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For Equine Vets Everywhere

Protect Me

The award winning antibiotic use tool kit

Antimicrobial resistance is a 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, modelled on the BSAVA PROTECT guidelines has been developed to support you in using antibiotics responsibly.


Practice Policy

Develop protocols for antimicrobial usage based on common clinical scenarios

Develop a practice policy by: 

  1. Identifying common clinical scenarios
  2. Formulating protocols for first line and alternative antimicrobial therapy for these conditions
  3. Consider appropriate antimicrobial dosing using an evidence based approach 
  4. Classify key antibiotics as protected and avoided 

Useful resources to help you develop your practice policy:

Download the PROTECT ME policy template

Download the PROTECT ME example practice protocol for use of the protected antimicrobials

Please note the policy template available to download is by no means the ideal antimicrobial policy. It is offered as an example that you can amend as appropriate. 

 

R reduce prophylaxis

Develop rational protocols for prophylaxis

 

Define prophylaxis for surgical procedures whether clean, contaminated or high risk. Practice protocols can be included as part of the general clinic protocols.

 

O oTHER OPTIONS

 

Reduce or replace antimicrobials with other methods for bacterial reduction

Utilise wound debridement / lavage

Consider topical preparations or local intravenous administration

Types of drugs and bacteria

Select appropriate drugs based on empirical use guidelines

Use cytology where possible

Consider the dose and pharmacokinetics of the drugs selected

 

eMPLOY APPROPRIATE DRUGS BASED ON EMPIRICAL USE GUIDELINES

 

Predict likely bacteria based on type of infection
Staphylococcus sp are common skin commensals and will often colonise wounds and commonly sensitive to penicillins and/or gentamicin

Streptococcus sp are common respiratory pathogens and often sensitive to pencillins

Wounds with environmental contamination are likely to be colonised by Coliform bacteria or Pseudomonas sp and are frequently sensitive to aminoglycosides

Culture and sensitivity

Use bacterial culture and sensitivity, even initiating empirical therapy pending results where needed especially where:
clinical response is less than expected
when long term therapy is suspected
critically important antibiotics (PROTECTED) are being used

Formulate practice policies for when culture and sensitivity is used as part of your PROTECT ME policy.

T Treat effectively 

As little as possible, as much as needed 

Standardise dosing frequency and does 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  

M Monitor

Audit antibiotic use and resistance

MONITORING ANTIMICROBIAL USE

1. Monitoring impact of your practice policy - CLICK HERE FOR CLINICAL AUDIT TOOLS

The is considerable evidence in human health that auditing antimicrobial use can be a powerful tool to changing prescribing practices. If the highest priority critically important antibiotics are used sparingly then we can preserve their effectiveness for the future. 

BEVA has created a flexible framework allowing veterinary surgeons to undertake effective clinical audit without significantly impacting on working practices. This will help members comply with their obligations under the RCVS practice standards scheme

2. Monitoring the impact of your policy on emergence of antimicrobial resistance

Regular review of emerging antimicrobial resistance is as important as the establishment of your initial practice policy. It will enable you to monitor the effectiveness of your practice protocol in reducing the emergence of resistance, while making it respond to changes in bacterial sensitivity in your practice.

The practice should establish a protocol for monitoring of emerging resistance. The guide below is designed to give a simple mechanism, but can be adapted as needed to your individual needs. Ideally bacterial culture and sensitivity will be undertaken prior to any change in antimicrobials, in a prospective manner, however the analysis of any culture and sensitivity can be used in an opportunistic manner. 



The purpose of this process is to record the development of resistance that should impact on your prescribing policy. An example template document for recording and reviewing the emergence of antimicrobials is shown below


3. Monitor use of critically important antimicrobials in your practice

Decisions regarding antimicrobial selection are often based upon previous experience of a disease. In order to promote change of behaviour BEVA suggest that practices require staff to record the reasons why critically important antimicrobials are used. These antibiotics include

  1. The macrolides (eg erythromycin)
  2. The fluoroquinolones (eg enrofloxacin)
  3. The 3rd and 4th generation cephalosporins (ceftiofur and cefquinome)

Experience from practices that have developed this policy have seen a 90% reduction in the use of these agents.

E Educate 

Educate your team and your clients

PRACTICE STAFF

Education is a vital part of changing practice and promoting responsible use. When constructing and reviewing local policies it is vital to develop buy in from all members of the practice. A range of resrouces have been curated to enable staff to develop an evidence based approach to antimicrobial use in the horse. The abstracts of these can be viewed here

BEVA members have free access to the full text from all EVJ and EVE articles. Simply click here to login first

 

A Virtual issue of Equine Veterinary Journal on the subject can be accessed here

This will open a new window / tab so that you can continue browsing in this window. If you have a pop-up blocker this can usually be overridden by holding the alt key while clicking on this link

A brochure promoting responsible antimicrobial use can be downloaded below


CLIENTS

1. Promote responsible use of prescribed antibiotics

BEVA has produced client information leaflets that can be provided to clients in paper form, as well as shortened URLs and QR codes that can be attached to medicine packaging. 

These leaflets are designed to promote a better understanding of antimicrobial resistance and how to use these medicines responsibly. Recent research from the WHO showed that 74% of the global population do not understand what the term antimicrobial resistance means. 

   

Labels can be printed (21 per page) and attached prior to prescribing. CLICK HERE TO ACCESS


2. Reduce pressure to prescribe antibiotics

A poster and fact sheet have been developed for use by practices to help explain the importance of responsible antimicrobial use. Click on the images below to download these.


 

             

In addition a series of light hearted cartoons have been created to spread the message of responsible antimicorbial use. These can be used on websites or social media.






FREQUENTLY ASKED QUESTIONS

Why is BEVA promoting responsible antimicrobial usage?

Antimicrobial resistance is an emerging clinical problem that is recognised internationally as one of the largest threats to health. AMR has been recently classified as a clinical disease in its own right. All major human health and veterinary organisations are working to try and limit the development of resistance so that we can retain effective antimicrobials for use in clinical practice.

Antibiotics are effective, and resistance is not causing any problems in our practice. Why change?

Although the clinical impact of antimicrobial resistance is a moderate term problem, the regulatory response that could be adopted to limit further development could have significant impacts on veterinary practices in the short term. BEVA believe that effective self-regulation is preferable to changes in legislation.

Is BEVA trying to regulate clinical practice?

No, BEVA are providing members with a toolkit to help them develop their own policy around antimicrobial use, in the same way that they develop policies around health and safety. There are always concerns that such policies limit clinical freedom and formularise veterinary practice, however BEVA believe that well formulated policies allow for clinical ‘freedom’, while regularizing routine cases. In equine practice antimicrobial choice is already limited, so in many cases you will be simply converting current practice into a policy.

Why is BEVA adopting a one-policy-fits all approach?

BEVA does not believe in a one-for-all policy. All of the documents that are available to download are examples. They demonstrate the procedures and standard operating procedures that should be adopted by practices. You are welcome to take this policy, to modify it, or create your own from scratch.

Do I have to formulate a policy?

No, currently there are no requirements of veterinary practices to develop antimicrobial policies. However if the industry does not demonstrate the ability to self-regulate then regulation is likely to be forced upon it.

Why is BEVA not developing a more uniform equine policy?

There are a large number of variables, include case profile, regional variations in antimicrobial resistance that means that a country-wide policy could be ineffective. We therefore believe that practices should develop their own policy.

What should I do if I do not believe the BEVA antimicrobial use policy will work in my practice?

Develop your own. The steps required to do so are detailed. BEVA would be happy for you to share your policy with them and others

What are other organisations doing?

BSAVA: SAMSoc developed the PROTECT concept and created a poster to allow practices to develop the first line antimicrobial for common clinical conditions

BVA: Developed the framework for the development of responsible antimicrobial use

ACVIM: The American College of Veterinary Internal Medicine developed a consensus statement for responsible antimicrobial use.

Why is BEVA trying to develop more regulation than BSAVA?

Monitoring antimicrobial usage and emerging resistance is an essential tool to help practices understand whether their policy is effective and identify when changes may be needed. BEVA do not believe that the proposal will add considerably to workloads and are ‘light-touch’ and effective.

Why is BEVA discouraging the use of licensed antimicrobials?

The ‘important’ antimicrobials are the 3rd and 4th generation cephalosporins and the fluoroquinolones . These are relied upon for treatment of challenging infections in human health. BEVA believe that these products should continue to be available to veterinary surgeons, and through self-regulation, they can be preserved for similar use in veterinary practices.

Why is BEVA encouraging the use of unlicensed products?

Our unique privilege to prescribe drugs using the ‘cascade’ means that in some clinical cases, one can predict that certain unlicensed products maybe effective. The benefits of using these products, rather than a licenced, but PROTECTED antimicrobial are for the wider community to prevent emergence of antimicrobial resistance in these species.

Why is BEVA encouraging off-label use by suggesting doses that are different to the data sheet?

For some antibiotics, evidence in the literature supports the use of dose rates and frequencies outwith the datasheets. Sub-therapeutic dosing is an important factor in the development of resistance and therefore we would encourage members to review this evidence when constructing these policies.

What has happened in other countries?

Any financial incentive to dispense has been prevented in some Scandinavian countries either by preventing profits being made from antimicrobial sales, or by preventing dispensing of antimicrobials by veterinary surgeons.

FREQUENTLY ASKED QUESTIONS

 
Why is BEVA promoting responsible antimicrobial usage?

Antimicrobial resistance is an emerging clinical problem that is recognised internationally as one of the largest threats to health. AMR has been recently classified as a clinical disease in its own right. All major human health and veterinary organisations are working to try and limit the development of resistance so that we can retain effective antimicrobials for use in clinical practice.

Antibiotics are effective, and resistance is not causing any problems in our practice. Why change?

Although the clinical impact of antimicrobial resistance is a moderate term problem, the regulatory response that could be adopted to limit further development could have significant impacts on veterinary practices in the short term. BEVA believe that effective self-regulation is preferable to changes in legislation.

Is BEVA trying to regulate clinical practice?

No, BEVA are providing members with a toolkit to help them develop their own policy around antimicrobial use, in the same way that they develop policies around health and safety. There are always concerns that such policies limit clinical freedom and formularise veterinary practice, however BEVA believe that well formulated policies allow for clinical ‘freedom’, while regularizing routine cases. In equine practice antimicrobial choice is already limited, so in many cases you will be simply converting current practice into a policy.

Why is BEVA adopting a one-policy-fits all approach?

BEVA does not believe in a one-for-all policy. All of the documents that are available to download are examples. They demonstrate the procedures and standard operating procedures that should be adopted by practices. You are welcome to take this policy, to modify it, or create your own from scratch.

Do I have to formulate a policy?

No, currently there are no requirements of veterinary practices to develop antimicrobial policies. However if the industry does not demonstrate the ability to self-regulate then regulation is likely to be forced upon it.

Why is BEVA not developing a more uniform equine policy?

There are a large number of variables, include case profile, regional variations in antimicrobial resistance that means that a country-wide policy could be ineffective. We therefore believe that practices should develop their own policy.

What should I do if I do not believe the BEVA antimicrobial use policy will work in my practice?


Develop your own. The steps required to do so are detailed. BEVA would be happy for you to share your policy with them and others

What are other organisations doing?

BSAVA: SAMSoc developed the PROTECT concept and created a poster to allow practices to develop the first line antimicrobial for common clinical conditions

BVA: Developed the framework for the development of responsible antimicrobial use

ACVIM: The American College of Veterinary Internal Medicine developed a consensus statement for responsible antimicrobial use.

Why is BEVA trying to develop more regulation than BSAVA?


Monitoring antimicrobial usage and emerging resistance is an essential tool to help practices understand whether their policy is effective and identify when changes may be needed. BEVA do not believe that the proposal will add considerably to workloads and are ‘light-touch’ and effective.

Why is BEVA discouraging the use of licensed antimicrobials?

The ‘important’ antimicrobials are the 3rd and 4th generation cephalosporins and the fluoroquinolones . These are relied upon for treatment of challenging infections in human health. BEVA believe that these products should continue to be available to veterinary surgeons, and through self-regulation, they can be preserved for similar use in veterinary practices.

Why is BEVA encouraging the use of unlicensed products?

Our unique privilege to prescribe drugs using the ‘cascade’ means that in some clinical cases, one can predict that certain unlicensed products maybe effective. The benefits of using these products, rather than a licenced, but PROTECTED antimicrobial are for the wider community to prevent emergence of antimicrobial resistance in these species.

Why is BEVA encouraging off-label use by suggesting doses that are different to the data sheet?

For some antibiotics, evidence in the literature supports the use of dose rates and frequencies outwith the datasheets. Sub-therapeutic dosing is an important factor in the development of resistance and therefore we would encourage members to review this evidence when constructing these policies.

What has happened in other countries?

Any financial incentive to dispense has been prevented in some Scandinavian countries either by preventing profits being made from antimicrobial sales, or by preventing dispensing of antimicrobials by veterinary surgeons.

FREQUENTLY ASKED QUESTIONS

 
Why is BEVA promoting responsible antimicrobial usage?

Antimicrobial resistance is an emerging clinical problem that is recognised internationally as one of the largest threats to health. AMR has been recently classified as a clinical disease in its own right. All major human health and veterinary organisations are working to try and limit the development of resistance so that we can retain effective antimicrobials for use in clinical practice.

Antibiotics are effective, and resistance is not causing any problems in our practice. Why change?

Although the clinical impact of antimicrobial resistance is a moderate term problem, the regulatory response that could be adopted to limit further development could have significant impacts on veterinary practices in the short term. BEVA believe that effective self-regulation is preferable to changes in legislation.

Is BEVA trying to regulate clinical practice?

No, BEVA are providing members with a toolkit to help them develop their own policy around antimicrobial use, in the same way that they develop policies around health and safety. There are always concerns that such policies limit clinical freedom and formularise veterinary practice, however BEVA believe that well formulated policies allow for clinical ‘freedom’, while regularizing routine cases. In equine practice antimicrobial choice is already limited, so in many cases you will be simply converting current practice into a policy.

Why is BEVA adopting a one-policy-fits all approach?

BEVA does not believe in a one-for-all policy. All of the documents that are available to download are examples. They demonstrate the procedures and standard operating procedures that should be adopted by practices. You are welcome to take this policy, to modify it, or create your own from scratch.

Do I have to formulate a policy?

No, currently there are no requirements of veterinary practices to develop antimicrobial policies. However if the industry does not demonstrate the ability to self-regulate then regulation is likely to be forced upon it.

Why is BEVA not developing a more uniform equine policy?

There are a large number of variables, include case profile, regional variations in antimicrobial resistance that means that a country-wide policy could be ineffective. We therefore believe that practices should develop their own policy.

What should I do if I do not believe the BEVA antimicrobial use policy will work in my practice?


Develop your own. The steps required to do so are detailed. BEVA would be happy for you to share your policy with them and others

What are other organisations doing?

BSAVA: SAMSoc developed the PROTECT concept and created a poster to allow practices to develop the first line antimicrobial for common clinical conditions

BVA: Developed the framework for the development of responsible antimicrobial use

ACVIM: The American College of Veterinary Internal Medicine developed a consensus statement for responsible antimicrobial use.

Why is BEVA trying to develop more regulation than BSAVA?


Monitoring antimicrobial usage and emerging resistance is an essential tool to help practices understand whether their policy is effective and identify when changes may be needed. BEVA do not believe that the proposal will add considerably to workloads and are ‘light-touch’ and effective.

Why is BEVA discouraging the use of licensed antimicrobials?

The ‘important’ antimicrobials are the 3rd and 4th generation cephalosporins and the fluoroquinolones . These are relied upon for treatment of challenging infections in human health. BEVA believe that these products should continue to be available to veterinary surgeons, and through self-regulation, they can be preserved for similar use in veterinary practices.

Why is BEVA encouraging the use of unlicensed products?

Our unique privilege to prescribe drugs using the ‘cascade’ means that in some clinical cases, one can predict that certain unlicensed products maybe effective. The benefits of using these products, rather than a licenced, but PROTECTED antimicrobial are for the wider community to prevent emergence of antimicrobial resistance in these species.

Why is BEVA encouraging off-label use by suggesting doses that are different to the data sheet?

For some antibiotics, evidence in the literature supports the use of dose rates and frequencies outwith the datasheets. Sub-therapeutic dosing is an important factor in the development of resistance and therefore we would encourage members to review this evidence when constructing these policies.

What has happened in other countries?

Any financial incentive to dispense has been prevented in some Scandinavian countries either by preventing profits being made from antimicrobial sales, or by preventing dispensing of antimicrobials by veterinary surgeons.

FREQUENTLY ASKED QUESTIONS

 
Why is BEVA promoting responsible antimicrobial usage?

Antimicrobial resistance is an emerging clinical problem that is recognised internationally as one of the largest threats to health. AMR has been recently classified as a clinical disease in its own right. All major human health and veterinary organisations are working to try and limit the development of resistance so that we can retain effective antimicrobials for use in clinical practice.

Antibiotics are effective, and resistance is not causing any problems in our practice. Why change?

Although the clinical impact of antimicrobial resistance is a moderate term problem, the regulatory response that could be adopted to limit further development could have significant impacts on veterinary practices in the short term. BEVA believe that effective self-regulation is preferable to changes in legislation.

Is BEVA trying to regulate clinical practice?

No, BEVA are providing members with a toolkit to help them develop their own policy around antimicrobial use, in the same way that they develop policies around health and safety. There are always concerns that such policies limit clinical freedom and formularise veterinary practice, however BEVA believe that well formulated policies allow for clinical ‘freedom’, while regularizing routine cases. In equine practice antimicrobial choice is already limited, so in many cases you will be simply converting current practice into a policy.

Why is BEVA adopting a one-policy-fits all approach?

BEVA does not believe in a one-for-all policy. All of the documents that are available to download are examples. They demonstrate the procedures and standard operating procedures that should be adopted by practices. You are welcome to take this policy, to modify it, or create your own from scratch.

Do I have to formulate a policy?

No, currently there are no requirements of veterinary practices to develop antimicrobial policies. However if the industry does not demonstrate the ability to self-regulate then regulation is likely to be forced upon it.

Why is BEVA not developing a more uniform equine policy?

There are a large number of variables, include case profile, regional variations in antimicrobial resistance that means that a country-wide policy could be ineffective. We therefore believe that practices should develop their own policy.

What should I do if I do not believe the BEVA antimicrobial use policy will work in my practice?


Develop your own. The steps required to do so are detailed. BEVA would be happy for you to share your policy with them and others

What are other organisations doing?

BSAVA: SAMSoc developed the PROTECT concept and created a poster to allow practices to develop the first line antimicrobial for common clinical conditions

BVA: Developed the framework for the development of responsible antimicrobial use

ACVIM: The American College of Veterinary Internal Medicine developed a consensus statement for responsible antimicrobial use.

Why is BEVA trying to develop more regulation than BSAVA?


Monitoring antimicrobial usage and emerging resistance is an essential tool to help practices understand whether their policy is effective and identify when changes may be needed. BEVA do not believe that the proposal will add considerably to workloads and are ‘light-touch’ and effective.

Why is BEVA discouraging the use of licensed antimicrobials?

The ‘important’ antimicrobials are the 3rd and 4th generation cephalosporins and the fluoroquinolones . These are relied upon for treatment of challenging infections in human health. BEVA believe that these products should continue to be available to veterinary surgeons, and through self-regulation, they can be preserved for similar use in veterinary practices.

Why is BEVA encouraging the use of unlicensed products?

Our unique privilege to prescribe drugs using the ‘cascade’ means that in some clinical cases, one can predict that certain unlicensed products maybe effective. The benefits of using these products, rather than a licenced, but PROTECTED antimicrobial are for the wider community to prevent emergence of antimicrobial resistance in these species.

Why is BEVA encouraging off-label use by suggesting doses that are different to the data sheet?

For some antibiotics, evidence in the literature supports the use of dose rates and frequencies outwith the datasheets. Sub-therapeutic dosing is an important factor in the development of resistance and therefore we would encourage members to review this evidence when constructing these policies.

What has happened in other countries?

Any financial incentive to dispense has been prevented in some Scandinavian countries either by preventing profits being made from antimicrobial sales, or by preventing dispensing of antimicrobials by veterinary surgeons.