Factors influencing the behaviour and perceptions of Australian veterinarians towards antibiotic use and antimicrobial resistance.

Jacqueline M Norris,Annie Zhuo,Michael P Ward,Dale Dominey-Howes,Samantha J Rowbotham,Maurizio Labbate,Chris Degeling,Gwendolyn L Gilbert,Merran Govendir,Glenn F Browning

doi:10.1371/journal.pone.0223534

Abstract

Antimicrobial resistance (AMR) is a global crisis with impacts on the future health and welfare of humans and animals. Determining key factors that influence veterinarians’ antimicrobial prescribing behaviours can bridge the gap between prescribing guidelines and clinical usage. Veterinarians practicing in Australia were surveyed on their frequency in prescribing different antibiotics; factors influencing their antibiotic prescribing behaviours; and their perceptions of current drivers of AMR. Antibiotics were prescribed in a third of consultations with key differences in the frequency of use of specific antibiotics by small companion animal (SCA), equine and livestock veterinarians, which broadly aligned with antibiotic registration restrictions in Australia. SCA veterinarians reported prescribing broad-spectrum antibiotics of higher importance to human health more frequently than livestock veterinarians. Factors that were reported as ‘strong’ or ‘moderate’ barriers to appropriate antibiotic prescribing were the 1) cost of culture and susceptibility testing and 2) lack of access to rapid and affordable diagnostic tests. Fear of losing clients, colleague pressure, and lack of their own understanding about antibiotics were considered to be ‘no’ or ‘somewhat’ of a barrier to appropriate prescribing by respondents. SCA veterinarians placed greater importance on the contribution of antibiotic use in livestock to AMR, than antibiotic use in companion animals. Despite reporting use of fewer, mostly narrow spectrum antibiotics of lower importance to human and animal health, livestock veterinarians were generally more aware of their potential contribution to AMR. This study provides insights into the similarities and differences in SCA, equine and livestock veterinarians practicing in Australia and informs sector-specific strategies to improve antimicrobial stewardship.

Highlights

Antimicrobial resistance (AMR) is a critical global health issue with potentially far-reaching impacts on the health of humans and animals [1]
We recently reported that prescribers of antibiotics tend to externalise the concept of who is most responsible for AMR, placing the contribution of other individuals and professional sectors before their own [3]
Progress and compliance with antimicrobial stewardship principles is evident in livestock veterinarians whose use of critically important antibiotics was low and their awareness of their role in AMR was higher than small companion animal (SCA) and equine veterinarians

Summary

Introduction

Antimicrobial resistance (AMR) is a critical global health issue with potentially far-reaching impacts on the health of humans and animals [1]. Following the recommendations of the Swann report [4], Australia was one of a few countries to restrict the legal prescription of antimicrobials to certain professions: dentists, doctors, veterinarians and later, nurse practitioners. In Australia, national practice-level therapeutic guidelines for antimicrobial use are widely available for doctors, nurse practitioners and dentists [5]. Assessment of antimicrobial prescribing practices in these professions has been actively performed via a range of audits. Examples include evidence-based consensus statements on specific common diseases [6,7,8,9], production-industry guidelines as part of quality assurance programs, and exclusion of many antimicrobial agents for use in livestock and horses by the Federal Government Agency—the Australian Pesticides and Veterinary Medicines Authority (APVMA). Monitoring or auditing the antimicrobial prescribing practices of Australian veterinarians has not been published to date

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