CVS Equine has undertaken a significant audit of antimicrobial use in its first opinion equine practices, in order to deepen the understanding of prescribing patterns. This work also creates opportunities for further clinical research and guideline development.
A preliminary audit[i] published in 2022 used sales data to record antimicrobial prescriptions in 11 of the group’s 22 first opinion practices. This demonstrated a decline in the quantities of antimicrobials prescribed from 2014 to 2018, including a reduction in the prescription of the critically important antimicrobials enrofloxacin and ceftiofur.
A further audit has now been undertaken in all 22 first opinion practices to investigate the age, breed and estimated weight of each horse; the clinical indication for antibiotic use; the drugs prescribed; their dose rates; the route of administration; and, whether culture and sensitivity were used to guide antimicrobial selection. Data collection was recently completed in August 2022.
This secondary audit was conducted using a ‘point prevalence’ survey, used extensively in human healthcare. Here it collects information on the prescribing practices of antibiotics and other information relevant to the treatment and management of infectious diseases.
To conduct the point prevalence survey, each CVS Equine first opinion Quality Improvement Lead gathered information about all systemic antibiotics prescribed by each of their practices on one day a month for 12 consecutive months.
The project has yielded information on 331 cases where systemic antimicrobials were prescribed. Complete data about the first line-drug selection were available for 261 prescriptions.
The commonest prescribed antimicrobial was sulfadiazine/trimethoprim (41%), followed by oxytetracycline (23%), procaine penicillin (16%), doxycycline (13%), gentamicin (4%), metronidazole (1%), ceftiofur (1%) and enrofloxacin (1%). Highest priority critically important antimicrobials (ceftiofur and enrofloxacin) were only prescribed in four horses (clinical indications for these included possible sepsis, skin infection, lower respiratory tract infection and a wound complication – in none of these cases was the first-line drug selection based on the results of culture and sensitivity. Overall, the clinical indications for antimicrobial use were recorded in 246 cases; the commonest indications were cellulitis/lymphangitis (27%), uncomplicated wounds (19%), surgical prophylaxis (15%), respiratory infections (11%) and skin infections (8%).
Hattie Lawrence, Director of CVS Equine, said: “We’ve had a major focus on antimicrobial stewardship for the last three years. Our repeated point prevalence surveys have been a hugely labour-intensive piece of work. They have required dedicated time from each of CVS Equine’s Quality Improvement Leads, since they required manual recording of data on a regular basis.
“Though the impact of this work is yet to be documented, there is anecdotal evidence that it has raised awareness amongst our veterinarians of the importance of antimicrobial stewardship. Taken together, the results of both pieces of work will be used to help develop and inform clinical audits and clinical guidelines of antimicrobial use in horses.”
CVS Equine’s work to date has received a ‘highly commended’ in RCVS Knowledge Antimicrobial Stewardship Award.
The group has also performed point prevalence surveys in its nine equine veterinary hospitals, including those in The Republic of Ireland and the Netherlands. This work involved point prevalence surveys of antimicrobial use in hospitalised horses, performed once a week for 12 months in each hospital. This survey was completed in 2022, and the data (results from approximately 1500 antimicrobial prescriptions) are currently being analysed.
CVS Group operates across small animal, farm animal, equine, laboratories and crematoria, with over 500 veterinary practices and referral centres in the UK, the Republic of Ireland and the Netherlands. In the last five years the company has invested nearly £80 million in its sites, facilities and equipment, in addition to industry leading training and support, to give the best possible care to animals.
[i] Mair, T.S. and Parkin, T.D. (2022) Audit of antimicrobial use in eleven equine practices over a five-year period (2014-2018). Equine Vet.Educ. 10.1111/eve.13438).