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An Urban Experience
The impact of the CPG on antibiotic consumption is dif cult to separate from other events, and the overall experience from both countries is that publishing guidelines alone has limited impact. In Sweden, the guidelines lived a life in silence until the  rst MRSP isolates in companion animals were isolated in 2006. This MRSP/MRSA outbreak created awareness on antibiotic resistance among companion animal practitioners, and led to numerous talks around the country on prudent AB use and infection control. Talks were mainly organized
by the Swedish National Veterinary Institute (SVA) in response to demands from clinicians. Between 2006 and 2016 Sweden moved from being the highest to the lowest antibiotic consuming country in Scandinavia. It
is worth noticing that the MRSP/MRSA outbreak made the implementation of guidelines and infection control a bottom-up process in Sweden, which may partly explain the success of the Swedish antibiotic policy.
In contrast to Sweden, there appeared to be a small, more immediate but less sustained effect of the Danish guidelines. The initial effect is probably explained
by the activities around the time of the launching including inauguration of the guidelines at the national veterinary conference, distribution of the hard copy booklet by mail to all members of the Danish Small Animal Veterinary Association (DSAVA) and a campaign on prudent antibiotic use in skin and gastrointestinal infections. The effect of campaigning activities was also apparent in a recent survey among Danish practitioners showing a high degree of adherence to guidelines for skin diseases(8). The current challenge in Denmark is to re-create awareness of antibiotic resistance, and
to promote the role of infection control and prudent antimicrobial use. The effort must be continuous to ensure a sustained response.
Future directions:
The experience from Sweden and Denmark shows that national guidelines carry a real potential for promoting rational antibiotic use if supported by proper dissemination strategy and campaign activities.
The emergence of antibiotic resistant bacteria in companion animals in Europe calls for action throughout the region. The ESCMID Study Group of Veterinary Microbiology (ESGVM) has therefore launched an initiative on the development of European antibiotic use guidelines in companion animals. European guidelines may support national and local guideline makers when writing recommendations on diagnostic procedures and therapy of common bacterial infections.
Acknowledgement: Oscar Nilsson from SVA and Ulrika Grønlund from Anicura Group for helping out with the Swedish data and Vibeke Frøkjær Jensen from the Danish Technological University (DTU) for assisting with the Danish data.
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