Cross-sectional survey on the use and impact of the Danish national antibiotic use guidelines for companion animal practice

Abstract

BackgroundThe Danish antibiotic use guidelines for companion animal practice were published by the Danish Veterinary Association in 2012. Since then, national surveillance data indicate a 10% reduction in the total use of antibiotics for companion animals, particularly a marked reduction in the use of third generation cephalosporins. The aim of the study was to assess if and how the guidelines have impacted diagnostic and antibiotic prescription habits of the users, and to identify user perceived barriers to implementation.ResultsAn online questionnaire was sent to all 882 members of the Danish Small Animal Veterinary Association in October 2015. The survey was completed by 151 veterinarians. Respondents most frequently consulted the recommendations on skin and urinary tract infections (UTI), and users generally reported a high degree of adherence to the recommendations. Sixty-five per cent indicated that the guidelines had influenced their habits in one or more of the areas being investigated, i.e. perioperative use of antibiotics, use of first line antibiotics for the treatment of pyoderma or UTI, and/or use of microbiological diagnostics. Perioperative use of antibiotics for clean surgeries was uncommon, irrespective of whether respondents had consulted the relevant recommendations or not. On the contrary, significant differences in the prescribing habits between guideline users and non-users were observed for pyoderma and UTI, suggesting an impact of the guidelines towards more prudent antimicrobial use. The diagnostic habits were examined in a subgroup of 63 guideline users. Of those, 19 and 39% reported frequent use of culture and susceptibility (C&S) testing prior to treating pyoderma and UTI respectively, whereas 68–84% reported C&S testing in the event of poor response to treatment or recurrence of infections. The main barriers for implementation of therapeutic recommendations were confidence in old prescribing practices and unavailability of recommended drugs. The main barriers for C&S testing were good experience with empiric treatment, and the owners’ financial situation.ConclusionsThe findings suggest a positive influence of the national antibiotic guidelines on prescription patterns among companion animal practitioners in Denmark. Sustained campaign activity is encouraged and should include promotion of bacteriological testing.Electronic supplementary materialThe online version of this article (10.1186/s13028-017-0350-8) contains supplementary material, which is available to authorized users.

Effects of Diagnostic Work‐Up on Medical Decision‐Making for Canine Urinary Tract Infection: An Observational Study in Danish Small Animal Practices

“…The majority of prescribed doses were in accordance with current guidelines. However, the duration of treatment was longer than recommended by the national Danish guidelines as well as international guidelines . Uropathogen resistance to recommended first‐line antibiotics in our population was low, with only 5% of E. coli displaying in vitro resistance to ampicillin and 5% to TMS, making the use of clavulanate inappropriate in the majority of cases.…”

“…The preferred empiric treatment among veterinarians was amoxicillin with clavulanate potassium as also reported by other studies,. This is incoherent with the Danish national guidelines, which recommends the use of un‐potentiated amoxicillin or TMS . The majority of prescribed doses were in accordance with current guidelines.…”

“…Appropriate COT was defined as (i) prescribing antibiotics to which the pathogen was in vitro susceptible (according to reference QBC), and (ii) choosing recommended first‐line agents over second‐line agents. The recommended first‐line agents in Denmark are amoxicillin or potentiated sulfonamides (TMS) …”

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

“…The barriers to implementation of such guidelines have not been investigated in veterinary medicine in Australia. Barriers to implementing similar guidelines have been evaluated in Denmark, with confidence in old prescribing practices, lack of availability of products, difficulties in dosing, cost, lack of time, the limited number of drugs available in practices and the difficulties owners experience in administering drugs all given as reasons for not adhering to the therapeutic recommendations . Similar responses seem likely to apply in Australia, although this needs further investigation and could follow full implementation of these guidelines.…”

Prescription rebellion: reduction of antibiotic use by small animal veterinarians

“…The effectiveness of antibiotic stewardship guidelines among vets has been examined in a veterinary hospital in Canada (Weese 2006) and after the introduction of National guidelines in Denmark (Jessen et al 2017). The BSAVA PROTECT ME guidelines were the most commonly cited resource by practices completing policies in line with the Practice Standard Scheme.…”