Clair L. Firth

Animal disease outbreaks at the wildlife-livestock interface threaten animal health, ecosystems, food systems, and, for zoonoses, human health, while veterinary authorities must maintain preparedness with limited resources. However, existing preparedness tools characterize capacity, exposure, or risk largely in isolation. This study developed a framework to assess whether preparedness is commensurate with disease-specific challenge. Questionnaire-derived Preparedness capacity for 26 European countries was estimated using Item Response Theory and adjusted for socioeconomic and governance context. Context-adjusted preparedness was then compared with disease-specific Challenge Indices combining livestock population, livestock density, animal imports, and wildlife reservoir abundance, for two diseases at the wildlife-livestock interface: avian influenza (AI) in domestic poultry and African swine fever (ASF) in domestic pigs. Countries were classified into four Preparedness-Challenge profiles and summarized regionally, with uncertainty propagated by Monte Carlo simulation and decomposed by variance-based sensitivity analysis. The Underprepared (high challenge) profile included 9 countries for AI and 10 for ASF and was the most common profile in Southern and Western Europe for both diseases, and in Central Europe for ASF. Livestock weighting sharpened this pattern, with this profile holding 66-91% of poultry and 79-97% of pigs in Central, Southern, and Western Europe. In Northern Europe, 76% of pigs were in the Prepared (high challenge) profile. Preparedness estimation was the largest source of uncertainty in country-level classifications and regional AI results, whereas Challenge Index weighting dominated regional ASF results. Countries with less preparedness relative to their challenge tended to have greater recorded outbreak burden (concordance probability: AI 0.63-0.70 for continuous burden measures, ASF 0.58-0.85 for all measures). Preparedness gaps were therefore disease-specific, and unweighted country summaries obscured where livestock exposure was concentrated. Disease-specific, livestock-weighted comparisons offer veterinary authorities a transparent basis for prioritizing preparedness investment, complementing established One Health tools.

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).

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: Antimicrobial resistance (AMR) is a critical global health issue, with antimicrobial use (AMU) in veterinary medicine playing a relevant role in its emergence. This study aimed to evaluate the knowledge, attitudes and practices of Austrian veterinarians regarding AMU and AMR. Methods: An online survey was conducted in 2022. Veterinary respondents were grouped according to their type of practice (companion animals, i.e., pets and horses; farm; mixed practice). Results: Knowledge gaps were identified, particularly among companion animal veterinarians, with only 31% correctly recognising cefovecin as a critically important antimicrobial and 16% incorrectly stating it was a first‐choice drug. However, treating groups of animals with orally administered antibiotics was correctly classed as having the highest influence on AMR by 75% of 165 respondents. With respect to deciding to use antibiotics, all practitioners considered a clinical examination to be important or very important, while cost considerations and owner expectations were classed by companion animal practitioners as being significantly less important than among farm and mixed practitioners. Of all 180 veterinarians, 47% reported using antimicrobial susceptibility testing always or regularly (approximately 20%‒50% of antibiotic treatments). Limitations: The small sample size may have introduced confirmation bias, as practitioners with a particular interest in AMU and AMR may have been more likely to respond to the survey. Conclusion: The findings confirm the need for additional training to improve prudent AMU and awareness of antimicrobial stewardship in clinical practice across all veterinary sectors in Austria. Future efforts should prioritise the knowledge gaps among companion animal practitioners, in particular.

Knowledge of common diseases and their treatment in minor species, such as llamas and alpacas, is growing, but frequently drugs are not licensed in these species. Our aim was to evaluate frequent diagnoses and commonly applied antibiotics in patients of a university clinic with a particular focus on EMA Category B antibiotics, which are critically important for human health. We retrospectively analyzed anonymized patient records between 2005 and 2019 regarding the causes for antibiotic treatment and choice of antibiotic substance. The most frequent indications for antibiotic treatment were diseases of the digestive tract and perioperative prophylaxis for castrations. The number of applications of EMA Category B antibiotics initially increased with the number of patients treated, then remained stable, while the use of Category D drugs increased over time. Most Category B antibiotics were used for diseases of crias and diseases of the digestive tract, primarily dental disease. The use of EMA Category B antibiotics cannot be completely avoided based on the types of cases treated. However, antibiotic stewardship guidelines should be followed wherever possible.

Background: Monitoring antibiotic use is essential to provide a framework enabling veterinarians to use antibiotics prudently. Methods: Electronic medical records from the University of Veterinary Medicine's Clinic for Ruminants in Vienna were analysed with respect to sheep and goat antibiotic doses administered over a 15‐year period (2005–2019). Antibiotic use was assessed using total milligrams per kilogram (mg/kg), total milligrams, number of doses administered, defined daily doses (DDD) for cattle and estimated DDD for sheep. Results: A total of 5113 antibiotic doses were recorded over the 15‐year period. Urinary tract disorders required the highest number of doses administered per animal (mean 16.9; median 16.0). Antibiotic use patterns varied according to the metrics used for analysis. By mg/kg, the largest proportion of antibiotics administered were penicillin/streptomycin (43.0% of the total mg/kg), followed by tetracyclines (17.3%) and sulphonamide/trimethoprim combinations (15.2%). By number of doses administered, the most frequently used antibiotics were penicillins (excluding combinations with streptomycin) (33.9% of total number of doses administered), fluoroquinolones (25.1%), third/fourth‐generation cephalosporins (13.6%) and penicillin/streptomycin (13.4%). Limitations: As the university clinic was a city‐based referral centre, this analysis cannot be compared directly with antibiotic use in commercial herds or flocks. Conclusions: The considered choice of antibiotic use metrics is essential for an effective and meaningful analysis of the responsible use of antibiotics by veterinarians in practice.

The aim of this study was to investigate the prevalence of ESBL/AmpC-producing E. coli and the resistance pattern of commensal E. coli, as well as the link between the use of antibiotics (AMU) and the occurrence of resistance in E. coli on Austrian dairy farms. AMU data from 51 farms were collected over a one-year period in 2020. Fecal samples were collected from cows, pre-weaned and weaned calves in 2020 and 2022. Samples were then analyzed using non-selective and selective agar plates, E. coli isolates were confirmed by MALDI-TOF analysis. Broth microdilution was used for antimicrobial susceptibility testing. The AMU of each farm was quantified as the number of Defined Daily Doses (nDDD_vet) and Defined Course Doses (nDCD_vet) per cow and year. Cephalosporins (mean 1.049; median 0.732 DDD_vet/cow/year) and penicillins (mean 0.667; median 0.383 DDD_vet/cow/year) were the most frequently used antibiotics on these farms, followed by tetracyclines (mean 0.275; median 0.084 DDD_vet/cow/year). In 2020, 26.8% of the E. coli isolated were resistant to at least one antibiotic class and 17.7% of the isolates were classified as multidrug resistant (≥3 antibiotic classes). Out of 198 E. coli isolates, 7.6% were identified as extended-spectrum/AmpC beta-lactamase (ESBL/AmpC) producing E. coli. In 2022, 33.7% of E. coli isolates showed resistance to at least one antibiotic and 20.0% of isolates displayed multidrug resistance. Furthermore, 29.5% of the samples carried ESBL/AmpC-producing E. coli. In 2020 and 2022, the most frequently determined antibiotic resistances among commensal E. coli isolates were to tetracyclines, sulfonamides and penicillins. In addition, pre-weaned calves had the highest resistance rates in both years. Statistical analyses showed a significant association between low and high use AMU classifications for penicillins (in nDDD_vet/cow/year) and their respective resistance among commensal E. coli isolates in 2020 (p = 0.044), as well as for sulfonamide/trimethoprim (p = 0.010) and tetracyclines (p = 0.042). A trend was also noted between the total amount of antibiotics used on farm in 2020 (by nDDD_vet/cow/year) and multidrug resistances in commensal E. coli isolated on farm that year (p = 0.067). In conclusion, the relationship between AMU and antimicrobial resistance (AMR) on dairy farms continues to be complex and difficult to quantify.