Guidance on antimicrobial stewardship
The Board reminds vets to exercise their professional judgement, referring to contemporary evidence, when deciding whether and how to use antimicrobials.
Vets are a crucial "frontline" defence against antimicrobial resistance (AMR) because they control public access to antimicrobials. They can refuse requests for antibiotics from animal owners where there is no substantiated case for their use.
Vets have access to prescribing guidelines for different animal species which are regularly updated. One example is the Antibiotic prescribing detailed guidelines (PDF) for companion animals published by the Australasian Infectious Diseases Advisory Panel (AIDAP), which provide a range of scenarios relevant to Australian practice.
The Board has seen cases where urinary and gastrointestinal issues were treated with antibiotics without cultures being taken. Vets should feel confident in explaining to their clients that diagnostic testing will confirm the presence of infection, identify the presence of resistant bacteria that may not respond to initial therapy, help differentiate reinfection from relapse and provide information on the most common bacteria causing urinary tract infections in the local area.
While the Board recognises that the cost and logistics of diagnostic testing may be off-putting to animal owners, veterinary practitioners should not agree to use antimicrobials "just in case", without evidence-based reasons for such use.
The principles of appropriate antimicrobial selection, administration and supply must be applied.
Antibiotics should only be used as a “preventative” where the evidence indicates a significant risk of problematic microbial infection (not just microbial presence). An example in the AIDAP guidelines where a prophylactic antimicrobial may be justifiable is where teeth are extracted from an animal with co-morbidities or implants which put them at higher risk of infection from a reasonably expected bacteraemia.
Crucial requirements in the Board's Guideline 15 - Responsible supply and use of antibiotics are that veterinary practitioners should:
- maintain their current knowledge of issues relating to antimicrobial resistance by undertaking training or other continuous professional development, e.g. in antimicrobial stewardship, at least every 3 years
- develop or have available, and comply with, a written protocol describing prudent and responsible use of antibiotics which directs their supply and use of antibiotics.
Antimicrobial stewardship is most effective when the whole veterinary team is involved. If veterinary nurses and other staff understand responsible antimicrobial supply and use, they can help to convey and reinforce messages about antibiotic resistance to
clients.
Simple ways to share knowledge and build confidence around communicating messages about prescribing or not prescribing antimicrobials are to ensure prescribing guidance is readily accessible and is part of practice signage and have regular peer discussions about the use of antimicrobials.
When a vet explains to a client that there is no case for using an antibiotic in a particular situation - based on the current evidence and expert sources of information, they help to build public understanding of antimicrobial resistance. Veterinary practitioners who safeguard the health of animals and the public as antimicrobial stewards have the full support of the Board.
More information and resources
Relevant guidelines: