“Every prescribing decision to administer antimicrobials contributes to a selection for antimicrobial resistance”. This is a key message in the introduction to the online course on antimicrobial stewardship in veterinary practice*. It follows that every prescriber has a responsibility to use antibiotics only when needed, to select the most appropriate, narrowest spectrum antibiotic, avoid using critically important antibiotics where possible, and not to continue treatment for longer than necessary. Is this easier said than done?

Certainly. Many factors influence the decision to prescribe antibiotic therapy, including consultation times, client finances and perceived expectations, and not least, a conflict between avoiding the risk of a bad outcome as a result of not treating (defensive prescribing) and the less tangible objective of preventing antimicrobial resistance. Reforming antibiotic prescribing is a complex area, as illustrated in the Q and A with Fergus Allerton (champion of the BSAVA’s PROTECT guideline) in this month’s issue of the Journal of Small Animal Practice, which poses some searching questions .

Clearly there isn’t one simple solution to achieving more rational use of antibiotics and a range of interventions is needed: national and practice guidelines, antibiotic formularies, better use of cytology, development of other patient-side diagnostic tools, appointment of antimicrobial stewardship leads, and prescribing techniques such as de-escalation (changing the antibiotic to a narrower spectrum drug when culture information is available), delayed prescribing and use of non-prescription forms, and also education of clients.

In terms of choice of antibiotic, veterinary medicines regulations can appear to work against the principles of antimicrobial stewardship because there is a limited choice of authorised antibiotics. In some cases, particularly when prescribing for rabbits and exotics, the only authorised antibiotic is a critically important fluoroquinolone. This should be less of a problem since the VMD has sanctioned the use of the most appropriate antibiotic in the interests of good antimicrobial stewardship: "To minimise the development of antibiotic resistance, where a particular antibiotic is shown to be effective against a bacterial pathogen (for example by culture and sensitivity data), it is acceptable to prescribe a narrow spectrum antibiotic under the cascade instead of a broad spectrum antibiotic that has an authorised indication for the condition being treated." https://zurl.co/fHUU. Even so, confidence to go off-licence might be hampered by a lack of knowledge about alternative treatments.

*Antimicrobial Stewardship in Veterinary Practiceis a free online course presented by educators from UK veterinary schools. It covers the general principles and drivers of antimicrobial resistance including the effects of antibiotic therapy on the microbiome and the mechanisms of resistance. It encourages reflection on personal practice and includes case studies in farm, equine, companion animal and exotic animal practice. It's a 3-week course that you complete in your own time and is interactive through connection with the educators and other course participants. Click the link to go to the course website.

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