RESUMO
BACKGROUND: There has been an increased focus on antimicrobial stewardship (AMS) within the animal health domain (World Health Organization, 2015; O'Neill, 2016). Evidence of the effectiveness of interventions designed to enhance AMS is essential to support the development of this practice. This scoping review summarises for the first time the extent, range, and nature of global research activity on approaches for improving AMS in farmers and veterinarians involved in livestock farm animal management, health & well-being. METHODS: In November 2017 AGRICOLA, CAB Abstracts, EMBASE, MEDLINE, VetsRev and the Web of Science were searched. Studies were selected by two reviewers with 30 % of excluded and all included studies being independently reviewed by another reviewer. Inclusion criteria were primary studies or literature reviews focusing on antimicrobial use (AMU) in farming or veterinary practices for food-producing animals. Outcomes were changes in, or factors influencing farmers' or veterinarians' AMS. Exclusion criteria were studies on wild or companion animals or reports of the level of, rather influencing factors for AMS, or knowledge/awareness related to antimicrobial resistance (AMR). Study characteristics and relevant outcomes were extracted, identified facilitators and barriers grouped into categories, and a narrative synthesis was conducted. The PRISMA checklist extension for scoping reviews was used to guide the reporting of the review. RESULTS: 52 studies were included in the review; seven were intervention studies and 45 were studies of facilitators and barriers of AMU or antimicrobial prescribing (AMP). Studies were predominantly from high-income countries with only seven studies from low- or middle-income countries. Evidence for effective interventions was limited in terms of number of studies and robustness of evidence. There was some effect for an educational intervention in European cattle farmers and the Yellow Card scheme for Danish pig farmers. Significant facilitators to veterinarians' prudent AMP, in the cattle and pig livestock sector, included education, veterinarians' positive attitudes towards AMU reduction, and diagnostic. For farmers, significant facilitators to reduction of AMU were most frequently related to farming management practices. CONCLUSION: This review describes a scarcity of robust study designs and recommendations can be confidently made for better designed studies. Furthermore, greater consideration needs to be given to the outcome measures used in such studies. Nevertheless, the review summarises the evidence on the effectiveness of interventions and significant facilitators to farmers' and veterinarians' AMS, which can provide best currently available evidence to guide improvements in different livestock sectors.
