Responsible use of antibacterials

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Statement	The British Small Animal Veterinary Association (BSAVA) strongly recommends that the veterinary profession embraces the responsible use of antibacterials, as part of the One Health approach to antimicrobial use, in order to: Minimise the selection of resistant veterinary microorganisms, and therefore safeguard national health Minimise transfer of resistance mechanisms between microorganisms in animals, humans and the wider environment. The BSAVA recommends that veterinary surgeons in practice develop and implement a practice policy to encourage responsible prescribing of antibacterials in their practice. Examples of such policies include BSAVA PROTECT ME, FECAVA Recommendations for Appropriate Antimicrobial Therapy, Antibiotic Use Guidelines for Companion Animal Practice (2nd Edition) and Guidance for the use of antimicrobials (GRAM) book. It is recommended that advice be included about: reducing antibacterial use appropriate first line antibacterials peri-operative antibacterial use hand hygiene appropriate use of topical antibacterials use of alternatives, e.g. disinfectant/antiseptics such as chlorhexidine The BSAVA strongly discourages the use of antibacterials with restricted use in human medicine ( e.g. Imipenem and Vancomycin) in any circumstances. The BSAVA recommends that antibacterials such as 3rd or 4th generation Cephalosporins or Fluoroquinolones should only be used when culture and sensitivity results indicate efficacy and other agents are inappropriate. Antibacterial selection should not be made based on convenience of administration. The BSAVA recommends that veterinary surgeons implement hygiene and biosecurity practices to minimise the need for use of antibacterials. The BSAVA recommends that veterinary surgeons report antibacterial treatment failure (where culture and sensitivity results indicated a particular authorised antibacterial that was correctly used, but follow-up culture and sensitivity identified persistent infection) to the Veterinary Medicines Directorate (VMD) using the Suspected Adverse Reaction Surveillance Scheme (SARSS).
Date	January 2022
Background information	Antibacterials are essential drugs for treating bacterial infections, providing great benefits to humans and domestic animals by enabling the treatment of diseases that previously caused significant morbidity and mortality. Unfortunately, inappropriate use of antibacterials has hastened the development of antibacterial resistance. Although the use of antibacterials does not in itself induce resistance, reducing the growth or killing susceptible strains promotes the relative proliferation of resistant bacteria. Antimicrobial resistant infections can be associated with a variety of bacteria including multi-drug resistant Pseudomonas species, extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (e.g. ESBL E. coli) and, meticillin-resistant staphylococci such as Staphylococcus aureus (MRSA) and Staphylococcus pseudintermedius (MRSP). MRSA and other meticillin-resistant staphylococci have been isolated from humans, dogs, cats, rabbits, birds, horses and farm animals. Animals could be at risk of colonization or infection in veterinary premises and/or act as reservoirs for colonization or infection of in-contact humans. High standards of clinical practice and hygiene are vital to prevent the spread of these organisms. Responsible antimicrobial use will help slow the development of resistance and help preserve the efficacy of existing antimicrobial drugs for the future. At the same time as antibacterials have become less effective as a result of the development of antibacterial resistance, there has been a reduced rate of development of new drugs. These two factors mean that it is essential to protect the effectiveness of the currently available antibacterials through responsible use and stewardship. Antibacterial resistance is recognised as a “One Health” issue affecting humans, animals and the environment. It is a global issue that requires global solutions and an integrated strategy that aims to: improve the knowledge and understanding of antimicrobial resistance (AMR) conserve and steward the effectiveness of existing treatments through optimal use of antibiotics in both humans and animals stimulate the development of new antibiotics, diagnostics and novel therapies as detailed in the UK 5 year Antimicrobial Resistance Strategy produced by the Department of Health (DoH) and the Department for the Environment, Food and Rural Affairs (Defra). In the UK, all veterinary antibacterials are prescription-only medicines (POM-V); therefore the responsibility for and control of antibacterial use rests with the prescribing veterinary surgeon. Responsible antimicrobial prescribing is now a requirement under the RCVS Code of Professional Conduct which states: “Veterinary surgeons must be seen to ensure that when using antimicrobials they do so responsibly, and be accountable for the choices made in such use.” The BSAVA and Small Animal Medicine Society (SAMSOC) have produced the PROTECT ME poster and guidance to encourage responsible antibacterial prescribing.
Other statements	Cascade prescribing
Further information	BSAVA Medicines Guide: Antibacterials BSAVA Scientific Information Document: Meticillin-resistant staphylococci UK 5 year antimicrobial strategy (2013-2018) Bella Moss Foundation Companion November 2018: The why and how of antimicrobial prophylaxis Companion November 2018: PROTECT ME PROTECT ME Guidance for the rational use of antimicrobials (GRAM) book FECAVA Recommendations for Appropriate Antimicrobial Therapy World Health Organisation VMD position statement on antibacterial use NOAH information on AMR European Medicines Agency (EMA) information on veterinary medicines and AMR Antibiotic Use Guidelines for Companion Animal Practice (2nd Edition)
Provenance	Reviewed by Fergus Allerton and members of BSAVA Scientific Committee (Alexander German, Jeremy Kirk, Caroline Kisielewicz, Lisa Morrow, Ian Self, Melissa Upjohn, James Warland) 2022

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