Antimicrobial Resistance

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 new toolkit is modelled on BSAVA PROTECT guidelines developed by SAMSoc, but incorporating the essential watchwords ‘Monitor’ and ‘Educate’. The toolkit enables veterinary surgeons to:

Standardise dosing frequency and dose rates across the practice, to optimise antimicrobial effectiveness using the BEVA antimicrobial policy template 2012 as an example (see guidelines for use of PDF forms below). Sometimes dosing intervals licenced in the marketing authorisation differ from current clinical evidence. Members are encouraged to review the veterinary literature to determine these a collection of helpful articles can be found here. To access full text of EVJ and EVE articles you should login to the Members Area of the BEVA website first by clicking here.

Classify antimicrobials of critical importance as PROTECTED. This should include the 3rd and 4th Generation cephalosporins (eg Ceftiofur and cefquinome) and fluoroquinolones (eg enrofloxacin) as well as the Macrolides (eg Azithromycin). These drugs should not be used empirically without culture and sensitivity testing, with some exceptions where best evidence supports their use (eq the treatment of Rhodococcus equi in the foal). AVOIDED antimicrobials are defined as those which should not be used within your practice and include vancomycin, non-ocular chloramphenicol and the carbapenems. Educate your staff to ensure that no orders are placed for drugs in this category.

Formulate a policy whereby PROTECTED antimicrobials can be used with certain safeguards using the BEVA Use of protected antimicrobials policy document as an example.

Formulate a policy to record the use of protected antimicrobials in your practice using the BEVA recording of protected antimicrobials document as an example.

Identify common clinical presentations and suggest first line and alternative drugs for empirical treatment of these conditions using the BEVA antimicrobial policy template 2012 document as an example. Guidance on empirical and prophylactic antimicrobial use can be found here. To access full text of EVJ and EVE articles you should login to the Memebers Area of the BEVA website first by clicking here. Remember that the example document is by no means presented as the ‘ideal antimicrobial policy’. It is an example that you can change and amend as appropriate. Where members choose to, they may share their own version of this document with BEVA via the submit button in the hope that consensus can be achieved for a least some of these clinical conditions.

Develop protocols to use Prophylactic antimicrobials in a variety of clinical conditions using the BEVA antimicrobial policy template 2012 as an example

Formulate a policy to review antimicrobial susceptibility from any cultures obtained within the practice are using the BEVA review mechanisms document, and BEVA review mechanism form as examples. Audit emerging antimicrobial resistance and consider adapting guidelines for empirical use.

BEVA has compiled a list of Frequently Asked Questions as an aid.

Guidelines for use of PDF forms Several of the documents, including the BEVA antimicrobial policy template are available as PDF forms and require Adobe reader software to access. This can be downloaded for free from www.adobe.com/reader. An instructional video demonstrating how to use PDF forms can viewed here. A purple banner will appear at the top of the document asking you to complete the form. If this does not indicate ‘You can save data type into this form’ you should contact the protectme@beva.org.uk for assistance. While ‘highlight existing fields’ is selected the available sections that can be changed are highlighted. Use the TAB key or your mouse to move between fields. Once you have completed your policy, you should save it to your local computer so that it can be amended as needed. Print multiple copies and distribute to all members of the practice. We recommend additional copies are posted in your pharmacy. The dynamic functions of these PDF forms are not compatible with all tablet based PDF readers. The best solution to distribute to iphone / android devices is to print as a PDF using free software such as cutePDF available from cutepdf.com or primopdf from primopdf.com. Android users can download the free Adobe Reader software from Google Play. iOS users can purchase PDF forms software from the app store.
If you choose to you may submit your document to the BEVA office. This will enable BEVA to improve their documents for the future. All data submitted to BEVA will be treated in the strictest confidence and details of originating practices will not be used in any way. If you have any comments to improve these policy documents please email. The Toolkit