26 Mar 2021
James Westgate
Job Title
Structured stewardship programmes can deliver big reductions in the prescribing of highest priority critically important antimicrobials (HPCIAs) in small animal practice.
That was the headline finding from a new trial by the University of Liverpool’s Small Animal Veterinary Surveillance Network (SAVSNET), which saw a reduction of up to 40% in prescribing rates for HPCIAs by practices where antimicrobial stewardship programmes had been put in place.
All practices involved in the trial had been previously identified as relatively high frequency HPCIA prescribers and were randomly placed into three trial arms – a control group, a light intervention group and a heavy intervention group – consisting of 20 veterinary practices in each group.
Following eight months’ initial intervention, both intervention groups were associated with a significant post-intervention decrease in HPCIA prescription frequency in cats; the light group by 17% and the heavy group by 40%
In dogs, the only significant decrease was seen in the heavy group, which decreased HPCIA prescription frequency by 23%
HPCIAs are frequently prescribed as first-line agents in companion animal practice, particularly to cats.
Such antimicrobials should only be used third-line in response to clear evidence of likely or demonstrated treatment failure to other antimicrobials. In recognition of this issue, SAVSNET collaborated with the CVS Group on the randomised controlled trial.
Light and heavy intervention groups were informed of their outlier status, and were offered either remote (light group) or in-person (heavy group) support, in addition to their existing access to the SAVSNET portal, which offers free benchmarking for antimicrobial prescription.
CVS practice teams in the heavy group were asked to reflect on their HPCIA prescription and clinical decision-making to develop their own systems to promote responsible prescribing.
Lead researcher David Singleton said: “Use of antimicrobials is a key driver for development of AMR.
“It is vital that the veterinary profession embraces the responsible use of antimicrobials, to safeguard human and animal health, and to preserve the right to prescribe certain antimicrobials that are important in human medicine.
“Of these, the HPCIAs, including fluoroquinolones and third-generation cephalosporins, are considered of greatest importance by the World Health Organization.
“This trial demonstrates that companion animal veterinary practitioners respond to notification of being outside of a ‘social norm’ (that is, being a high frequency HPCIA prescriber) and are responsive to involvement in structured antimicrobial stewardship programmes.”
Published in Nature Communications, the findings are being used to inform development of a national veterinary antimicrobial stewardship scheme, in collaboration with SAVSNET, CVS Group and RCVS Knowledge.
Executive director of RCVS Knowledge Chris Gush said: “RCVS Knowledge is pleased to be working with the University of Liverpool’s SAVSNET to reduce the use of antibiotics in small animal practice.
“Findings from the SAVSNET trial will inform our new small animal antibiotic stewardship project, which builds on our existing antibiotic stewardship work in the areas of equine and farm animal health.
“There is a need for data to underpin continuous quality improvements in veterinary care and patient outcomes, which is in line with our mission to benefit animals, public and society.
“The project will allow practices to access a secure and free-to-use national veterinary audit and benchmarking tools.
“We look forward to continuing to work in collaboration with SAVSNET to present vital information to practices in a meaningful way, supporting evidence-based interventions leading to one health improvements.”
