Optimising the use of antibiotics in veterinary medicine

An online tool is intended to help vets use antibiotics responsibly and so reduce the development of resistance.

The cat is not well. Its nose is running, its eyes are gummed up and it’s having trouble breathing. The vet diagnoses feline influenza, or cat flu, and now has to decide whether or not to prescribe an antibiotic. There are many factors to consider, because cat flu is caused by several viral or bacterial pathogens and takes various forms. It sometimes resolves spontaneously within a few days, while in other cases the cat has to be treated with an antibiotic.

“Switzerland has no statutory regulations on the use of antibiotics in veterinary medicine,” explains Hanspeter Nägeli, Director of the Institute of Veterinary Pharmacology and Toxicology at the University of Zurich. “It only has guidelines.” It is not clear, however, how many vets follow these non-binding recommendations. This is why Claudia Lehner and Kira Schmitt, two vets from the Vetsuisse Faculty in Bern and Zurich, collected nearly 200 sets of medical records belonging to cat flu patients from 2016. A preliminary evaluation has shown that roughly three out of four patients were given antibiotics, despite the fact that on first sight only around half of these cases actually needed antibiotic treatment.

“However, it won’t be possible to determine the number of cases in which antibiotics really were superfluous until we have completed the detailed analysis of the records that is currently in progress,” Schmitt continues. The vets also found evidence of frequent use of antibiotic classes that are not considered to be first-line therapies and of unnecessary drug combinations. Critical or reserve antibiotics had been used in as many as one third of cases.

An online tool to aid decisions

Nägeli and his team have developed an online tool designed to halt this excessive and non-specific use of antibiotics; it has been available since the end of 2016 on a frequently visited veterinary information website. The aim of the tool is to prevent resistance from developing and preserve the efficacy of the available antibiotics – not least with a view to their use in human medicine.

The tool, which goes by the name of AntibioticScout.ch, provides vets with a fast, uncomplicated decision-making aid to help them determine which type and dosage of antibiotic to choose for infections commonly encountered in cats, dogs, horses, cattle and pigs. For cat flu, for example, antibiotics are only recommended if certain symptoms are present at the same time and the cat is generally in a poor condition. “Our aim is to ensure that these guidelines are widely accepted and followed even if they are not prescribed by law,” Nägeli explains.

Over the coming years, the researchers want to use their NRP 72 project to establish whether AntibioticScout.ch has a measurable effect on prescribing habits, and cat flu is one of the examples they will be looking at. Lehner and Schmitt will compile case records again two years after the tool’s introduction and will analyse whether vets are taking a more conservative and targeted approach to prescribing antibiotics. In addition to cat flu, the team is also studying other conditions in small animals, such as urinary tract infections and diarrhoea in dogs. “We have selected indications where we feel there is potential for improvement because antibiotics are often not used correctly,” Lehner says. Selected indications in calves and cattle will also be studied.

Limiting factors for implementation

Although the researchers have already received a lot of positive feedback on the tool, Nägeli is aware that many vets are sceptical about the project. “Some are worried, for example, that animal owners will go to another medical centre if a sick animal doesn’t always get a powerful antibiotic injected straight away.” He therefore feels that one of the vets’ tasks must be to help animal owners to change their way of thinking. He also expects resistance from livestock owners. Here the situation is more complex because economic factors play a major role in addition to animal welfare. Yet Nägeli is confident that over the next few years there will be measurable progress in fighting antibiotic resistance, because AntibioticScout.ch is just one small part of a much larger project. The Federal Council has approved a comprehensive raft of measures as part of the Strategy on Antibiotic Resistance (StAR), and these will be implemented gradually over the next few years.