Bacterial resistance to antibacterials has become a major international problem with vets undoubtedly playing a role in its development. Even Alexander Fleming, the discoverer of penicillin, knew bacterial resistance would be a concern, so nobody should be surprised by its increasingly ominous presence in recent years. Burying our heads in the sand over this potentially catastrophic problem is no longer an option and it is imperative that the veterinary profession takes all the necessary precautions to minimise the risk of bacterial resistance developing. Last week’s webinar delivered by Professor Ian Ramsey offers advice on how we can practically achieve this goal within small animal practice.
Before taking steps to protect against the development of bacterial resistance, we have to try and understand where we are going wrong in small animal practice. Professor Ramsey explained that the vast range of antibacterials used and the number of prescriptions prescribed in small animal practice are all contributing factors. The failure to kill all bacteria when treatment is administered is another issue and usually occurs when we use the wrong drug, give the wrong dose or administer the drug for the wrong duration. It is these contributing factors which need to be addressed in small animal practice by educating the general practitioner as well as the general public about the responsible use of antibacterials and by implementing a number of policies within small animal practice.
The avoidance of antibacterials wherever possible is one example of how to reduce the number of antibiotics being used in general practice especially knowing that an estimated 50% of antibiotic prescriptions for humans are in fact unnecessary. I am of the era where, when I first qualified, every surgical patient had long acting amoxycillin administered. I’m glad to say, it is now widely accepted that prophylactic antibiotics are not necessary for routine surgeries and I have not come across this in practice for many years. There are other conditions we know of such as colitis and feline cystitis where we have traditionally given antibiotics but evidence now shows that more often than not antibiosis is not necessary. Physical removal of infection by draining an abscess or removing an implant could also be equally, if not more effective than treatment with antibacterials. The use of topical disinfectants such as chlorhexidine and povidine iodine can also play an important role in treating infections thereby avoiding the use of antibacterials.
Having practice policies and protocols in place are also crucial. An example would be implementing a prescribing policy within your practice which could be based around the newly updated PROTECT ME poster which Professor Ramsey discussed in greater detail within the webinar. Part of this poster discusses the use of cultures and how to use them effectively. It does not advocate the use of cultures for every condition we see within a first consultation. However culture is recommended if you are intending to change one antibacterial for another or if the course of antibacterials is likely to be prolonged. Studies have also shown that taking a swab and awaiting the results prior to treatment does not alter the outcome for these patients. The monitoring of treatment is also essential, with Professor Ramsey advocating the treatment of a patient until they get better plus a little extra! Also if an infection recurs it is not the wrong antibacterial which has been administered, it is because the patient has been given the wrong course. Also if a patient does not respond at all to an antibacterial then it is likely to be the wrong drug, the wrong dose and/or the wrong route of administration.
Many more suggestions were made by Professor Ramsey in the battle against bacterial resistance and this webinar could act as an excellent educational tool for all those working within your practice. The more we keep educating ourselves and others about the appropriate use of antibacterials the more likely it is that we will maintain antibacterials as effective treatments for both ourselves and our patients.