Appraisal of the Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery in dogs and cats

Abstract

The Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery on dogs and cats are evidence-based guidelines for veterinary practitioners. Validation of these guidelines is necessary to ensure quality and implementability. Two validated tools, used for medical guideline appraisal, were chosen to assess the guidelines. The terminology from the GuideLine Implementability Appraisal (GLIA) and the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) were adapted for use by veterinarians. A two-phase evaluation approach was conducted. In the first phase of the evaluation, the GLIA tool was used by two specialist veterinary surgeons in clinical practice. The results of this phase were then used to modify the guidelines. In the second phase, the AGREE II tool was used by 6 general practitioners and 6 specialists to appraise the guidelines. In phase 1, the specialist surgeons either agreed or strongly agreed that the guidelines were executable, decidable, valid and novel, and that the guidelines would fit within the process of care. The surgeons were neutral on flexibility and measurability. Additional clarity around one common surgical procedure was added to the guidelines, after which the surgeons agreed that the guidelines were sufficiently flexible. In phase 2, 12 veterinarians completed the assessment using the AGREE II tool. In all sections the scaled domain score was greater than 70%. The overall quality of the guidelines was given a global scaled score of 76%. This assessment has demonstrated that the guidelines for antimicrobial prophylaxis for companion animal surgery are valid and appear implementable.

Antimicrobial prescriptions and adherence to prudent use guidelines for selected canine diseases in Switzerland in 2016

“…In this study, two-thirds of dogs with AD received antimicrobials even though dogs with parvovirosis were excluded from the analysis. Current guidelines only recommend the use of antimicrobials in dogs with AD if clinical or laboratory signs consistent with sepsis are present,7–9 but in this cohort, the use of antimicrobials was not significantly associated with the presence of sepsis. Instead the use of antimicrobials was clearly associated with the presence of haemorrhagic diarrhoea.…”

“…If kennel cough is associated with a poor general condition, fever or signs of lower airway involvement, doxycycline is recommended as first-line empirical treatment. Doxycycline is well tolerated by dogs and has good in vitro activity against canine isolates of Bordetella bronchiseptica 7–9 70 73…”

“…Antimicrobial prescriptions were compared with the recommendations summarised in table 2, which were based on existing consensus national and international guidelines 7–9 28. A previously published justification score (JS-1 to JS-4)33 was used with modifications to evaluate the appropriateness of the prescription in all cases where sufficient clinical information was available (table 3).…”

“…Small animal medicine therefore likely plays a significant role in the selection and dissemination of MDROs. To foster the prudent use of antimicrobials, guidelines have been created in both human and veterinary medicine 6–9…”

“…The aim of this study was to assess antimicrobial use in small animal medicine in Switzerland in 2016, before introduction of the antimicrobial stewardship tool AntibioticScout.ch. Four conditions in dogs for which antimicrobials are frequently prescribed, including acute diarrhoea (AD), urinary tract infections (UTI), respiratory tract infections (RTI) and wound infections (WI), were selected to describe prescription habits of veterinarians and their accordance with national and international prudent use recommendations 7–9 28…”