TABLE 1.
Antimicrobial classes and agents registered for human and veterinary use that are often screened in antimicrobial resistance surveillance programsa,b
| Antibacterial class and antibacterial (use in AMR surveillance) | Principal human use | Principal animal use |
|---|---|---|
| Narrow-spectrum penicillins | ||
| Benzylpenicillin (pen G) and phenoxymethylpenicillin (pen V) (AP) | Primary agents in pneumococcal and streptococcal infection | N/A |
| Procaine penicillin | Intramuscular—occasional substitute for benzylpenicillin | Primary agent for predominantly Gram-positive infections in a wide range of animals, mostly horses (often in combination with gentamicin) and livestock (intramuscular administration only) |
| Benzathine penicillin | Intramuscular—syphilis treatment and rheumatic fever prophylaxis | N/A |
| Penethemate hydriodide | N/A | Hydrolized to benzylpenicillin following injection for treatment of mastitis and respiratory and uterine infections, mainly in dairy cattle |
| Moderate-spectrum penicillins | ||
| Amoxycillin and ampicillin (AP, ZFP, AC) | Principal role in respiratory tract infections; widespread i.v. hospital use in combination for a range of moderate and serious infections; surgical and endocarditis prophylaxis | Broad-spectrum primary agent for a large range of infections in dogs and cats, horses, and livestock (oral or injectable) |
| Antistaphylococcal penicillin | ||
| Cloxacillin, dicloxacillin, and flucloxacillin (methicillin)Oxacillin (AP, ZP [MRSA/MRSP only]) | Standard treatment for Staphylococcus aureus infections (not MRSA)Surgical prophylaxis, especially orthopedics | Cloxacillin only: intramammary treatment of mastitis due to staphylococci and streptococci in dairy cattleOxacillin susceptibility used as a surrogate for MRSP identification in VDLs |
| Beta-lactamase inhibitor combinations | ||
| Amoxycillin-clavulanate (AP, ZP, ZFP, AC) | Second-line agent for respiratory tract infections; role in certain types of skin/soft tissue infections and mixed staphylococcal/Gram-negative infections and aerobic/anaerobic infections | Primary or second-line broad-spectrum agent in dogs and cats only (oral and injectable) for a wide range of infections (skin, soft tissue, and UTI)Intramammary formulation only for mastitis in dairy cattle |
| Piperacillin-tazobactam (AP) | Valuable agents for a range of severe mixed aerobic-anaerobic infections including intra-abdominal infections, aspiration pneumonia, skin/soft tissue infections.Neutropenic sepsis | N/A |
| First-generation cephalosporins | ||
| Cephalexin, cephalothin, and cephazolin (AP, ZP, ZFP, AC) | Treatment of minor and staphylococcal infections in penicillin-allergic patients Prophylaxis in orthopedic and other surgery | Primary agent for skin, soft tissue, and UTIs as well as surgical prophylaxis in dogs and cats only |
| Cephalonium/cephapirin | N/A | Intramammary treatment of mastitis due to staphylococci and streptococci in dairy cattle/intrauterine treatment for metritis in cattle |
| Second-generation cephalosporins and cephamycins | ||
| Cefaclor and cefuroxime-axetil | Treatment of respiratory infections in penicillin-allergic patients | Intramammary treatment of mastitis due to staphylococci and streptococci in dairy cattle |
| Cefoxitin (AP, ZP, ZFP, AC) | Useful antianaerobic activity, major role in surgical prophylaxis | N/A |
| Third-generation cephalosporins | ||
| Ceftriaxone (AP, ZP, ZFP, AC) | Major agent in severe pneumonia and meningitisUsed in selected cases for treatment of gonorrhea and alternative for prophylaxis of meningococcal infection | N/A |
| Cefotaxime (AP, ZP, ZFP, AC) | Major agent in severe pneumonia and meningitis | N/A |
| Ceftazidime (AP, ZP, ZFP, AC) | Restricted role in pseudomonal infection and neutropenic sepsis | N/A |
| Cefovecin (AP, ZP) | N/A | Reserve agent for skin, soft tissue, periodontal, and UTIs in dogs and cats only where compliance with oral medication is compromised (injection only) |
| Ceftiofur (AP, ZP, ZFP, AC) | N/A | Reserve agent for respiratory infections in cattleOff-label use for infections resistant to first-line therapies in individual food-producing animals (injection only) |
| Cefpodoxime (AP) | Broad-spectrum oral third-generation cephalosporin available in some countries | Reserve oral agent for skin, soft tissue, periodontal, and UTIs in dogs and cats only |
| Fourth-generation cephalosporins | ||
| Cefepime | Moderate-to-severe pneumonia, skin and soft tissue infections, complicated and uncomplicated UTIs (broad-spectrum) | N/A |
| Cefquinome (AP) | N/A | Reserve agent for respiratory infections in cattle and pigs, coliform mastitis in cattle |
| Carbapenems | ||
| Imipenem (AP, ZP, ZFP, AC), meropenem (AP, ZP, ZFP, AC), doripenem, and ertapenem | Very broad-spectrum reserve agents for multiresistant and serious Gram-negative and mixed infections | Use as a last resort option for multi-resistant Gram-negative infections in dogs has been reported |
| Tetracyclines/glycylcyclines | ||
| Doxycycline (AP), minocycline (AP), and demeclocycline | Major agents for minor respiratory tract infections and acneSupportive role in pneumonia for treating Mycoplasma and Chlamydia pneumoniae Malaria prophylaxis (doxycycline) | Doxycycline only: major primary agent for respiratory skin, soft tissue, urinary tract, and periodontal infections in dogs and cats including Mycoplasma and Chlamydia (oral only); occasional use of minocycline for MRSP |
| Chlortetracycline, oxytetracycline, and tetracycline (AP, ZP, ZFP, AC) | N/A | Major broad-spectrum primary agent for systemic infections in livestock |
| Tigecycline (ZFP, AC) | Reserve agent for multiresistant Gram-positive and some multiresistant Gram-negative infections | N/A |
| Glycopeptides | ||
| Vancomycin (AP, ZP, AC) | Drug of choice for serious methicillin-resistant staphylococcal infectionsReserve agent for enterococcal infection when there is resistance or penicillin allergy | N/A |
| Teicoplanin (AC) | Substitute for vancomycin if intolerance or outpatient i.v. therapyvanB vancomycin-resistant enterococcal infections | N/A |
| Aminoglycosides/aminocyclitols | ||
| Neomycin (including framycetin) (AP, AC) | Topical agent for skin infection and gut suppression. | Primary agent for enteric infections in livestock (oral form); broad-spectrum primary agent for a range of systemic infections in livestock and horses (parenteral form) |
| Gentamicin and tobramycin (AP, ZP, ZFP, AC) | Standard agents in combination for serious and pseudomonal infectionGentamicin used in combination for endocarditis | Gentamicin only: primary agent for broad-spectrum infections in horses (with penicillin); primary agent for short-term treatment of serious/life threatening infections in dogs and cats due to nephrotoxicityCannot be administered to livestock in Australia |
| Amikacin (AP, ZP, ZFP, AC) | Reserve agents for Gram-negatives resistant to gentamicin and tobramycin | Use as a last-resort option for multiresistant infections in companion animalsUse as a reserve agent for gentamicin-resistant infections in horses |
| Spectinomycin (AP, AC) | Spectinomycin only used for gonorrhea (infrequently) | Primary agent in combination with lincomycin for gastrointestinal and respiratory infections in pigs and broilers including mycoplasma (oral and injectable) |
| Streptomycin (AP, ZP, ZFP, AC) | Rare use in treatment of TB and enterococcal endocarditis | N/A |
| Apramycin (AP) | N/A | Primary agent for E. coli and Salmonella infections in calves, pigs, and broilers |
| Dihydrostreptomycin | N/A | Banned in livestock (except in oral or intramammary preparations) due to residue issues (apart from treatment of acute leptospirosis in cattle) |
| Sulfonamides and DHFR inhibitors | ||
| Trimethoprim (AP, ZP, ZFP, AC) | Treatment and prophylaxis of UTI | N/A |
| Trimethoprim-sulfamethoxazole (co-trimoxazole) (AP, ZP, ZFP, AC) | Minor infections, especially treatment and prophylaxis of UTIStandard for treatment and prophylaxis of Pneumocystis carinii infection and nocardiasisImportant for community-acquired MRSA infections | Trimethoprim-sulphonamide combinations are used as primary agents for broad-spectrum infections in livestock, horses, and dogs, including enteritis and pneumonia (oral and injectable) |
| Sulfadiazine, sulfadoxine, and sulfaquinoxaline | N/A | Oral sulfonamides (without trimethoprim) are also used for coccidiosis in poultry |
| Oxazolidinones | ||
| Linezolid (AP, ZP, AC) | Treatment of multiresistant Gram-positive infections, especially MRSA and VRE. | N/A |
| Macrolides | ||
| Azithromycin (ZFP) | Treatment of Chlamydia trachomatis infectionsMajor agent for treatment and suppression of atypical mycobacterial infection | Occasional use in dogs and cats for chlamydia/mycoplasma infection and foals for Rhodococcus infection (see erythromycin) |
| Clarithromycin | Treatment of minor Gram-positive infectionsMajor agent for treatment and suppression of atypical mycobacterial infection | Occasional use in dogs and cats for chlamydia/mycoplasma infection and foals for Rhodococcus infection (see erythromycin) |
| Erythromycin and roxithromycin (AP, ZFP, AC) | Treatment of minor Gram-positive, Chlamydia and Mycoplasma infections | Erythromycin only: livestock for respiratory infections and other serious systemic infections including mastitis; respiratory disease in broilers; administered to foals in combination with rifampicin for Rhodococcus infection |
| Spiramycin | Treatment of toxoplasmosis in pregnancy | Periodontal and other anaerobic infections in dogs and cats (with metronidazole) |
| Oleandomycin | N/A | Intramammary formulation in combination with neomycin and tetracycline for mastitis |
| Tulathromycin, gamithromycin, and tildipirosin (AP) | N/A | Primary agent for respiratory infections in cattle and pigs |
| Tilmicosin, tylosin, and kitasamycin (AP) | N/A | Primary agent for respiratory infections in cattleTreatment and prevention of enteritis and respiratory diseases in cattle, poultry, and pigs (especially Lawsonia infection)Growth promotion in pigs |
| Lincosamides | ||
| Clindamycin and lincomycin (AP) | Reserved for Gram-positive and anaerobic infections in penicillin-allergic patientsClindamycin topical used for acne | Clindamycin: Gram-positive and anaerobic infections in dogs and cats including osteomyelitisLincomycin: oral or injectable in livestock for respiratory and enteric infections (often in combination with spectinomycin) |
| Streptogramins | ||
| Quinupristin with dalfopristin (AC) | Reserve agent for multiresistant Gram-positive infections (MRSA and vancomycin-resistant Enterococcus faecium). | N/A |
| Pristinamycin | As for quinupristin-dalfopristin | N/A |
| Virginiamycin | N/A | Laminitis prevention in horses, rumen acidosis prevention in cattle, necrotic enteritis prevention in broilers |
| Quinolones/Fluoroquinolones | ||
| Naladixic acid (ZFP, AC)Ciprofloxacin (AP, ZP, ZFP, AC) | First-generation quinolone no longer used in human medicineMajor oral agent for the treatment of Gram-negative infections resistant to other agentsMinor role in meningococcal prophylaxis | N/A (often included in AMR surveillance as an indicator of reduced susceptibility to the quinolone class)N/A |
| Moxifloxacin | Restricted role in the management of serious respiratory infections, especially pneumonia in patients with severe penicillin allergy | N/A |
| Enrofloxacin, marbofloxacin, and pradofloxacin (AP, ZP) | N/A | Reserve agents for treatment of Gram-negative serious, chronic or life-threatening infections in dogs, cats, and occasionally horses and exotics, treatment of complicated pyoderma due to mixed infectionsRespiratory infections in feedlot cattle; historic use in poultryCannot be administered to food-producing animals in Australia |
| Ansamycins | ||
| Rifampicin (rifampin) (AP, ZP) | Meningococcal and H. influenzae type b prophylaxisStandard part of TB regimensImportant oral agent in combination for MRSA infections | Used in combination with a macrolide for treatment of Rhodococcus infection in foals |
| Bacitracin and gramicidin | Topical agents with Gram-positive activity | Treatment and prevention of necrotic enteritis in poultry, topical agents for mucocutaneous infections in companion animals (Gram-positive) |
| Polymyxins | ||
| Colistin (ZFP, AC) | Reserve agent for very multiresistant Gram-negative infection (both inhaled and intravenous) | N/A |
| Phenicols | ||
| Chloramphenicol (AP, ZP, ZFP, AC) | Usage largely as topical eye preparationOccasional need for the treatment of bacterial meningitis. | Reserve agent for multiresistant infections in companion animals (dogs and cats only), especially E. coli and MRSP |
| Florfenicol (AP, ZP, ZFP, AC) | N/A | Respiratory infections in cattle and pigsOff-label use for multiresistant E. coli in pigs |
| Nitrofurans | ||
| Nitrofurantoin (AP) | Treatment and prophylaxis of UTIs only | N/A |
| Lipopeptides | ||
| Daptomycin (AP, ZP, AC) | Reserve agent for serious MRSA and VRE infections | N/A |
a
The table focusses on animal pathogens (AP), zooanthroponotic pathogens (ZP), zoonotic foodborne pathogens (ZFP), and animal commensal indictor organisms (AC). Adapted from Shaban et al. (11).
b
N/A, not applicable; i.v., intravenous; MRSP, methicillin-resistant Staphylococcus pseudintermedius; VDL, veterinary diagnostic laboratories; DHFR, dihydrofolate reductase; UTI, urinary tract infection; VRE, vancomycin-resistant enterococci; MRSP, methicillin-resistant Staphylococcus pseudintermedius.