Quantification of Antimicrobial Use on Commercial Broiler Farms in Pakistan

Pakistan has a large, intensive broiler production industry, where antimicrobials are extensively used for both therapeutic and prophylactic purposes. Monitoring antimicrobial use (AMU) at the farm level is crucial to guide interventions for antimicrobial stewardship. The objective of this study was to comprehensively quantify AMU on commercial broiler farms in Pakistan using different metrics. Data on on-farm AMU (both therapeutic and prophylactic) were collected from intensive commercial broiler farms in Punjab, Pakistan. AMU was quantified using four different metrics: treatment incidence (TI) based on defined daily dose (TIDDD_vetPK), TI based on defined course dose (TIDCD_vetPK), TI based on used daily dose (TIUDD_vetPK), and mg/kg biomass. The median TIDDD_vetPK, TIDCD_vetPK, TIUDD_vetPK, and mg/kg biomass values were 57.7 (7.5-257.9), 13.3 (1.8-52.5), 75.3 (21.1-182.9), and 301 (46.8-1009.6), respectively, based on 741 group treatments given at 100 participating farms with 225 flocks. About 34% treatments were administered for therapeutic purposes, with 66% administered as prophylaxis. A total of 41 active substances, distributed across 17 antimicrobial classes, were identified from 139 commercial antimicrobial products used. The most commonly used active substances (AS), out of total 741 group treatments, were colistin (polymyxins) at 17%, enrofloxacin (quinolones) at 8%, neomycin (aminoglycosides) and amoxicillin (aminopenicillins) at 7% each, and procaine penicillin (NS penicillins) and streptomycin (aminoglycosides) at 6% each. According to the WHO categorization, 57% of the used AS were found to be critically important antimicrobials (CIAs) for human medicine. As many as 30% of treatments were administered in the first week (13% on the first day of production), and the main indication was prophylaxis for early chick mortality, followed by 21% in week 5, with main indication being feed supplements for necrotic enteritis. The average weight at slaughtering was 2.25 kg, gained after an average of 44 days of the production cycle. The alarmingly high AMU in Pakistani broiler production emphasizes the urgent need to reduce AMU, particularly involving CIAs and the prophylactic use of antimicrobials. This can be achieved by improving farm management practices and strengthening regulatory oversight to enable prudent antimicrobial use, eventually reducing the risk of AMR.