Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
Department of Veterinary Medicine, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
Prev Vet Med. 2023 Mar;212:105836. doi: 10.1016/j.prevetmed.2022.105836. Epub 2022 Dec 31.
Antimicrobial resistance (AMR) and irrational antimicrobial usage (AMU) are a global problem, particularly evident in low- and middle-income countries including Pakistan. Our study aimed to assess the knowledge, attitudes and prescribing practices (KAP) of field veterinarians regarding AMR and AMU.
A questionnaire-based online survey was conducted using Google forms to collect data on AMR and AMU from veterinary practitioners in Pakistan between July 25, 2020, and February 2, 2021. The questionnaire was comprised of four sections: 1) Demographic information of the respondents, 2) Knowledge about AMR, and AMU, 3) Antibiotic prescribing behavior, attitudes and influencing drivers and 4) Practices of respondents about AMU and drug disposal.
A total of 545 participants (Male 84%, Female 16%) completed the survey. The respondents' qualification (P = 0.008), gender (P = 0.007) and type of practitioner (P < 0.001) had a significant association with the mean knowledge score about AMR. Most of the veterinarians had never attended any training, symposium, or awareness session on AMR (63%) and methods to detect antibiotic residues (71%). Participating veterinarians frequently included "critically important antimicrobials" in their treatment regimens. Most veterinarians (60%) prescribed antibiotics for viral diseases. Our study showed that about 44% of veterinarians disposed of expired drugs in the garbage. Antibiotics were prescribed as mass medication and for prophylaxis by 59% and 33% of the veterinarians, respectively, while about 60% of the veterinarians prescribed antibiotics starting with double doses in their treatment regimens. Importantly, only 4% of the veterinarians recognized the concept of One Health. Male veterinarians had higher odds of prescribing mass medication (OR=3.07, P < 0.001) and use of antibiotics for disease prophylaxis (OR=2.31, P = 0.002) than females, whereas improper disposal of expired antimicrobials (OR=2.12, P = 0.003) was more common in female veterinarians. Government veterinarians had 2 (OR=1.95, P = 0.016) and 3 (OR=3.05, P < 0.001) times higher odds to prescribe antibiotics prophylactically and for mass treatments, respectively compared to full-time private veterinarians.
Our study identifies key factors influencing veterinarians' decision about antimicrobial prescription and highlights important shortcomings such as lack of training on rational use of antimicrobials, frequent use of antimicrobials for mass medication and prophylaxis, widespread use of critically important antimicrobials, and improper disposal practices. There is a dire need to improve knowledge of veterinary practitioners regarding AMR and to adopt a One Health approach to rationalize AMU at the national level in line with the regional and international guidelines.
抗生素耐药性（AMR）和不合理使用抗生素（AMU）是一个全球性问题，在包括巴基斯坦在内的低收入和中等收入国家尤为明显。我们的研究旨在评估兽医领域从业者对 AMR 和 AMU 的知识、态度和处方实践（KAP）。
2020 年 7 月 25 日至 2021 年 2 月 2 日，我们使用谷歌表格在线进行了一项基于问卷的调查，以收集来自巴基斯坦兽医从业者关于 AMR 和 AMU 的数据。问卷包括四个部分：1）受访者的人口统计学信息，2）关于 AMR 和 AMU 的知识，3）抗生素处方行为、态度和影响因素，以及 4）受访者关于 AMU 和药物处理的实践。
共有 545 名参与者（男性 84%，女性 16%）完成了调查。受访者的资格（P=0.008）、性别（P=0.007）和执业类型（P<0.001）与 AMR 知识得分的平均值显著相关。大多数兽医从未参加过任何关于 AMR（63%）和检测抗生素残留方法（71%）的培训、研讨会或宣传活动。参加的兽医经常将“至关重要的抗生素”纳入他们的治疗方案。大多数兽医（60%）开抗生素治疗病毒性疾病。我们的研究表明，约 44%的兽医将过期药物丢弃在垃圾中。抗生素作为群体用药和预防用药分别被 59%和 33%的兽医开具，而约 60%的兽医在治疗方案中开始使用双倍剂量的抗生素。重要的是，只有 4%的兽医认识到“同一健康”的概念。男性兽医开具群体用药（OR=3.07，P<0.001）和预防性使用抗生素（OR=2.31，P=0.002）的可能性高于女性兽医，而女性兽医更有可能不当处理过期的抗生素（OR=2.12，P=0.003）。政府兽医开具预防性和群体治疗抗生素的可能性分别是全职私人兽医的 2 倍（OR=1.95，P=0.016）和 3 倍（OR=3.05，P<0.001）。
我们的研究确定了影响兽医对抗生素处方决策的关键因素，并强调了一些重要的不足之处，例如缺乏对抗生素合理使用的培训、经常将抗生素用于群体用药和预防用药、广泛使用至关重要的抗生素、以及不当的处置做法。迫切需要提高兽医从业者对抗生素耐药性的认识，并采取同一健康方法，根据区域和国际准则，在国家层面上合理化抗生素的使用。
