Lutz Bérénice, Lehner Claudia, Schmitt Kira, Willi Barbara, Schüpbach Gertraud, Mevissen Meike, Peter Ruth, Müntener Cedric, Naegeli Hanspeter, Schuller Simone
Department Clinical Veterinary Medicine, Division Small Animal Internal Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland.
Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.
Vet Rec Open. 2020 Mar 9;7(1):e000370. doi: 10.1136/vetreco-2019-000370. eCollection 2020.
Antimicrobial resistance is an increasing problem in human and veterinary medicine and is closely linked to the use of antimicrobials. The objective of this study was to describe antimicrobial prescriptions for selected canine diseases in Switzerland during 2016.
Dogs presented to two university hospitals and 14 private practices for acute diarrhoea (AD; n=371), suspected or confirmed urinary tract infections (UTIs; n=245), respiratory tract infections (RTIs; n=274) or wound infections (WIs; n=175) were included. Clinical history, diagnostic work-up and antimicrobial prescription (class, dosage and duration) were retrospectively assessed. A justification score was applied to evaluate appropriateness of antimicrobial therapy based on available national and international consensus guidelines.
Antimicrobials were prescribed in 65 per cent of dogs with AD, 88 per cent with UTI, 62 per cent with RTI and 90 per cent with WI. The most prescribed antimicrobial classes (monotherapy and combination therapy) were potentiated aminopenicillins (59 per cent), nitroimidazoles (22 per cent), non-potentiated aminopenicillins (16 per cent) and fluoroquinolones (13 per cent). Overall, 38 per cent (95 per cent CI 0.35 to 0.41) of the prescriptions were in accordance with consensus guidelines. In dogs with AD, antimicrobial therapy was associated with the presence of haemorrhagic diarrhoea (P<0.05) and complied in 32 per cent with consensus guidelines, which recommend antimicrobial treatment only when sepsis is suspected. A bacterial aetiology was confirmed via culture and/or sediment examination in 36 per cent of dogs with suspected UTI.
Overall, adherence to consensus guidelines was poor both, at university hospitals and private practices. Antimicrobial stewardship measures are therefore needed to improve prudent use.
抗菌药物耐药性在人类医学和兽医学领域日益严重，且与抗菌药物的使用密切相关。本研究旨在描述2016年瑞士针对特定犬类疾病的抗菌药物处方情况。
纳入前往两家大学医院和14家私人诊所就诊的患有急性腹泻（AD；n = 371）、疑似或确诊尿路感染（UTIs；n = 245）、呼吸道感染（RTIs；n = 274）或伤口感染（WIs；n = 175）的犬只。回顾性评估临床病史、诊断检查和抗菌药物处方（类别、剂量和疗程）。应用合理性评分，根据现有的国家和国际共识指南评估抗菌治疗的合理性。
65%的AD犬、88%的UTI犬、62%的RTI犬和90%的WI犬使用了抗菌药物。最常开具的抗菌药物类别（单药治疗和联合治疗）为加酶氨基青霉素（59%）、硝基咪唑类（22%）、非加酶氨基青霉素（16%）和氟喹诺酮类（13%）。总体而言，38%（95%CI 0.35至0.41）的处方符合共识指南。在AD犬中，抗菌治疗与出血性腹泻的存在相关（P<0.05），且32%符合共识指南，该指南仅在怀疑败血症时推荐抗菌治疗。通过培养和/或沉淀物检查，在36%疑似UTI的犬中确诊了细菌病因。
总体而言，大学医院和私人诊所对共识指南的遵循情况均较差。因此，需要采取抗菌药物管理措施以促进合理使用。
