; and (ii) is composed wholly or partly of— (I) any kind of penicillin, tetracycline, macrolide, lincosamide, streptogramin, aminoglycoside, sulfonamide, cephalosporin, or fluoroquinolone, or any drug included in the list pursuant to updates under subparagraph (B); or (II) a drug from an antimicrobial class that is listed as highly important , critically important , or important in Appendix A of the Guidance for Industry entitled, Evaluating the Safety of Antimicrobial New Animal Drugs with Regard to Their Microbiological Effects on Bacteria of Human Health Concern (or any successor guidance). (B) Review and updates The Secretary shall conduct periodic reviews of the drugs included in the list described in subparagraph (A)(ii)(I), and add to or remove from such list any drugs that the Secretary determines appropriate. A review shall be undertaken at the Secretary’s discretion, but not less than once every five years. . 4. Veterinary oversight of use of medically important antimicrobials (a) In general A valid veterinarian-client-patient relationship should exist to ensure that medically important antimicrobials are used in food-producing animals in a manner that is consistent with professionally accepted best practices. (b) Veterinarian-Client-Patient relationship In this section, the term veterinarian-client-patient relationship means a relationship in which all of the following criteria are met: (1) The veterinarian has assumed the responsibility for making medical judgments regarding the health of the patient and the client has agreed to follow the veterinarian's instructions. (2) The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient. This means that the veterinarian is personally acquainted with the keeping and care of the patient by virtue of— (A) a timely examination of the patient by the veterinarian