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Antimicrobial Resistance

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Antimicrobial resistance is an emerging clinical problem that is recognised internationally as one of the largest threats to human and animal health.

All major health and veterinary organisations are working to try and limit the development of resistance so that effective antimicrobials can be retained for use in clinical practice. BEVA believes that effective self-regulation on the responsible use of antimicrobials is a more suitable option than a legislative solution.

The PROTECT ME toolkit is modelled on BSAVA PROTECT guidelines developed by SAMSoc, but incorporating the essential watchwords ‘Monitor’ and ‘Educate’. 

NEW: EAAD 2014 - Monitoring antimicrobial use

As part of European Antimicrobial Awareness Day in 2014, BEVA is calling on members to introduce clinical audit into responsible antimicrobial use.

BEVA has created a flexible framework allowing veterinary surgeons to undertake effective clinical audit without significantly impacting on working practices.

P

Practice Policy

Develop protocols for antimicrobial usage based on common clinical scenarioas

Classify key antibiotics as PROTECTED or AVOIDED

R

Reduce Prophylaxis

Develop rational protocols for prophylaxis

  • Define prophylaxis for surgical procedures whether CLEAN, CONTAMINATED or HIGH RISK

Rationalise disease control

  • For common conditions eg the neonate and Streptococcus equi var equi
  • Utilise HBLB codes for management of infectious diseases

O

Other options

Reduce or replace antimicrobials with other methods for bacterial reduction

• Utilise wound debridement / lavage

• Consider topical preparations or local intravenous administration

T

Types of drug and bacteria

Select appropriate drugs based on empirical use guidelines

  • Use cytology where possible 
  • Consider the dose and pharmacokinetics of the drugs selected
  • Avoid empical use of the highest priority critically important antimicrobials
    • The macrolides (eg azithromycin)
    • The fluoroquinolones (eg enrofloxacin)
    • The 3rd and 4th generation cephalosporins (ceftiofur and cefquinome)

E

Employ narrow spectrum drugs wherever possible

• e.g. penicillin, rather than drug combinations.

C

Culture and sensitivity

Use bacterial culture promptly

  • Especially when
    • clinical response is less than expected
    • when long term therapy is suspected 

T

Treat effectively

Enough drug for long enough then stop 

  • Standardise dosing frequency and dose rates across the practice
  • Sometimes dosing intervals licenced in the marketing authorisation differ from current clinical evidence.
  • Review the veterinary literature to determine optimal dosing here

M

Monitor antimicrobial use, compliance and resistance

  • Undertake a clinical audit of antimicrobial use within your practice *NEW FOR 2014*
  • Formulate a policy to record the use of protected antimicrobials in your practice 
  • Formulate a policy to review antimicrobial susceptibility from any cultures obtained within the practice
  • Audit emerging antimicrobial resistance and consider adapting guidelines for empirical use.

E

Educate

Inform your team and your clients 

  • Ensure that protocols and changes to protocols are cascaded through the entire team 

  • Educate your clients to reduce pressure for antimicrobial prescribing

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PROTECT ME by BEVA & Mark Bowen is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.