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Making better use of antimicrobials when treating pets’ urinary tract infections

Responsible use of antimicrobial medications is essential to ensure that effective treatments are available to treat infectious diseases in people as well as pets. Urinary tract infections (UTIs) in pets are among the most common indications for antimicrobial use in veterinary medicine1, and the International Society for Companion Animal Infectious Diseases (ISCAID) recently updated its guidelines for diagnosing and treating UTIs in pets2. As part of our ongoing commitment to the pursuit of quality in veterinary medicine, we compared current diagnostic and prescription practices for UTIs at Banfield’s network of hospitals with the new ISCAID recommendations. We identified opportunities to reduce antimicrobial usage by raising awareness of the ISCAID guidelines and best practices. We recently shared the findings with the veterinary community at the 16th International Symposium of Veterinary Epidemiology and Economics (ISVEE16) in Halifax, Canada, to promote antimicrobial stewardship across the profession.

What this means for veterinary teams 
a dog at the vet
By following industry guidelines and capitalizing on opportunities to improve antimicrobial stewardship, veterinary teams can help to preserve the efficacy of antimicrobial agents against infectious diseases in both human and animal populations.

Diagnostic and prescription practices for UTIs
For all canine and feline patients diagnosed with a UTI at Banfield hospitals from May 2020 to May 2021, we looked at laboratory testing (urinalysis, culture and sensitivity) and antibiotic prescription practices (antibiotic type, dosage, and duration). We manually reviewed randomly selected records to confirm that antibiotics were prescribed for UTI management rather than other causes.

During the 12-month period, 58,164 dogs and 23,505 cats were diagnosed with a UTI. Most of these pets (88.5% of dogs and 77.6% of cats) received an antibiotic agent. However, in some cases (13.0% of dogs and 36.3% of cats), urinalysis was not performed, or results were inconsistent with a UTI, suggesting that this treatment plan may not be supported. Culture and sensitivity testing was done in only a small fraction of pets (6.3% of dogs and 4.3% of cats).

Two of the most frequently prescribed medications were amoxicillin and amoxicillin clavulanate (together accounting for 72% of canine prescriptions and 49% of feline prescriptions), which are recommended by ISCAID for first-line treatment of UTIs. A third-generation cephalosporin (cefovecin) was also administered in many cases (13% of canine prescriptions and 46% of feline prescriptions). We reviewed the records for some of these cases and found that this injectable drug was often used in noncompliant patients, because of owner preference, or while awaiting culture and sensitivity results. These reasons are consistent with findings from a 2018 Banfield Veterinary Emerging Topics (VET)TM report on antimicrobial usage in feline patients3.

Duration of antibiotics was usually 7-10 days or 11-15 days (together accounting for >90% of canine and feline prescriptions for amoxicillin clavulanate), which is consistent with the historical practice of prescribing 10-14 days of antibiotics. However, the recent ISCAID guidelines suggest a shorter duration of as little as 3-5 days.

Opportunities to improve stewardship
Raise awareness of guidelines and best practices
A 2017 Banfield report suggested that awareness of ISCAID guidelines among veterinarians may be relatively low. Veterinary practices can raise awareness by providing educational materials and resources about the guidelines, promoting the importance of antimicrobial stewardship, and encouraging the entire veterinary team to share the responsibility.

Because client preferences and expectations are reported to influence diagnostic and prescription practices, it is important for hospital teams to engage pet owners in conversations about relevant best practices, responsible antibiotic use, and the importance of treatment plan compliance. The use of fear-free and low-stress handling methods by team members and pet owners may help to reduce the use of the injectable drug cefovecin and to facilitate compliance with the treatment plan at home.

Reduce antimicrobial usage
Following the ISCAID guidelines has the potential to reduce antimicrobial usage in several ways. The guidelines recommend a shorter duration of treatment, which could reduce oral drug dispensation by at least 30% or 289,000 tablets in dogs and 15% or 12,000 tablets in cats. Completing diagnostic testing before prescribing antibiotics could also reduce dispensation.

Conclusion
Antimicrobial stewardship is the responsibility of all healthcare professionals. Judicious use of antimicrobial agents helps to limit the development of resistant microorganisms and preserves the efficacy of treatments for infectious diseases in both humans and animals. Learn more about Banfield’s efforts to promote antimicrobial stewardship.

References
1. Dorsch R, Teichmann-Knorrn S, Sjetne Lund H. 2019. Urinary tract infection and subclinical bacteriuria in cats: A clinical update. J Feline Med Surg 21: 1023-1038.
2. Weese JS, Blondeau J, Boothe D, Guardabassi LG, Gumley N, Papich M, Jessen LR, Lappin M, Rankin S, Westropp JL, Sykes J. 2019. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Vet J 247: 8-25.