To better understand how veterinarians are using antibiotics now and where there might be opportunity to become even better stewards, a collaborative team of researchers from the University of Guelph and VCA Animal Hospitals teamed up. They reviewed 6,582 case records of dogs treated for bacterial urinary tract infections, a condition that’s regularly treated with antibiotics. The researchers tracked which classes of antibiotics were prescribed and for how long, using definitions and guidelines from the International Society for Companion Animal Infectious Diseases (ISCAID).
“It has been tough to benchmark treatment practices around antibiotic use in private practice because it’s harder to get the information,” says Veterinary Specialist Dr. J. Scott Weese, an Internal Medicine Specialist at the University of Guelph’s Centre for Public Health and Zoonoses and the Chief of Infection Control at the Ontario Veterinary College Health Sciences Centre. “In discussions with colleagues at VCA, we realized we had the same interest in learning more about how we’re currently using antibiotics and how we could use them better. So we agreed to work together.”
“This research is the outcome of a relatively unique collaboration between veterinary academia and private practice,” says Dr. Phil Bergman, Director of Clinical Studies for VCA. “It’s part of our mission at VCA to uncover new and better ways to care for our patients, and we hope we’ll get more chances for these kinds of collaborative efforts.”
If physicians and veterinarians hit the perfect mark on antimicrobial stewardship, they get the best possible outcomes for the human or pet—knocking back the infection and minimizing any negative effects of the treatment on the patient or the population. Ideally, in most cases medical professionals would start with the least powerful antibiotic that will get the job done, so the more powerful drugs will work if the patient has a critical need later.
In the big picture, studies like this one provide benchmarks that help medical professionals and public health experts track changes in treatment—which reflect changes in mindset. It’s important to know when and how antimicrobials are currently being used to measure progress toward stewardship goals.
In this study, slightly over 50 percent of prescriptions were consistent with ISCAID treatment guidelines. While there are reasons that a veterinarian might start with a stronger antibiotic, researchers say it’s reasonable to assume those exceptions would be a relatively small percentage of the cases. So there’s room for improvement in terms of starting with less critical drugs.
The researchers did see a shift toward the recommended prescriptions between 2016 and 2018, which is the time span of the cases they studied. That change could be because of increasing awareness of the need for more antimicrobial stewardship, continuing education about treatment of urinary tract infections, and increasing awareness of the ISCAID guidelines.
“It’s important for pet owners to know that treating a pet with antibiotics involves important choices,” says Dr. Weese. “We only want to use antibiotics when we must, because we want to be sure the next time the pet really needs an antibiotic it will work. As hard as it is in the moment, sometimes doing nothing is actually better for the pet in the long run.”
The study also shows that duration of treatment was relatively long. The most recent guidelines recommend that veterinarians consider a 3- to 5-day treatment period, which is consistent with the current approach in human medicine. Ten to 14 days of treatment was the most common treatment duration for the cases reviewed in the study. Choosing to treat for fewer days reduces cost and the risk of side effects, like diarrhea—and probably improves compliance, because it’s easier to remember to give a pet medication for fewer days.
“Although there’s room for improvement here, we did see a reasonable number of veterinarians using shorter durations—in the 5-day range—and some decrease in medium duration treatments. When we see even small changes over a such a relatively short period of time, those are good signs of progress,” says Dr. Weese.
“Microbial stewardship is a long-term issue and knowing where we are now and where we can take the next step is important and exciting,” says Dr. Weese. “But there’s still a long way to go. As veterinarians increasingly work toward these important guidelines for antibiotic use, you may notice your own veterinarian suggest a different medication or fewer total doses. And that’s a good thing for you and your pet.”
Dr. J. Scott Weese is a Professor in the Department of Pathobiology at the University of Guelph, Director of the University of Guelph’s Centre for Public Health and Zoonoses and a Fellow of the Canadian Academy of Health Sciences. After graduating with a Doctor of Veterinary Medicine degree and spending time in private practice, he completed a large animal internal medicine residency and Doctor of Veterinary Science graduate program. He’s a board-certified specialist in internal medicine and Chief of Infection Control at the Ontario Veterinary College Health Sciences Centre. His research focuses on infectious diseases, particularly those that can be transmitted between animals and people. Dr. Weese lives outside of Guelph, Ontario with his family and a collection of pets, including a dog, cat, fish and 6 alpacas. Dr. Weese also coaches competitive girls’ hockey, so he spends hours a week at the rink.
““We only want to use antibiotics when we must, because we want to be sure the next time the pet really needs an antibiotic it will work," says Dr. Weese.”