Patterns of antimicrobial agent prescription in a sentinel population of canine and feline veterinary practices in the United Kingdom
Singleton, D.A. et al. (2017) Patterns of antimicrobial agent prescription in a sentinel population of canine and feline veterinary practices in the United Kingdom. The Veterinary Journal, 224 (June), pp. 18-24
Antimicrobial resistance is recognised as a global health threat and tackling the use of antibiotics is a high priority. As such, guidance for practice level prescription policies have been published. This study aimed to gauge the level of antimicrobial agent prescription (AAP) at practice level.
The study was carried out over a two year period, from 2014 to 2016, using Small Animal Veterinary Surveillance Network (SAVSNET) collected electronic health records (EHRs) from 216 volunteer UK veterinary practices (457 premises). A total of 918,333 canine EHRs (from 413,870 dogs) and 352,730 feline EHRs (from 200,541 cats) were used.
Key results included:
- The percentage of consultations where at least one antimicrobial agent was prescribed was 18.8% for dogs; 17.5% for cats
- The most frequently prescribed antimicrobial agent in dogs was clavulanic acid potentiated amoxicillin (28.6% of total AAP); and in cats was cefovecin, a third generation cephalosporin (36.2% of total AAP)
- The most frequently prescribed topical antimicrobial agent in dogs and cats was fusidic acid (44.3% of topical AAP in dogs, 55.1% in cats)
- The highest priority critically important antimicrobial agents (HPCIA) prescriptions were 5.4% of total AAPs in dogs and 39.2% in cats
- The most frequently prescribed HPCIAs in dogs were fluoroquinolones and in cats cefovecin
- Dogs were significantly more likely to be prescribed topical antimicrobial agents than cats
- Cats were significantly more likely to be prescribed systemic antimicrobial agents than dogs
- The number of AAP consultations decreased significantly over the course of the study within this population of cats and dogs.
- The AAP pattern was considerably different according to premises
- Premises that prescribed antimicrobial agents more frequently to dogs also tended to do the same for cats
- The main presenting complaints with the highest frequency of AAP were pruritus in dogs (51%) and trauma in cats (53.5%)
It is encouraging to see from this study that there was an overall reduction in AAP over the two year period of the study. However, continued monitoring of AAP is necessary as surveillance of AAP in human medicine has shown short-term temporal variations in prescribing patterns.
The most commonly prescribed antimicrobial agent in cats is a HPCIA, the third generation cephalosporin, cefovecin, which is a cause for concern. Cefovecin was frequently prescribed for cats with main presenting complaints for which the drug is indicated, such as pruritus and kidney disease, as well as complaints for which there is no indication according to its datasheet, such as respiratory and gastroenteric disease. Use of cefovecin is probably linked to its ease of administration and duration of action.
The most frequently prescribed antimicrobial in dogs was clavulanic acid potentiated amoxicillin. Fluoroquinolones were the most commonly prescribed HPCIA in dogs but only represented 5.4% of total AAPs.
To assist practitioners in assessing their own level of antibiotic prescription and benchmarking it against their peers, SAVSNET has launched a free service ‘mySavsnet-AMR’ (https://www.liverpool.ac.uk/savsnet/my-savsnet-amr/)
This study was not designed to evaluate whether antimicrobial prescriptions were appropriate or not and this would be an area for further study.
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