background Bovine respiratory disease (BRD) is a major cause of morbidity, mortality, impaired welfare, production loss, and antimicrobial use in cattle. These European Network for Optimization of Veterinary Antimicrobial Therapy (ENOVAT) guidelines provide evidence-based recommendations for antimicrobial and non-steroidal anti-inflammatory drug (NSAID) use in cattle with acute, undifferentiated BRD, balancing animal-level outcomes with antimicrobial stewardship. Methods Recommendations were developed using the GRADE approach and Evidence-to-Decision frameworks, following ENOVAT procedures and RIGHT reporting guidance. Evidence came from two prespecified systematic reviews and meta-analyses of randomized controlled trials evaluating individual treatment of clinical BRD: one comparing antimicrobial classes head-to-head and one evaluating NSAIDs as adjunctive treatment or monotherapy. Metaphylaxis and prophylaxis were excluded. Certainty of evidence was assessed with GRADE. Panel judgments incorporated stakeholder-derived thresholds for clinically meaningful differences in short-term therapeutic failure, defined as need for antimicrobial re-treatment, and a merged stewardship perspective based on WHO antimicrobial importance and EMA AMEG categories. Results Across antimicrobial comparisons, no class showed a clinically meaningful advantage in reducing short-term re-treatment sufficient to override stewardship considerations. The panel conditionally suggests penicillin G, oxytetracycline, or florfenicol as first-line empirical treatment, guided by local susceptibility data, herd treatment history, product authorization, withdrawal periods, and suspicion of Mycoplasmopsis bovis infection. Macrolides are conditionally suggested as second-line treatment, preferably guided by culture and susceptibility testing or documented treatment failure. Fluoroquinolones are recommended against as primary or secondary treatment, except in exceptional, justified circumstances consistent with regulations. Adding NSAIDs to antimicrobials did not meaningfully reduce antimicrobial re-treatment; the panel recommends against NSAID use for this specific purpose. Evidence was insufficient to recommend for or against NSAIDs for welfare-related outcomes or as antimicrobial substitutes. Conclusions These guidelines prioritize effective BRD treatment while reducing unnecessary use of higher-priority antimicrobials. Local adoption or adaptation using GRADE-ADOLOPMENT is recommended.

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used as ancillary therapy for bovine respiratory disease (BRD) alongside antimicrobials, and interest in NSAID monotherapy has grown amid antimicrobial stewardship and welfare concerns. We evaluated the clinical effectiveness of NSAIDs for BRD as adjunctive or sole therapy. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in cattle with naturally occurring BRD. Databases searched were MEDLINE (Ovid), Embase (Ovid), CAB Abstracts (Ovid), Biological Abstracts (Ovid), Web of Science Core Collection, and Scopus (search: 22 Apr 2024; update: 12 Sep 2025). Primary outcomes were short-term treatment failure (need for re-treatment); secondary outcomes included relapse, mortality, adverse events, and performance where available. Random-effects pairwise meta-analyses estimated risk ratios (RRs) with 95% CIs. Risk of bias was assessed with a modified RoB 2.0 tool; certainty of evidence was appraised using GRADE. Registration/protocol: this review extends a prior ENOVAT BRD protocol; no separate registration was created. Funding: COST Action CA18217. Results Seventeen RCTs (22 comparisons; 4,909 animals) compared NSAID+antimicrobial versus antimicrobial alone. Adding an NSAID did not reduce re-treatment (RR 0.94, 95% CI 0.84–1.05; I 2 = 0%; moderate certainty). Subgroup (same vs different antimicrobial) and sensitivity analyses (handling of multi-arm trials; follow-up restricted to ≤14 or ≤ 10 days; risk-of-bias restrictions) did not change conclusions. Two RCTs in UK dairy calves compared NSAID monotherapy with antimicrobial monotherapy (RR 1.19, 95% CI 0.72–1.97; very low certainty). Re-treatment is an indirect outcome and may not capture analgesia, fever reduction, or growth effects. Conclusions Across RCTs, NSAID use did not confer a clinically relevant reduction in re-treatment when added to antimicrobials, and evidence is very uncertain for NSAID monotherapy versus antimicrobials. Future trials should include validated pain/welfare measures, clinical and ultrasonographic outcomes, and performance metrics, with pathogen identification to explore effect modification.

Bovine respiratory disease (BRD) is a leading cause of illness and death in cattle and a major driver of antimicrobial use. This systematic review and meta-analysis assessed the clinical effectiveness of five commonly used antimicrobial classes (penicillins, tetracyclines, phenicols, macrolides, and fluoroquinolones) in the treatment of cattle with natural BRD. Cattle from all production systems (feedlot, dairy, slaughter, and stocker) were included, and metaphylaxis trials were excluded. Peer-reviewed trials were searched in several databases, and all reports were screened in duplicate for data extraction and risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was employed to evaluate the certainty of evidence. Twenty-eight randomized controlled trials were included. We did not detect clinically meaningful differences between antimicrobial classes in reducing the need for re-treatment (a surrogate for short-term therapeutic failure). Certainty of evidence ranged from very low to moderate, and results should be interpreted cautiously. Subgroup estimates were broadly consistent for production systems (feedlot and non-feedlot) and for trials with Mycoplasma-positive animals; however, these subgroup analyses were small and imprecise and do not allow firm conclusions. Mortality, relapse, and growth outcomes were measured inconsistently and could not be reliably pooled. Overall, we did not identify any class with a clinically meaningful short-term advantage based on our prespecified thresholds. The results of this systematic review and meta-analysis will inform the BRD Antimicrobial Use Guidelines of the European Network for Optimization of Antimicrobial Therapy (ENOVAT).

To monitor the epidemiological situation of bluetongue virus (BTV) in Belgium, a national surveillance programme was conducted during the 2024–2025 winter season. The objective was to estimate the apparent seroprevalence of BTV-3 following the 2023–2024 epidemic and to prove the absence of active circulation of other BTV serotypes in mixed herds (cattle and sheep). A total of 2551 cattle and 1458 sheep were sampled across Belgium. Serological analyses were performed using ELISA, and molecular detection of BTV-3, BTV-8, and BTV-12 was conducted by RT-qPCR. The majority of cattle and sheep herds showed evidence of exposure to BTV-3, with a very high herd-level apparent seroprevalence (100%; 95% CI: 96.2–100% in cattle and 98.9%; 95% CI: 93.8–99.8% in sheep). Apparent within-herd seroprevalence was also high in cattle (94.6%; 95% CI: 91.8–96.5%) and sheep (85.5%; 95% CI: 80.4–89.5%). No evidence of active circulation of BTV-8 or BTV-12 was detected. A moderate significant positive correlation between Ct values and sampling date was observed both for bovine and ovine samples, consistent with a progressive decline in detectable BTV RNA during winter in the absence of vector activity.

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used as ancillary therapy for bovine respiratory disease (BRD) alongside antimicrobials, and interest in NSAID monotherapy has grown amid antimicrobial stewardship and welfare concerns. We evaluated the clinical effectiveness of NSAIDs for BRD as adjunctive or sole therapy. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in cattle with naturally occurring BRD. Databases searched were MEDLINE (Ovid), Embase (Ovid), CAB Abstracts (Ovid), Biological Abstracts (Ovid), Web of Science Core Collection, and Scopus (search: 22 Apr 2024; update: 12 Sep 2025). Primary outcomes were short-term treatment failure (need for re-treatment); secondary outcomes included relapse, mortality, adverse events, and performance where available. Random-effects pairwise meta-analyses estimated risk ratios (RRs) with 95% CIs. Risk of bias was assessed with a modified RoB 2.0 tool; certainty of evidence was appraised using GRADE. Registration/protocol: this review extends a prior ENOVAT BRD protocol; no separate registration was created. Funding: COST Action CA18217. Results Seventeen RCTs (22 comparisons; 4,909 animals) compared NSAID+antimicrobial versus antimicrobial alone. Adding an NSAID did not reduce re-treatment (RR 0.94, 95% CI 0.84–1.05; I 2 = 0%; moderate certainty). Subgroup (same vs different antimicrobial) and sensitivity analyses (handling of multi-arm trials; follow-up restricted to ≤14 or ≤ 10 days; risk-of-bias restrictions) did not change conclusions. Two RCTs in UK dairy calves compared NSAID monotherapy with antimicrobial monotherapy (RR 1.19, 95% CI 0.72–1.97; very low certainty). Re-treatment is an indirect outcome and may not capture analgesia, fever reduction, or growth effects. Conclusions Across RCTs, NSAID use did not confer a clinically relevant reduction in re-treatment when added to antimicrobials, and evidence is very uncertain for NSAID monotherapy versus antimicrobials. Future trials should include validated pain/welfare measures, clinical and ultrasonographic outcomes, and performance metrics, with pathogen identification to explore effect modification.

Bovine respiratory disease (BRD) is a leading cause of illness and death in cattle and a major driver of antimicrobial use. This systematic review and meta-analysis assessed the clinical effectiveness of five commonly used antimicrobial classes (penicillins, tetracyclines, phenicols, macrolides, and fluoroquinolones) in the treatment of cattle with natural BRD. Cattle from all production systems (feedlot, dairy, slaughter, and stocker) were included, and metaphylaxis trials were excluded. Peer-reviewed trials were searched in several databases, and all reports were screened in duplicate for data extraction and risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was employed to evaluate the certainty of evidence. Twenty-eight randomized controlled trials were included in the final analysis, and no pairwise comparison between antimicrobial classes showed a clinically meaningful effect in reducing the need for re‑treatment. The results were consistent in the subgroup analysis of different production systems (feedlot and non-feedlot) and in trials with Mycoplasma positive animals. Mortality, relapse, and growth outcomes were measured inconsistently and could not be reliably pooled. Overall, certainty ranged from very low to moderate, largely due to indirectness of the outcomes and risk of bias. These findings suggest that commonly used antimicrobial classes have broadly comparable short-term therapeutic performances, without any apparent advantage for those classified as high-priority, critically important antimicrobials in human medicine. The results of this systematic review and meta-analysis will inform the BRD Antimicrobial Use Guidelines of the European Network for Optimization of Antimicrobial Therapy (ENOVAT).

Background/Objectives: As part of the European Union’s harmonized monitoring framework, Belgium conducts antimicrobial resistance (AMR) monitoring in commensal bacteria from livestock. The aim of this study was to conduct a cost analysis of the national AMR monitoring in livestock, and to explore sampling size scenarios in relation to their associated costs and statistical performance (power and confidence) of monitoring. Methods: To our knowledge, this is the first published cost evaluation using unit cost aggregation of a national AMR monitoring program in animals. Results: The testing of the different sample size scenarios showed that if the sample size increases, the costs increase linearly. A sample size increase of 10 samples/isolates (e.g., from 170 to 180) can increase the yearly total costs per animal species by 5.2%. Moreover, the testing of the different scenarios showed that if the sample size increases, the power and the confidence level also increase, providing a higher level of trust in the results of the monitoring program. The highest total monitoring costs per animal category were estimated for fattening pigs, broilers and veal calves (over 18% of total costs each, using 2024 data). Among the various monitoring activities, antimicrobial susceptibility testing emerged as the costliest component, representing 50.2% of the total monitoring costs. Conclusions: The approach presented allows it to be used by other countries aiming to estimate the cost of their national AMR monitoring in animals or other similar activities. This economic and scenario testing analysis can be used to suggest informed suggestions to improve AMR monitoring in animals.

Linezolid is a critically important antimicrobial used in human medicine. While linezolid is not licensed for food-producing animals, the veterinary use of other antimicrobials, such as phenicols (e.g., florfenicol), could cross/co-select for linezolid-resistant (LR) bacteria. Such LR strains pose a great concern for public health due to their potential transfer between animals and humans. This study explored possible associations between epidemiological risk factors, including phenicol use, and the occurrence of LR bacteria, such as enterococci and staphylococci, in poultry, pigs, and veal calves in Belgium. Florfenicol use significantly increased the likelihood of harboring LR bacteria in veal calves, sows, and fattening pigs, particularly for the digestive tract (odds ratio (OR): [3.19–5.29]) and the respiratory tract (OR: [6.11–9.09]). LR strains from feces from fattening pigs were significantly associated with production type (OR: [3.31–44.14]) and the presence of other animal species (OR: 0.41). The occurrence of LR strains in the respiratory tract from sows was also significantly associated with using antimicrobials other than florfenicol (OR: 10.07) and purchasing animals (OR: 7.28). Our study highlights the potential risks of using certain veterinary antimicrobials, such as florfenicol, in food-producing animals and emphasizes the need for responsible antimicrobial use to safeguard both animal and public health.

(1) Background. Antimicrobial resistance (AMR) poses a substantial global health threat with profound economic implications. Acknowledging the imperative for a One Health (OH) strategy to combat this menace, Belgium introduced an annual national OH report, known as the “BELMAP report,” encompassing antimicrobial use (AMU) and AMR, with the first edition completed in 2021. The integration of innovations for the healthcare system demands a meticulously planned process. (2) Methods. We introduced a three-step stakeholder analysis (SA) as a prospective framework for navigating this new report process, fostering complementary collaboration, pinpointing obstacles, suggesting approaches to overcome them, and facilitating national policy development. The SA unfolds in three steps: stakeholders identify and list their relevant activities, assess their positions regarding the BELMAP report, and complete “actor mapping” of national AMR and AMU stakeholders. (3) Results. Stakeholder identification reveals a fragmented landscape of AMR and AMU activities across Belgium. Assessment of stakeholder positions uncovers diverse expectations, collaborative challenges, and resource considerations. “Actor mapping” identifies key stakeholders, emphasizing the importance of high-interest and high-power actors. (4) Conclusions. This SA approach not only provides insights into the present stakeholder landscape in Belgium, it can also serve as a blueprint for other countries in the process of developing OH reports.