Antimicrobial prescriptions in cats in Switzerland before and after the introduction of an online antimicrobial stewardship tool.

BACKGROUND: Antimicrobial stewardship activities are essential to improve prudent antimicrobial use. The aim of the present study was to evaluate changes in antimicrobial prescriptions in cats after the introduction of prudent use guidelines promoted by an online antimicrobial stewardship tool (AntibioticScout.ch) in Switzerland. Data from 792 cats presented to two university hospitals and 14 private practices in 2018 were included and compared to 776 cases from 2016. Cats were diagnosed with acute upper respiratory tract disease (aURTD), feline lower urinary tract disease (FLUTD) and abscesses. Clinical history, diagnostic work-up and antimicrobial prescriptions (class, dosage, duration) were assessed. Type and proportions [95% confidence intervals] of antimicrobial prescriptions were compared between the two evaluation periods and a mixed effects logistic regression model was applied to evaluate compliance with Swiss prudent use guidelines. RESULTS: From 2016 to 2018, the proportion of antimicrobial prescription in all included cases decreased from 75.0% [71.8-78.0] to 66.7% [63.3-69.9]; this decrease was most pronounced for treatments at university hospitals (67.1% [59.5-74.0] to 49.3% [40.9-57.8]) and for cats with FLUTD (60.1% [54.6-65.4] to 48.8% [43.2-54.4]). Use of 3rd generation cephalosporins in private practices declined from 30.7% [26.5-35.1] to 22.1% [18.4-26.2], while overall use of non-potentiated aminopenicillins increased from 19.6% [16.4-23.0] to 27.8% [24.1-31.9]. In cases where antimicrobial therapy was indicated, compliance with guidelines did not increase (33.3% [26.6-40.6] to 33.5% [27.2-40.2]), neither at universities nor in private practices. On the other hand, antimicrobial treatment was more often withheld in cases with no indication for antimicrobial therapy (35.6% [30.1-41.4] to 54.0% [47.6-60.4]); this was found for private practices (26.7% [20.8-33.4] to 46.0% [38.4-53.7]) and for aURTD cases (35.0% [26.5-44.2] to 55.4% [44.7-65.8]). CONCLUSIONS: Overall proportions of antimicrobial prescription, unjustified antimicrobial therapy and, in private practices, use of 3rd generation cephalosporins decreased from 2016 to 2018 for the investigated feline diseases. However, overall compliance with Swiss prudent use guidelines was still low, implying that further efforts are required to foster prudent antimicrobial use in cats.

Antimicrobial dispensing by Ontario dairy veterinarians.

This questionnaire-based cross-sectional study was designed to capture the demographics of dairy practitioners in Ontario and to describe aspects of antimicrobial dispensing on-farm and over-the-counter by these veterinarians. The information collected revealed that the prescription status of a drug and the level of veterinary-client-patient relationship were important elements of dispensing policies. Over-the-counter dispensing records were incomplete, while only a small proportion of on-farm dispensing records contained pertinent information and directions as required by the Veterinarians Act. While respondents recognized that antimicrobial use in dairy herds could lead to resistance in cattle, few indicated that this was a significant public health issue. Veterinarians can play a key role in antimicrobial stewardship, part of which is the provision of complete written dispensing instructions to producers for antimicrobial use in dairy cattle.

La distribution des agents antimicrobiens par les vétérinaires qui s'occupent des vaches laitières en Ontario. Cette étude en coupe transversale a été réalisée à partir de réponses recueillies d'un questionnaire qui ciblait les données démographiques des praticiens des fermes laitières de l'Ontario en plus de décrire les habitudes de dispense des doses d'agents antimicrobiens in situ par les vétérinaires ou en vente libre auprès des distributeurs. Cette information nous a permis de reconnaître que le statut de l'agent antimicrobien prescrit et le niveau de relation entre le vétérinaire-client-patient sont des éléments très importants de la politique de dispense. Les données concernant les agents antimicrobiens achetés sans prescription étaient incomplètes dans les points de vente et seulement une petite proportion des données internes à la ferme contenait les informations et les dosages tels que requis par la loi sur les vétérinaires. Les répondants reconnaissaient que l'utilisation des agents antimicrobiens chez les vaches laitières pouvait élever leur résistance à ceux-ci, mais peu d'entre eux mentionnaient que ceci engendrait une réelle inquiétude pour la santé publique. Les vétérinaires ont donc un rôle clé à jouer et ils devront être assidus en fournissant, par écrit, des instructions complètes sur les prescriptions d'agents antimicrobiens aux producteurs de vaches laitières.(Traduit par les auteurs).

[Medicinal products for human use in veterinary prescription]. / Preskripce humánních lécivých prípravku na veterinárních lékarských predpisech.

The paper deals with the problem of prescription and use of the medicinal products for human use in veterinary medicine. Using partial model analysis describes volume and structure of the prescription of medicinal products for human use in the veterinary practice in the years 2007-2011. Prescriptions included to the study were dispensed in a community pharmacy located in a county town in the Slovak Republic. Data were obtained from the basic collection of 845 veterinary prescriptions that included 1178 prescribed items in a total of 2954 packages.

The role of veterinarians and feed-store vendors in the prescription and use of antibiotics on small dairy farms in rural Peru.

This study aimed to describe and compare the role of veterinarians and feed-store vendors in the use of antibiotics on small dairy farms in Cajamarca, Peru, a major dairy-producing center characterized by small, rural farms with poor, mostly uneducated farmers. We used a purposive sampling strategy to recruit 12 veterinarians into 2 focus group discussions and supplemented these data with 8 semi-structured interviews with feed-store vendors. Participants reported that inappropriate antibiotic usage was widespread among their clients, which may prevent the efficient use of drugs on farms where animal disease can be devastating to the livelihood of the farmer. Participants also identified many barriers to appropriate prescribing and use, including availability of drugs, competition from other prescribers, economic constraints and habits of farmers, and limited farmer knowledge of drugs and disease. Veterinarians expressed mistrust toward nonprofessional prescribers, whereas feed-store vendors felt that veterinarians were important partners in promoting the health of their clients' animals.

[Calculation of therapeutic intensity for piglets and fattening pigs during the use of antibiotics in feed]. / Berechnung der Therapieintensität bei Ferkeln und Mastschweinen beim Einsatz von Antibiotika in Fütterungsarzneimitteln.

Oral treatments for groups of pigs via medicated feed must be prescribed on specific forms submitted to veterinary authorities. We analyzed 869 such prescription forms for the year 2009 representing the treatment of 69'863 piglets and 31'506 fattening pigs. Parameters under investigation were indication and quantity of antimicrobials prescribed. Most of the treatments took place at weaning with 10 - 14 kg and again at the beginning of the fattening period with 20 - 29 kg body weight. The average body weights at treatment were 16 kg (piglets) and 29 kg (fatteners). In analogy with the indicator DID of human medicine, we developed PIDvet describing the prescribed dose per 1000 individuals on given day in veterinary medicine. Calculated PIDvet on a given day was 180.9 for the whole population, 297.6 for piglets and 83.2 for fatteners. This shows PIDvet to be useful to stratify therapeutic intensity in different age classes and could represent a new tool to monitor the use of antibiotics.

Les aliments médicamenteux pour traiter les porcs nécessitent une prescription vétérinaire du médicament, au moyen d'un formulaire d'ordonnance officiel. Un échantillon de 869 ordonnances pour le traitement de 69'863 porcelets et de 31'506 porcs d'engraissement en 2009 a été analysé quant à l'indication et à la quantité de l'antibiotique utilisé. C'est le plus souvent lors du sevrage, avec un poids de 10 ­ 14 kg (porcelets), et lors du changement de porcherie, avec un poids de 20 ­ 29 kg (porcs d'engraissement) que les animaux sont traités. Les poids moyens dans les deux sous-populations étaient de 16 kg (porcelets) et 29 kg (porcs d'engraissement). Pour la première fois en Suisse, on a développé une mesure spécifique pour le calcul de l'intensité thérapeutique dans des groupes d'animaux, analogue à la valeur DID de la médecine humaine. Ce PIDvet décrit la somme des doses journalières pour 1000 individus par jour (prescribed daily doses per 1000 Individuals on a given day in veterinary medicine). Pour une valeur de PIDvet de 180.9 pour l'ensemble de la population à un jour donné, les valeurs individuelles pour la population de porcelets étaient de 297.6 et de 83.2 pour la population de porcs d'engraissement. Ceci montre que l'intensité thérapeutique doit être analysée de façon ciblée et par couche selon le poids et ou l'âge des animaux.

Survey of companion animal veterinarians' antimicrobial drug prescription practices and awareness of antimicrobial drug use guidelines in the United States.

Antimicrobial drug use in companion animal medicine, the subsequent development of antimicrobial resistance and the potential hazard of animals transmitting resistant bacteria to humans are of increasing concern. Antimicrobial prescription patterns among companion animal veterinarians in the United States are understudied, and the association between antimicrobial drug use guideline awareness and antimicrobial drug prescription practices is unknown. Information on antimicrobial recommendations for five hypothetical clinical scenarios, including canine pyoderma, acute canine diarrhoea, feline lower urinary tract illness, canine dental procedures and feline upper respiratory illness, was gathered using an anonymous, online cross-sectional survey. A logistic regression approach was used to assess the association between self-reported awareness of antimicrobial drug use guidelines and prescribing recommendations for the five hypothetical scenarios. Responses (n = 2,410) indicated antimicrobial drugs were commonly recommended for the five hypothetical clinical scenarios. After controlling for key demographic characteristics, prescribers who reported an awareness of existing antimicrobial drug use guidelines were significantly less likely to recommend antimicrobial drugs for the scenarios describing feline lower urinary symptoms, feline upper respiratory illness and canine acute diarrhoea. Results from hypothetical clinical scenarios point to the possibility for widespread unsupported prescribing of antimicrobial drugs in companion animal medicine. Additionally, results provide evidence of an association between awareness of antimicrobial drug use guidelines and lower prescribing levels for certain hypothetical disease presentations.

[Survey on the use of antibiotics in exotic pets among Swiss veterinarians]. / Umfrage bei Schweizer Tierärzte/-innen über den Einsatz von Antibiotika bei exotischen Heimtieren.

INTRODUCTION: Monitoring programs and guidelines on the use of antibiotics and antibiotic resistance in human and veterinary medicine have been developed worldwide to promote the prudent use of antibiotics in recent years. However, such information on the use of antibiotics in exotic pets is absent. This fact must be taken into account, since the number of exotic pet patients is constantly increasing and the administration of antibiotics is particular challenging due to the diversity of species and the differences in physiology. The present study reports the results of a survey of frequently used antibiotics and the criteria of antibiotic usage in exotic pets (rabbits, rodents, birds and reptiles) among Swiss veterinarians. These data should form the basis for the development of antibiotic usage guidelines in exotic pets. A total of 61 veterinarians returned the questionnaire. The most important decision-making criteria for antibiotic treatment and antibiotic selection were clinical symptoms (55/59, 93% for antibiotic treatment and 40/59, 68% for antibiotic selection), experience (41/59, 69% and 36/59, 61%, respectively) and textbooks (39/59, 66% and 40/59, 68%). The most important decision-making criteria for dosage and duration of therapy were textbooks (59/59, 100%) and experience (31/59, 53%). The use of a microbial culture was used as a decision criterion for both antibiotic treatment and antibiotic selection by 39% of the participants, sensitivity testing was chosen as a decision criterion by 37% for antibiotic treatment and by 46% for antibiotic selection. Fluoroquinolones were used most frequently, 46/56 (82% of the participants) for rabbits, 49/57 (86%) for rodents, 36/37 (97%) for reptiles and 38/46 (83%) for birds. The vast majority of veterinarians (57/58, 98%) would consult a guide for the use of antibiotics. The frequent use of critical antibiotics in exotic pets underscores the need for a guide to the prudent use of antibiotics. The positive influence of such guidelines has already been proven in dogs and cats.

INTRODUCTION: Pour promouvoir une utilisation prudente des antibiotiques, des programmes de surveillance et des lignes directrices sur l'utilisation des antibiotiques et la résistance aux antibiotiques en médecine humaine et vétérinaire ont été élaborés dans le monde entier ces dernières années. Cependant, il n'existe actuellement aucune information de ce type en ce qui concerne les nouveaux animaux de compagnie ainsi que des informations exhaustives sur l'utilisation d'antibiotiques dans la pratique vétérinaire. Ce fait doit être pris en compte, d'autant plus que le nombre d'nouveaux animaux de compagnie est en constante augmentation dans la patientèle et que l'administration d'antibiotiques est un défi particulier en raison de la diversité des espèces et des différences de physiologie. Dans la présente étude, une enquête a été menée pour avoir un aperçu des antibiotiques fréquemment utilisés et de leurs critères d'utilisation chez les nouveaux animaux de compagnie (lapins, rongeurs, oiseaux et reptiles) auprès de vétérinaires suisses. Ces données sont destinées à servir de base à l'élaboration d'un guide sur les antibiotiques pour les animaux exotiques. Au total 61 vétérinaires ont répondu au questionnaire. Les critères de décision les plus importants pour le traitement antibiotique et la sélection d'un antibiotique étaient les symptômes (55/59, 93% pour le traitement antibiotique et 40/59, 68% pour la sélection de l'antibiotique), l'expérience (41/59, 69% et 36/59, 61%, respectivement) et la littérature spécialisée (39/59, 66% et 40/59, 68%). Les critères de décision les plus importants pour e dosage et la durée du traitement étaient la littérature spécialisée (59/59, 100%) et l'expérience (31/59, 53%). L'utilisation d'une culture bactériologique a été donnée par 39% des participants comme critère de décision à la fois pour le traitement antibiotique et le choix de l'antibiotique et un antibiogramme a été choisi par 37% comme critère de décision pour le traitement antibiotique et 46% pour le choix de l'antibiotique. Il a été constaté que les fluoroquinolones sont utilisées le plus fréquemment, chez 46/56 (82% des participants) pour les lapins, 49/57 (86%) pour les rongeurs, 36/37 (97%) pour les reptiles et 38/46 (83%) pour les oiseaux. La grande majorité des vétérinaires (57/58, 98%) a déclaré qu'ils consulteraient un guide pour l'utilisation des antibiotiques. L'utilisation fréquente d'antibiotiques critiques chez les nouveaux animaux de compagnie souligne la nécessité d'un guide sur l'utilisation prudente des antibiotiques. L'influence positive de ces recommandations a déjà été prouvée pour les chiens et les chats.

Unsafe "crossover-use" of chloramphenicol in Uganda: importance of a One Health approach in antimicrobial resistance policy and regulatory action.

Since the introduction of antibiotics into mainstream health care, resistance to these drugs has become a widespread issue that continues to increase worldwide. Policy decisions to mitigate the development of antimicrobial resistance are hampered by the current lack of surveillance data on antibiotic product availability and use in low-income countries. This study collected data on the antibiotics stocked in human (42) and veterinary (21) drug shops in five sub-counties in Luwero district of Uganda. Focus group discussions with drug shop vendors were also employed to explore antibiotic use practices in the community. Focus group participants reported that farmers used human-intended antibiotics for their livestock, and community members obtain animal-intended antibiotics for their own personal human use. Specifically, chloramphenicol products licensed for human use were being administered to Ugandan poultry. Human consumption of chloramphenicol residues through local animal products represents a serious public health concern. By limiting the health sector scope of antimicrobial resistance research to either human or animal antibiotic use, results can falsely inform policy and intervention strategies. Therefore, a One Health approach is required to understand the wider impact of community antibiotic use and improve overall effectiveness of intervention policy and regulatory action.

Patterns of antimicrobial drug use in veterinary primary care and specialty practice: A 6-year multi-institution study.

BACKGROUND: Combatting antimicrobial resistance requires a One Health approach to antimicrobial stewardship including antimicrobial drug (AMD) use evaluation. Current veterinary AMD prescribing data are limited. OBJECTIVES: To quantify companion animal AMD prescribing in primary care and specialty practice across 3 academic veterinary hospitals with particular focus on third-generation cephalosporins, fluoroquinolones, and carbapenems. ANIMALS: Dogs and cats presented to 3 academic veterinary hospitals from 2012 to 2017. METHODS: In this retrospective study, AMD prescribing data from 2012 to 2017 were extracted from electronic medical records at each hospital and prescriptions classified by service type: primary care, specialty practice or Emergency/Critical Care (ECC). Hospital-level AMD prescribing data were summarized by species, service type, AMD class, and drug. Multivariable logistic full-factorial regression models were used to estimate hospital, year, species, and service-type effects on AMD prescribing. Estimated marginal means and confidence intervals were plotted over time. RESULTS: The probability of systemic AMD prescribing for any indication ranged between 0.15 and 0.28 and was higher for dogs than cats (P < .05) apart from 2017 at hospital 1. Animals presented to primary care were least likely to receive AMDs (dogs 0.03-0.15, cats 0.03-0.18). The most commonly prescribed AMD classes were aminopenicillins/ß-lactamase inhibitors (0.02-0.15), first-generation cephalosporins (0.00-0.09), fluoroquinolones (0.00-0.04), nitroimidazoles (0.01-0.06), and tetracyclines (0.00-0.03). Among the highest priority classes, fluoroquinolones (dogs 0.00-0.09, cats 0.00-0.08) and third-generation cephalosporins (dogs 0.00-0.04, cats 0.00-0.05) were most frequently prescribed. CONCLUSIONS AND CLINICAL IMPORTANCE: Antimicrobial drug prescribing frequencies were comparable to previous studies. Additional stewardship efforts might focus on fluoroquinolones and third-generation cephalosporins.

Homeopathic prescribing for chronic conditions in feline and canine veterinary practice.

INTRODUCTION: The peer-review literature contains no controlled clinical research of homeopathy in cats and very little in dogs. MAIN OBJECTIVE: To collect clinical outcomes data systematically from individualised homeopathic treatment of cats and dogs that would help to inform controlled research in feline and canine homeopathy. METHODS: Twenty-one homeopathic veterinary surgeons recorded data systematically from consecutive feline and canine patients over a 12-month period. Records included: date; patient and owner identity (anonymised); medical problem treated; whether new or follow-up (FU) appointment; chronic or acute condition; owner-assessed clinical outcome (7-point scale, range -3 to +3) compared with first appointment. RESULTS: Data from 400 cats comprised a total of 372 individual chronic problems, of which 270 had FU assessment. Data from 1504 dogs comprised a total of 1408 individual chronic problems, of which 1070 had FU assessment. In both species, 22% of FUs in chronic cases received conventional medicines concurrently. In cats, 117 different chronic medical conditions in total were treated with homeopathy. Five of those conditions included ≥20 cases, in which owner-reported outcomes (in decreasing rank order of frequency) were: dermatitis (69.6% patients with +2 or +3 outcome, 0% patients with -2 or -3 outcome); renal failure (57.1%, 14.3%); overgrooming (57.1%, 7.2%); arthritis (80.0%, 0%); hyperthyroidism (66.7%, 0%). In dogs, of 301 different chronic medical conditions treated in total, those most commonly recorded (≥20 cases) were: dermatitis (66.2% with +2 or +3 outcome, 5.4% with -2 or -3 outcome); arthritis (80.2%, 0.8%); pyoderma (75.8%, 0%); colitis (85.2%, 0%); fear (31.6%, 0%); epilepsy (63.6%, 4.5%); otitis externa (72.7%, 0%); diarrhoea (68.2%, 0%); urinary incontinence (73.7%, 0%); aggression (57.1%, 0%); spondylosis (81.0%, 0%); lymphoma (40.0%, 6.7%). CONCLUSIONS: A programme of controlled research in veterinary homeopathy for these feline and canine conditions is clearly indicated.

Effect of antimicrobial stewardship on antimicrobial prescriptions for selected diseases of dogs in Switzerland.

BACKGROUND: Antimicrobial stewardship programs (ASPs) are important tools to foster prudent antimicrobial use. OBJECTIVE: To evaluate antimicrobial prescriptions by Swiss veterinarians before and after introduction of the online ASP AntibioticScout.ch in December 2016. ANIMALS: Dogs presented to 2 university hospitals and 14 private practices in 2016 or 2018 for acute diarrhea (AD; n = 779), urinary tract infection (UTI; n = 505), respiratory tract infection (RTI; n = 580), or wound infection (WI; n = 341). METHODS: Retrospective study. Prescriptions of antimicrobials in 2016 and 2018 were compared and their appropriateness assessed by a justification score. RESULTS: The proportion of dogs prescribed antimicrobials decreased significantly between 2016 and 2018 (74% vs 59%; P < .001). The proportion of prescriptions in complete agreement with guidelines increased significantly (48% vs 60%; P < .001) and those in complete disagreement significantly decreased (38% vs 24%; P < .001) during this time. Antimicrobial prescriptions for dogs with AD were significantly correlated with the presence of hemorrhagic diarrhea in both years, but a significantly lower proportion of dogs with hemorrhagic diarrhea were unnecessarily prescribed antimicrobials in 2018 (65% vs 36%; P < .001). In private practices, in 2018 a bacterial etiology of UTI was confirmed in 16% of dogs. Prescriptions for fluoroquinolones significantly decreased (29% vs 14%; P = .002). Prescriptions for antimicrobials decreased significantly in private practices for RTI (54% vs 31%; P < .001). CONCLUSION: Antimicrobials were used more prudently for the examined indications in 2018 compared to 2016. The study highlights the continued need for ASPs in veterinary medicine.

Modification of empirical antimicrobial regimens in large animal medicine.

BACKGROUND: Empirical antimicrobial regimens can be modified following new diagnostic information or when empirical treatment fails. Little is known about the frequency or clinical context in which these modifications occur. We characterised these modifications in a large animal hospital to identify when antimicrobial use could be optimised. METHODS: Chart reviews were performed for all inpatients and outpatients administered antimicrobials at a large animal veterinary referral and teaching hospital in 2017-2018 (n=1163 visits) to determine when and why empirical regimens were modified. Multinomial logistic regression was performed to identify factors associated with reasons for modification. RESULTS: Empirical antimicrobial regimens were modified in 17.3 per cent of visits. The main reasons were parenteral-oral conversions in horses and failure of disease prevention or treatment in ruminants. Empirical therapy for disease prevention was more likely to be modified because of complications in ruminants and in animals on the emergency/critical care service. Empirical therapy for disease treatment was more often modified for reasons other than de-escalation in ruminants and in animals with longer lengths of stay. CONCLUSIONS: Empirical antimicrobial regimens were modified infrequently and mostly for purposes of parenteral-oral conversion in horses and lack of response in ruminants. De-escalation of antimicrobials administered for disease treatment, when guided by diagnostics, is a major tenet of judicious antimicrobial use. However, more research is needed to determine when and how antimicrobial regimens administered for disease prevention should be modified.

Herd typologies based on multivariate analysis of biosecurity, productivity, antimicrobial and vaccine use data from Danish sow herds.

The use of antimicrobials in livestock constitutes an increasing global concern, and many countries pursue approaches to reduce the amount used, particularly in the pig production industry. The EU Commission has decided, due to environmental concerns, to phase out use of zinc oxide in pigs by 2022. This poses an additional challenge to efforts to reduce antimicrobial use (AMU) in European pig production. The pig production sector needs further information about how to comply with official AMU requirements without losing competitiveness. The most efficient approaches are likely to involve a combination of multiple factors. Therefore, the objective of this study was to explore multidimensional associations between biosecurity, productivity, vaccination and AMU. A cross sectional study was conducted using data from 160 Danish sow herds in 2014-2015. Biosecurity data were collected through computer-assisted telephone interviews using a pre-developed questionnaire (Biocheck.UGent®) supplemented with additional country-specific questions and translated into Danish. Herd-specific data, consisting of antimicrobial prescriptions, purchase of vaccines against five endemic infections, herd health status and one productivity measure (i.e. number of weaned piglets per sow per year) were extracted from various databases. Factor analysis was conducted on a subset of the data from 152 herds with sufficiently complete data. The identified factors were explained by evaluating data from herds with extreme loadings on the respective factor. The results were further discussed based on plots combining herd factor loadings on two factors at a time. Four factors were selected based on the break-point in the scree-plot. Factor 1 included herd type, herd size, and age of farm buildings. Factor 2 covered general biosecurity, including several internal and external biosecurity measures. Factor 3 represented preventive measures implying specific focus on avoiding introduction of ASF by foreign employees. Lastly, Factor 4 covered vaccination status, specifically regarding vaccination against Mycoplasma hyopneumoniae and Porcine Reproductive and Respiratory Syndrome virus. These factors were used to group the 152 sow herds into herd typologies. Feasible strategies aimed at improving health by reducing AMU without hampering animal welfare were identified and discussed for each typology. AMU and productivity correlated only weakly with other variables. This is probably due to limited variability in both these variables in study herds, which might be attributed to official restrictions on AMU, and a general high level of health and biosecurity in Danish sow herds.

Condition-based use of antimicrobials in cats in Finland: results from two surveys.

Two surveys were carried out to investigate how antimicrobials are used in cats in Finland. Information was retrieved from 419 prescriptions and 311 questionnaire sheets concerning antimicrobial treatment for feline patients. Infected wounds, skin disorders and urinary tract infections were the most common reasons for antimicrobial treatment in cats. Compliance with prudent use guidelines was good. beta-Lactams such as amoxycillin and amoxycillin with clavulanic acid were frequently used. Fluoroquinolones were used judiciously. The median length of treatment was 10 days for most conditions. Diagnosis was mainly based on clinical signs, and bacteriological culture and sensitivity testing was rarely performed. This study provides basic descriptive information on how antimicrobials are used in cats and that could help when revising guidelines for the condition-based use of antimicrobials in animals.

Characterization of antimicrobial prescription frequency and diversity in a large animal veterinary medical teaching hospital.

Antimicrobials are commonly used in veterinary medicine for therapeutic and prophylactic purposes, but little is known about the frequency with which they are prescribed or the quantity administered, especially in large animals. Furthermore, there are no standardized metrics for characterizing antimicrobial use, which can lead to confusion when comparing antimicrobial use among different units (institution, clinical service, clinician). Because there is no gold standard metric, the most comprehensive characterization of antimicrobial use will be achieved using a variety of metrics. The goal of this study was to characterize antimicrobial use from 2013 to 2018 at a tertiary care teaching hospital for large animals using different metrics, including novel ones. We found that at least one antimicrobial was prescribed in 42% of visits and that antimicrobials were prescribed at a rate of 919 animal-defined daily doses (ADDs) per 1000 animal days. A median of 3.6 ADDs and a mean of 2 different classes of antimicrobial were prescribed per patient, and penicillin was the most commonly used antimicrobial. The prescription diversity, a metric accounting for richness and evenness (similarity of frequencies) of different types of antimicrobials, was 0.82, with 1.0 representing maximal richness and diversity. Antimicrobial use differed significantly by species and by organ system affected for all metrics, though in general antimicrobials were prescribed most frequently and with the largest amounts in animals presenting with integumentary or respiratory signs. Many of our findings were consistent with those of other studies examining antimicrobial use in the species represented in our patient population, but more research is needed to determine how to best characterize antimicrobial use and assess appropriateness of prescribing.

Systemic glucocorticoid usage in dogs under primary veterinary care in the UK: prevalence and risk factors.

Glucocorticoids are widely used in primary care veterinary practices. The study aimed to quantify the usage of systemic glucocorticoids (SGC) in dogs in the UK using primary care treatment records recorded during 2013 in the VetCompass Programme. From a study population of 455 557 dogs, 28 472 dogs (6.2 per cent, 95 per cent CI 6.2 to 6.3) received a total of 50 971 SGC therapy events in 2013. Prednisolone represented the most frequently used oral preparation (27 362 events, 90.0 per cent of oral events). Dexamethasone sodium phosphate was the most commonly used injectable agent (12 796 events, 62.7 per cent of injectable events). The most common breed treated was Staffordshire Bull Terriers (2236/28 472 dogs, 7.9 per cent, 95 per cent CI 7.5 to 8.2) and within-breed prevalence of SGC usage was 2236/32 635, 6.9 per cent, 95 per cent CI 6.6 to 7.1. The most commonly treated age group was dogs older than eight years (8931/28472, 31.4 per cent) and the most commonly treated bodyweight group was 10.01-20.0 kg (7918/28 472, 27.8 per cent). Dexamethasone and prednisolone were the most commonly prescribed SGC. Short-acting and intermediate-acting injectable SGC were more commonly used compared with long-acting injectable SGC. Older and medium size dogs were most likely to receive SGC and certain breeds appeared predisposed. These data can provide a useful benchmark for glucocorticoid usage and highlight the benefits from 'Big Data' analyses.

Reduced antimicrobial prescribing during autogenous staphylococcal bacterin therapy: a retrospective study in dogs with pyoderma.

Autogenous staphylococcal bacterins are commonly mentioned as treatment for canine recurrent pyoderma but little is known about their efficacy. This retrospective study describes use and assesses efficacy of an autogenous Staphylococcus (pseud)intermedius bacterin in dogs with pyoderma. Frequency and duration of systemic antimicrobial therapy were compared 12 months before and after starting bacterin (Wilcoxon signed-rank test) with data extracted from general practice medical histories.

Proportion of nonsteroidal anti-inflammatory drug prescription in equine practice.

BACKGROUND: There is little knowledge of the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) and whether their prescription varies between countries. OBJECTIVE: To describe prescription practices of NSAIDs in equids in the United Kingdom (UK), United States of America (USA) and Canada. STUDY DESIGN: Descriptive observational study. METHODS: Free-text electronic medical records from 141,543 equids from 10 equine practices in the UK, 255,777 equids from 7 equine practices with 20 branches from the USA and 2 practices with 7 branches from Canada were evaluated. A validated text-mining technique was used to describe the proportion of equids prescribed NSAIDs at least once in these countries. The choice of NSAIDs in orthopaedic and colic cases was evaluated. RESULTS: The prescription of NSAIDs is more common in the USA (42.4%) and Canada (34.2%) than in the UK (28.6%). Phenylbutazone and flunixin meglumine were the drugs mostly prescribed in all countries. While flunixin meglumine was most prescribed with colic cases in all countries, a proportion received phenylbutazone despite this drug being licensed for use only with musculoskeletal disease. Phenylbutazone was the most commonly prescribed drug in cases with orthopaedic disease followed by flunixin meglumine in all countries. Only a small proportion of cases received meloxicam, ketoprofen or firocoxib. MAIN LIMITATIONS: The retrospective design might have resulted in an unknown number of incomplete records, particularly in the reporting of colic and orthopaedic disease. Although the data set is large, the relatively small number of practices recruited from each country may introduce bias. CONCLUSIONS: Clinical practice can differ between countries although the influence of individual practitioners and practice-specific policy on apparent intercountry differences requires further research. Despite several other NSAIDs being available and a substantial effort being made to evaluate their efficacy, the prescription of NSAIDs other than phenylbutazone and flunixin meglumine remains rather limited.

HPLC-DAD analysis of florfenicol and thiamphenicol in medicated feedingstuffs.

A simple and reliable method using liquid chromatography with diode array detector was developed for the simultaneous determination of florfenicol and thiamphenicol in medicated feed. The analytes were extracted from the minced feed with methanol and ethyl acetate (1:1, v/v). Next, the extract was further cleaned up by dispersive solid phase extraction using anhydrous magnesium sulfate, PSA and C18 sorbents. Finally, 1 mL of extract was evaporated, the residue resuspended in Milli-Q water, and filtered. The method was validated in-house at medicated levels, in the concentration range 10-300 µg/mL (50-1500 mg/kg). Values of <6.5% and <6.0% were found, respectively, for repeatability and within-laboratory reproducibility. The LODs for the two fenicols were 2.4-5.3 mg/kg, while the LOQs were 3.8-5.6 mg/kg. The expanded uncertainty was estimated to be in the range of 10.0-14.5%, depending on the analyte. Recoveries varied from 81.7% to 97.5%. The methodology was applied to the analysis of animal feedingstuffs collected from poultry and pig farms.