Effect of an antimicrobial stewardship intervention on the prescribing behaviours of companion animal veterinarians: A pre–post study
B. Walker, F. Sánchez-Vizcaíno and E.N. Barker (2022) Effect of an antimicrobial stewardship intervention on the prescribing behaviours of companion animal veterinarians: A pre–post study. Vet Record, no e1485.
The aim of this study was to evaluate the effect of antimicrobial stewardship (AMS) intervention on the antimicrobial prescribing behaviours of first opinion vets at one multi-branch small animal practice in the UK.
Over a 2-week period in March 2019, a series of discussions on antimicrobial behaviours were held, in which the findings of an in-house audit and a summary of the PROTECT-ME small animal antimicrobial usage guidelines were presented. Attendance at the meetings was voluntary. The audit summarised prescribing rates for cats and dogs in 2018: antimicrobials prescribed per 100 consultations, proportion of antimicrobial prescriptions by ingredient, proportion of antimicrobial prescriptions that were off-licence and antimicrobials prescribed under the recommended dose.
Clinicians present at the meetings agreed on first-line choices of antimicrobials for various conditions. A summary of the discussions was displayed on the PROTECT-ME poster in the clinics.
Practice electronic health records (EHRs) covering the period April 2017 and March 2020 were analysed for services and product sales. Data from the two-week intervention period were excluded.
18/25 clinicians attended one of the meetings. A total of 15,453 and 6,936 prescriptions were obtained from the EHRs for the pre-intervention and post-intervention periods, respectively. Although there was no evidence for an immediate decrease in prescribing rates, and some evidence of an increase in prescribing rates after 12 months, overall there was evidence of a change in prescribing practices.
In cats, there was a sustained decrease in the prescribing rate of cefovecin and metronidazole per 100 prescriptions for the 12 months post-intervention. However, the prescribing rate of amoxicillin-clavulanic acid saw a sustained increase over the same period.
In dogs, the prescribing rate for amoxicillin-clavulanic acid increased, with a more pronounced increase at 6 and 12 months. The prescribing rate for metronidazole saw a sustained decrease over the 12-months. While no change was observed for cefalexin, immediately post-intervention and in the following 12 months.
The prescribing rate for off-licence antimicrobials decreased for both cats and dogs immediately post-intervention, and this was sustained for the following 12-months.
Limitations of the study include factors that were not taken into consideration, such as staff turnover or changes in practice policy or management. As the results are for a single practice across nine sites, extrapolating the results to other practices is not possible.
The study provides evidence that an AMS intervention can have an impact on antimicrobial prescribing behaviour, though this may not lead to a reduction in overall prescribing rates. Further research is required into how antimicrobial prescribing can be reduced, and behavioural changes can be maintained in first opinion practice.
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