New approaches to pharmacosurveillance for monitoring prescription frequency, diversity, and co-prescription in a large sentinel network of companion animal veterinary practices in the United Kingdom, 2014–2016

Singleton, David A.; Sánchez‐Vizcaíno, Fernando; Arsevska, Elena; Dawson, Susan; Jones, Philip H.; Noble, P. J. W.; Pinchbeck, Gina; Williams, Nicola; Radford, Alan

doi:10.1016/j.prevetmed.2018.09.004

Cited by 33 publications

(44 citation statements)

References 39 publications

(62 reference statements)

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“…The antimicrobial prescription rate was 16.5% in our ER outpatient population. This is comparable with data from a recent survey of UK general practices that found antimicrobials were the second most commonly prescribed drugs (after vaccines) and comprised 17.6% of canine prescriptions and 14.5% of feline prescriptions (26). To the authors' knowledge, the frequency of antimicrobial drug prescription for companion animal ER outpatients has not been previously reported.…”

Section: Discussionsupporting

confidence: 86%

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

et al. 2020

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Background: Antimicrobial use contributes to emergence of antimicrobial resistance. It was hypothesized that antimicrobial prescribing behavior varies between the emergency (ER) and critical care (CC) services in a veterinary teaching hospital. This study aimed to: (i) describe antimicrobial prescribing patterns in the ER and CC services; (ii) assess adherence to stewardship principles; (iii) evaluate the prevalence of multidrug resistant (MDR) bacterial isolates. Methods: Institution electronic medical records were queried for all antimicrobial prescriptions from the ER and CC services between 1/1/2017 and 12/31/2017. Prescriptions were manually reviewed, and the following data recorded: drug, dosage, duration, diagnosis, outcome, hospitalization duration, culture submission, and susceptibility results. Results: There were 5,091 ER visits, of which 3,125 were not transferred to another service. Of these emergency visits, 516 (16.5%) resulted in 613 antimicrobial drug prescriptions. The most commonly prescribed drugs for the ER were amoxicillin/clavulanate (n = 243, 39.6%), metronidazole (n = 146, 23.8%), and ampicillin/sulbactam (n = 55, 9.0%). The most common reasons for antimicrobial prescriptions were skin disease (n = 227, 37.0%), gastrointestinal disease (n = 173, 28.2%), and respiratory disease (n = 50, 8.2%). For ER patients 18 cultures were submitted, equivalent to a 3.5% submission rate. The CC service managed 311 case visits for 822 patient days. Of these, 133 case visits (42.7%) resulted in 340 prescriptions. The most commonly prescribed drugs for the CC service were ampicillin/sulbactam (n = 103, 30.3%), enrofloxacin (n = 75, 22.1%), and metronidazole (n = 59, 17.4%). The most common reasons for antimicrobial prescriptions were gastrointestinal disease (n = 106, 31.2%), respiratory disease (n = 71, 20.9%), and sepsis (n = 61, 17.9%). On the CC service, 46 patients had ≥1 culture submitted, equivalent to a 34.6% submission rate. Of patients prescribed antimicrobials, 13/38 (34%) with urinary tract disease, 2/28 (7%) with pneumonia, 1/11 (9%) with canine infectious respiratory disease complex and 2/8 (25%) with feline upper respiratory infection were compliant with published guidelines. Robbins et al. Antimicrobial Prescribing Emergency Critical Care Conclusions: Antimicrobial prescription was common in both ER and CC services and followed similar patterns. Adherence to published guidelines for urinary and respiratory infections was poor.

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Section: Discussionsupporting

confidence: 86%

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

et al. 2020

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“…Most dogs (88.2%) have resolution of diarrhea within 1 week even in the absence of treatment. Also, metronidazole is not approved by the Food and Drug Administration for veterinary purposes despite its commonplace usage in companion animal medicine . Acute diarrhea is a common reason owners seek veterinary care, and widespread antimicrobial treatment could impact both veterinary and human health by promoting bacterial resistance .…”

Section: Discussionmentioning

confidence: 99%

Metronidazole treatment of acute diarrhea in dogs: A randomized double blinded placebo‐controlled clinical trial

Langlois

Koenigshof

Mani

2019

Veterinary Internal Medicne

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Background: Metronidazole is commonly administered to dogs with acute diarrhea, but there is limited evidence to support this practice.Objective: To investigate the effects of metronidazole administration on dogs with acute nonspecific diarrhea.Animals: Thirty-one dogs, including 14 test population dogs and 17 controls.Methods: Randomized controlled clinical trial. Dogs with acute diarrhea in which causation was not determined by routine fecal diagnostic testing were randomly assigned to metronidazole treatment (10-15 mg/kg PO q12h for 7 days) or placebo.Fecal cultures and characterization of Clostridium perfringens isolates also were performed. Owners maintained medication and fecal scoring logs, and fecal diagnostic tests were repeated on day 7.Results: The mean ± SD time to resolution of diarrhea for test population dogs (2.1 ± 1.6 days) was less than that for controls (3.6 ± 2.1 days, P = .04). Potential relationships of C. perfringens with acute diarrhea pathogenesis were not investigated, but only 3 of 13 (23.1%) test population dogs had persistent C. perfringens carriage at day 7, which was less than the 11 of 14 (78.6%) controls with persistent growth (P = .007).Conclusions and Clinical Importance: Our results suggest that metronidazole treatment can shorten duration of diarrhea and decrease fecal culture detection of C. perfringens in some dogs with acute nonspecific diarrhea. Additional studies are needed to assess the benefits and risks of routine use of metronidazole for this purpose because most dogs achieve resolution of diarrhea within several days regardless of treatment.

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“…Pharmaceutical agent prescriptions were identified and classified via the semi-structured text-based product description field of the EHR (28). Antimicrobials and anti-inflammatories were further classified by authorised administration route as systemic (oral or injectable forms, hence “systemic”) or topical administration (aural, ocular, skin).…”

Section: Methodsmentioning

confidence: 99%

Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices

et al. 2019

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Canine acute diarrhoea is frequently observed in first opinion practice, though little is known about commonly used diagnostic or therapeutic management plans, including use of antimicrobials. This retrospective observational study utilised electronic health records augmented with practitioner-completed questionnaires from 3,189 cases (3,159 dogs) collected from 179 volunteer veterinary practices between April 2014 and January 2017. We used multivariable analysis to explore factors potentially associated with pharmaceutical agent prescription, and resolution of clinical signs by 10 days post-initial presentation. Use of bacteriological and/or parasitological diagnostic tests were uncommon (3.2% of cases, 95% confidence interval, CI, 2.4–4.0), though systemic antimicrobials were the most commonly prescribed pharmaceutical agents (49.7% of cases, 95% CI 46.1–53.2). Such prescription was associated with haemorrhagic diarrhoea (odds ratio, OR, 4.1; 95% CI 3.4–5.0), body temperature in excess of 39.0°C, or moderate/severe cases (OR 1.3, 95% CI 1.1–1.7). Gastrointestinal agents (e.g., antacids) were prescribed to 37.7% of cases (95% CI 35.4–39.9), and were most frequently prescribed to vomiting dogs regardless of presence (OR 46.4, 95% CI 19.4–110.8) or absence of blood (OR 17.1, 95% CI 13.4–21.9). Endoparasiticides/endectocides were prescribed to 7.8% of cases (95% CI 6.8–9.0), such prescription being less frequent for moderate/severe cases (OR 0.5, 95% CI 0.4–0.7), though more frequent when weight loss was recorded (OR 3.4, 95% CI 1.3–9.0). Gastrointestinal nutraceuticals (e.g., probiotics) were dispensed to 60.8% of cases (95% CI 57.1–64.6), these cases less frequently presenting with moderate/severe clinical signs (OR 0.6, 95% CI 0.5–0.8). Nearly a quarter of cases were judged lost to follow-up ( n =754). Insured (OR 0.7, 95% CI 0.5–0.9); neutered (OR 0.4, 95% CI 0.3–0.5), or vaccinated dogs (OR 0.3, 95% CI 0.3–0.4) were less commonly lost to follow-up. Of remaining dogs, clinical signs were deemed resolved in 95.4% of cases (95% CI 94.6–96.2). Provision of dietary modification advice and gastrointestinal nutraceuticals alone were positively associated with resolution (OR 2.8, 95% CI 1.3–6.1); no such associations were found for pharmaceutical agents, including antimicrobials. Hence, this study supports the view that antimicrobials are largely unnecessary for acute diarrhoea cases; this being of particular importance when considering the global threat posed by antimicrobial resistance.

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New approaches to pharmacosurveillance for monitoring prescription frequency, diversity, and co-prescription in a large sentinel network of companion animal veterinary practices in the United Kingdom, 2014–2016

Cited by 33 publications

References 39 publications

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

Metronidazole treatment of acute diarrhea in dogs: A randomized double blinded placebo‐controlled clinical trial

Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices

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