Page 632 - ONLINE PROCEEDING BOOK WSAVA 2017
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An Urban Experience
WSVA7-0537
MISCELLANEOUS
ANTIMICROBIAL STEWARDSHIP IN COMPANION ANIMAL PRACTICE- WHERE ARE WE NOW?
J. Sykes1
1University of California- Davis, Department of Medicine & Epidemiology, Davis, USA
ANTIMICROBIAL STEWARDSHIP IN COMPANION ANIMAL PRACTICE
The expansion of antimicrobial-resistant bacterial populations that contribute to infections in small animal practice is of increasing concern to practitioners, academicians, and public health of cials. The isolation of antimicrobial-resistant pathogens is associated with poorer patient outcomes, higher costs of treatment, and longer hospital stays. Some of these organisms are capable of infecting humans in contact with infected or colonized pets.
In the United States, several efforts have been made to try to reduce the overall quantity of antimicrobial drugs used and to help practitioners select the most appropriate antimicrobial drug for a particular infection. These efforts include the development of speci c antimicrobial use guidelines for different infections
by the International Society for Companion Animal Infectious Diseases (ISCAID),1,2 an American College
of Veterinary Internal Medicine (ACVIM) Consensus Statement on antimicrobial use,3 and the assignment of an Antimicrobial Stewardship Taskforce for Companion Animal Practice to develop a stewardship program by the American Veterinary Medical Association (AVMA).4
It should be noted that some of the recommendations in these guidelines as well as the following notes include treatments that are off-label, but are based
on their known in vitro or in vivo activity against speci c pathogens, as well as consideration of drug pharmacokinetics and adverse effects.
Activities of the AVMA taskforce have included:
1. Performing a survey of practitioners’ thoughts on antimicrobial use5
2. Performing a survey of laboratory practices relating to susceptibility testing
3. Developing a “do’s and don’t’s” list for antimicrobial use
4. Supporting the development of local and regional antibiograms (An antibiogram provides information on the prevalence of resistance to certain antimicrobials in different populations of bacteria and can help guide practitioners’ decisions in selecting antimicrobials in their local area.)
5. Providing a comparison of susceptibility test results across multiple veterinary teaching hospitals
6. Creation of a core stewardsip document and associated educational materials and resources for practitioners and clients addressing appropriate antimicrobial use
What Is Antimicrobial Stewardship?
Antimicrobial stewardship is an effort to consider the bene t of antibiotic use to the patient while minimizing the development of antibiotic resistance and adverse effects in the patient from unnecessary therapy.
Antimicrobial Stewardship Programs in Human Health
In human hospitals, antimicrobial stewardship programs are multi-pronged efforts that include prescriber education, hospital formulary restriction; a requirement for antibiotic use approval for certain drugs before dispensing, streamlining, or de-escalating therapy;
and computer-assisted programs that track use
and antimicrobial resistance while providing clinician guidance. These programs have generally led to a reduction in the percentage of antibiotic-resistant organisms in hospitals, improved patient outcomes, and reduced costs.
Antimicrobial Stewardship Programs for Veterinary Practices
For smaller veterinary practices, an antimicrobial stewardship program can be much simpler. At a minimum, an antimicrobial stewardship program in
a companion animal practice is simply an attitude toward antimicrobial use that effects re ection on their appropriate use. Whenever antibiotics are considered for a patient, alternative therapies should be considered and the necessity of antibiotic use should be substantiated. Then, for every antibiotic dispensed, the name, dose, route, and duration of treatment should be noted in the record, as well as the indication for the antibiotic. Of relevance, a study that looked at prescribing behavior by referring veterinarians for the year before patient referral to a veterinary teaching hospital in the United States found that for 197 of 549 cases examined, the duration of administration of antibiotics that had been prescribed was not noted in the record and that dose and route of administration were frequently not included.6 After 48- 72h hours, a “timeout” should be taken (i.e., a period of reconsideration) to re-evaluate the need for an antibiotic; the dose, frequency, duration, and indication; and whether its de-escalation or discontinuation is indicated.
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42ND WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS AND FECAVA 23RD EUROCONGRESS


































































































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