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News Article

Strategies for reducing the use of critically important antimicrobials in pets

Antimicrobial stewardship interventions are needed in companion animal practice

A trial by the University of Liverpool’s Small Animal Veterinary Surveillance Network (SAVSNET) has demonstrated effective strategies for reducing the prescription of critically important antimicrobials in veterinary practice. The findings are published in Nature Communications.

Highest priority critically important antimicrobials (HPCIAs) are frequently prescribed to companion animals, despite recommendations this group of antimicrobials should be largely reserved for human use. Companion animals are increasingly being recognised as an important contributor to the development, carriage and transmission of antimicrobial resistant (AMR) bacteria both between animals and to/from humans, primarily due to frequent antimicrobial prescription driving selection for resistance.

“Use of antimicrobials is a key driver for development of AMR. It is vital that the veterinary profession embraces the responsible use of antimicrobials, to safeguard human and animal health and to preserve the right to prescribe certain antimicrobials that are important in human medicine. Of these, the highest priority critically important antimicrobials (HPCIAs), including fluoroquinolones and third-generation cephalosporins, are considered of greatest importance by the World Health Organisation,” explained lead researcher Dr David Singleton.

HPCIAs are frequently prescribed as first-line agents in companion animal practice, particularly to cats. Such antimicrobials should only be used third-line in response to clear evidence of likely or demonstrated treatment failure to other antimicrobials. In recognition of this issue, SAVSNET collaborated with one of the largest integrated veterinary services providers in the UK, CVS Group, on a randomised controlled trial to see if prescription of HPCIAs could be reduced.

Relatively high frequency HPCIA prescribing veterinary practices were randomly placed into three trial arms: a control group, light intervention group and heavy intervention group, consisting of 20 veterinary practices in each group. The heavy group were allowed to volunteer to participate in the trial, to which most agreed.

Light and heavy intervention groups were informed of their outlier status and were offered either remote (light group) or in-person (heavy group) support, in addition to their existing access to the SAVSNET portal which offers free benchmarking for antimicrobial prescription. CVS practice teams in the heavy group were asked to reflect on their HPCIA prescription and clinical decision-making to develop their own systems to promote responsible prescribing.

Over eight months following initial intervention both intervention groups were associated with a significant post-intervention decrease in HPCIA prescription frequency in cats; the light group by 17% and the heavy group by 40%. In dogs, the only significant decrease was seen in the heavy group, which decreased HPCIA prescription frequency by 23%.

“This trial demonstrates that companion animal veterinary practitioners respond to notification of being outside of a ‘social norm’ (i.e. being a high frequency HPCIA prescriber), and are responsive to involvement in structured antimicrobial stewardship programmes,” said Dr Singleton.

The findings of the study are being used to inform development of a national veterinary antimicrobial stewardship scheme in collaboration with SAVSNET, CVS Group and RCVS Knowledge.

Article: Singleton, D. A., Rayner, A., Brant, B., Smyth, S., Noble, P. M., Radford, A. D., Pinchbeck, G. L. (2021). A randomised controlled trial to reduce highest priority critically important antimicrobial prescription in companion animals. Nature Communications, 12, 1593, doi: 10.1038/s41467-021-21864-3

Article details

  • Date
  • 17 March 2021
  • Source
  • University of Liverpool
  • Subject(s)
  • Dogs, Cats, and other Companion Animals