I spend a lot of time working in this area, and figuring out how to effect real change is the challenge. That means getting to prescribers. If I’m at a conference and have a talk titled “Antimicrobial stewardship” (or something along those lines), the audience will likely consist of the moderator, some people from the pharma industry, some regulatory personnel and the guy that ended up in the wrong room. It might be a great talk and discussion, but it’s unlikely to do anything with that crowd.
In contrast, if I’m at the same conference and do a talk about “Treatment of urinary tract infections in dogs and cats”, the room’s probably going to be packed, and hopefully I can get some points across that improve antibiotic use AND patient care. The “and” is critical, because taking care of our patients (and their owners) is the most obvious goal for a practicing vet.
So, improving antibiotic use while maintaining some clinical perspective and fostering good patient care is the key, at least for me.
Along those lines, Clinician’s Brief (of which I’m Editor-in-Chief) recently adopted an antimicrobial stewardship policy. As a leading provider of veterinary continuing education, case management recommendations in Clinician’s Brief get a lot of mileage, and we’ve tried to optimize patient care and antimicrobial stewardship.
Here’s the highlight:
Authors who provide antimicrobial treatment recommendations must consider the potential impact of veterinary drug use on public health. In particular, authors should avoid recommending extralabel use of fluoroquinolones and extended-spectrum b-lactam antimicrobials (eg, third- or fourth-generation cephalosporins) or recommending drugs such as carbapenems, glycopeptides, and oxazolidinones used for treatment of multidrug-resistant pathogens in humans. If use of any of these is recommended, there must be specific mention of the relevant issues, and evidence supporting the recommendation must be provided.
Is it perfect? No.
Is it useful? Hopefully.
It means that authors have to think about their antibiotic recommendations, which is good because sometimes recommendations just get written out by rote, or passed down from earlier (untested) recommendations, or they’re made without much thought about resistance issues. This makes authors and editorial staff think about which way the balance of patient care and antibiotic stewardship tips.
Baby steps for a big problem, but if we’re stepping in the right direction, that’s good.