Antimicrobial resistance (AMR) seems a big topic and it is certainly one that will be a major challenge for years to come. It is a challenge in which we must all play our part; clinicians, animal owners, patients, consumers, business organisations, pharmaceutical companies, governments, scientists and others. If we don’t all work together to combat AMR, then, in the words of Chief Medical Officer, Sally Davies “Antimicrobial resistance poses a catastrophic threat.”
There have been many successes and the veterinary sector working collaboratively with other stakeholders have made real changes particularly in the agriculture section, spearheaded by the Responsible Use of Medicines in Agriculture Alliance. Research and technology will play an important part, for instance, with better animal side testing but some of the things that we can do as clinicians are basic yet effective. One of these is simply understanding what is happening in our practices and working as a team to make a positive change. In the 2017 Society of Practising Veterinary Surgeons fees survey respondents were asked if, as practice policy, they give antibiotics after routine small animal neutering. 12.9% replied that they always give antibiotics. This seems a high figure given the concern around AMR. Sometimes stopping and thinking about why we prescribe in a certain way may help us make a change. Practice audit in the use of antibiotics particularly for certain procedures can often help practices to reconsider their use and make a positive change. There are a number of professional tools available for practitioners which I outlined in my blog post last year.
Audit is one way we can use evidence to make an informed change. Behavioural change can be difficult for all of us irrespective of whether we are a clinician or owner yet behavioural change is vital. A meeting by the World Health Organisation studied behavioural change in the context of AMR. The report of the meeting has some fascinating insights. With one study discussing how “Understanding the gap between knowledge, intention, and action, as well as how social norms, peer pressure and behaviour choices interact and influence actors at the point of decision-making is crucial.” This study showed that even when “knowledge and awareness are higher than expected regarding AMR other factors were contributing to decision choice (when prescribing).” We know this from practice when the clinical decision that we make is based on many factors and not just the gold standard evidence. In terms of AMR, as clinicians, much of our work is around education. Educating ourselves and our clients to facilitate positive behaviour change. This handy Bust the myths is great to help educate clients.
There has been some interesting work carried out at The University of Bristol in terms of behavioural change in farm animal practice with an update in this BVA blog post.
Doing the right thing can feel difficult, particularly when as clinicians we are hampered by a lack of choice when working with some species under the Cascade, but this guidance from the Veterinary Medicine Directorate for vets on Responsible antibiotic use under the prescribing cascade is useful.