ANTIMICROBIAL STEWARDSHIP

ANTIMICROBIAL STEWARDSHIP

Our microbiology department is involved in a joint project with the BSAVA and Vetoquinol regarding the appropriate use of antimicrobials, and Stephen has recorded a webinar for the BSAVA website as well as lecturing on this subject.  We have approached the BSAVA Regionals to ask if they may be interested in hosting this lecture series.

You may have heard the PM and CMO speaking in the media recently about the need for new antimicrobials. It is important, however, to keep in mind that the appropriate use of the ones we currently have available is of equal if not greater importance.

Antimicrobial stewardship deals with helping curtail the development and spread of multi-resistant bacteria through the appropriate use of antimicrobial agents.

In the current climate, the empirical prescription of antimicrobials, often repeatedly, is not advocated. It is no longer possible to ‘predict’ which antimicrobials are likely to be effective, even when in-house cytology has been performed. The empirical prescription of antimicrobials should really be reserved for those instances in which the situation is life threatening.

However, it is accepted that this is going to be a hard practice to break, and therefore the following key points should be kept in mind before prescribing empirically:

  • The cost of culture and sensitivity can often be far less than the greater ‘cost’ (in the wider sense) that may result from dispensing inappropriate drugs, often repeatedly.
  • Our microbiology reports provide comprehensive comment with respect to the isolates recovered, their antibiogram, and relevance of this to recent, current or intended antibiosis.
  • Before prescribing, ask yourself: ‘Is an antibiotic necessary at all, and, if it is, is the one I am about to prescribe appropriate?’
  • Non-potentiated penicillins (e.g. ampicillin, amoxicillin, etc) should be avoided unless susceptibility to them has been proven.
  • Cephalosporins should be reserved for use as second-line agents. This class of drug is very greatly overprescribed in primary care. Specialist veterinary dermatologists, who see the difficult skin and ear cases referred to them when all else has failed, have reduced their use of this class of drug by 70% in the past 12-months. These drugs are often used time after time without performing culture. They can select for meticillin resistant strains of staphylococci, and permit overgrowth by bacteria that are either innately resistant or which have acquired resistance to them.
  • Fluroquinolones are another group of antimicrobials much overused, and the inappropriate use of these is also aiding the spread of resistance. Current recommendations are that these should be reserved for use in deep pyoderma involving Gram-negative rods. They should not be prescribed empirically for systemic use, and should not be prescribed repeatedly without culture and sensitivity results. Again, use of these selects for meticillin resistant staphylococci and for development of resistance in other bacteria, both Gram-positive and Gram-negative.
  • The use of topical shampoos for pyoderma, or topical ear preparations for otitis, may be a useful alternative or adjunct therapy in many instances.
  • Practices are encouraged to develop their own set of guidelines for using antimicrobials.

If you would like further information, or for guidance with selecting antimicrobials, please call the laboratory.

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