Overview and Evaluation of Existing Guidelines for Rational Antimicrobial Use in Small-Animal Veterinary Practice in Europe.

Fergus Allerton,Clare Phythian,Els Broens,Maria-Eleni Filippitzi,Ana Mateus,Jeroen Dewulf,Flavia Zendri,Cameron Prior,Lisbeth Jessen,Luís Carmo,Erez Harpaz,Bénédicte Callens,Peter Damborg,Dorina Timofte,Jonathan Gómez-Raja,Mirja Nolff,Arzu Bagcigil

doi:10.3390/antibiotics10040409

Abstract

Antimicrobial stewardship guidelines (ASGs) represent an important tool to help veterinarians optimize their antimicrobial use with the objective of decreasing antimicrobial resistance. The aim of this study was to map and qualitatively assess the ASGs for antimicrobial use in cats and dogs in Europe. Country representatives of the European Network for Optimization of Veterinary Antimicrobial Treatment (ENOVAT) were asked to identify ASGs published in their countries. All collated ASGs updated since January 2010 containing recommendations on antimicrobial therapy for at least three conditions affecting different organ systems in cats and dogs underwent detailed review including AGREE II analysis. Out of forty countries investigated, fifteen ASGs from eleven countries met the inclusion criteria. Several critical principles of antimicrobial use were identified, providing a framework that should assist development of stewardship guidance. The AGREE II analysis highlighted several methodological limitations of the currently available ASGs. This study sheds light on the lack of national ASGs for dogs and cats in multiple European countries and should encourage national bodies to prioritize guideline development in small animals. A greater awareness of the need to use a structured approach to guideline development could improve the quality of ASGs in the future.

Highlights

In response to the rising threat to both human and animal health from multidrugresistant (MDR) infections [1,2], there is an urgent need to adopt measures to preserve the efficacy of available antimicrobials
Representatives of every country participating in the ENOVAT Cooperation in Science and Technology (COST) Action were contacted by email to inform them of this study and to seek assistance in the identification of Antimicrobial stewardship guidelines (ASGs) offering recommendations pertaining to cats and dogs
Replies were obtained relating to 38/40 countries, identifying 23 potential guidelines from 17 different countries, a further pan-European document produced by the Federation of European

Summary

Introduction

In response to the rising threat to both human and animal health from multidrugresistant (MDR) infections [1,2], there is an urgent need to adopt measures to preserve the efficacy of available antimicrobials. Since antimicrobial use (AMU) is recognized as a key driver of antimicrobial resistance (AMR) [3], any steps that can reduce unnecessary or inappropriate AMU should diminish the selection pressure for resistant bacterial strains. The vast majority of AMU in animals occurs on farms promoting development of AMR and creating an important potential reservoir of resistance genes [4]. The overall AMU is substantially lower compared to production animals and the sales of antimicrobial tablets (a surrogate measure of AMU in companion animals) accounted for. The use of critically important antimicrobials belonging to the European

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Results