ARE WE SERIOUS AND KNOWLEDGEABLE ENOUGH TO EFFECTIVELY LIMIT ANTIBIOTIC RESISTANCE?

Inappropriate antibiotic prescribing and increased antibiotic consumption in animals have contributed to antibiotic resistance (ABR). Human health is negatively affected by ABR in animal health as observed in resistance to colistin due to its use in animal production. Colistin is an antibiotic of last resort in humans for the treatment of infections caused by multidrug resistant Gram-negative bacteria. Loss of antibiotic efficacy due to resistance will also have a negative impact on animal health and welfare. Damage to the tissues and organs can occur due to bacterial infections, and there is a high risk of disease outbreaks and the dissemination of zoonotic bacteria. The problem is exacerbated by a lack of new antibiotics that are specifically being produced for animal health.

Although many antibiotics are unsanctioned sold over the counter, veterinarians are primarily responsible for prescribing and administering antibiotics to animals and are critical to appropriate antibiotic use in animal health. The authors cited below, therefore conducted a survey to determine the knowledge, attitudes and practices (KAP) of veterinarians and health professionals on antibiotic use, resistance, and its containment in the country in order to inform interventions to optimise use and contain resistance.

A quantitative questionnaire-based online survey was conducted amongst members of professional veterinary associations. The questionnaire consisted of four sections focusing on socio-demographic characteristics, KAP of participants on antibiotic use, ABR, and its containment in the South African veterinary sector.

The results and their implications as discussed by the authors are the following:

• Average knowledge scores on antibiotic use, antibiotic resistance, and its containment in animal health in South Africa were good. The training the respondents received appeared to equip the majority of respondents with adequate knowledge on the rational use of antibiotics.
• There was a high degree of concern about antibiotic-resistant infections. The veterinarians sometimes consulted veterinary guidelines for appropriate use of antibiotics, and penicillins were the most preferred antibiotic class.
• Veterinarians in urban practice were more knowledgeable about ABR than those in rural practice. This may be due to fewer ABR awareness campaigns targeting the rural areas as compared to urban areas.
• A few of the respondents believed that ABR is not an issue in the country. Having a belief that ABR is not a threat might hinder the implementation of antibiotic stewardship programmes in animal health, thus worsening ABR, as was evident in the study where few respondents had antimicrobial stewardship programmes in their practices. [Antibiotic stewardship refers to approaches that encompass correct antibiotic usage, dosage, and duration whilst preventing ABR. It involves the use of guidelines for appropriate use of antibiotics, culture and sensitivity testing before antibiotic usage, surveillance and monitoring of antibiotic usage, client education, and the implementation of effective infection prevention and control programmes].
• Generally, the respondents indicated that they had good knowledge of antibiotic pharmacology, appropriate antibiotic use that minimises the development of ABR, antibiotic stewardship and ABR mechanisms.
• Some veterinarians viewed their clients as being slightly concerned over antibiotic-resistant infections. This may be due to a low frequency of discussions with clients over the ABR matter. A more significant percentage of veterinarians in rural practice frequently carried out such discussions than their urban counterparts. Such disparities might be influenced by an over-reliance on antibiotics in clients from rural areas compared to those in urban areas, hence the need for frequent discussions in those areas.
• Most respondents believed that antibiotics were sometimes prescribed for suspected but not confirmed infections regardless of bacteriological culture and antibiotic susceptibility importance. This suggests that an empiric approach to treatment could be preferred compared to a microbiology-guided approach in some instances. [Microbiology forms an integral part of antibiotic stewardship with microbial culture and susceptibility testing as part of the diagnostic testing]. Notably, most respondents indicated the cost of diagnostic testing, time to results of diagnostics and client expectations of receiving antibiotics as barriers to the implementation of antibiotic stewardship programmes. As expected, client finances were among the important factors that could influence the submission of samples for microbiological investigations. All these factors combined could be responsible for such an empiric approach to antibiotic treatment. Personal comment: Farmer clients should reconsider their position/attitude here.
• Most respondents read guidelines for appropriate use of antibiotics. The use of any veterinary formulary, peer-reviewed scientific literature, textbooks or drug handbooks were chosen as the most important sources of information in determining antibiotic choice for clinical use.
• Most respondents prescribed antibiotics for pre-operative prophylaxis and the prevention of post-operative infections. [Avoiding prophylactic antibiotic use is necessary to minimise the selection of resistant bacteria and possible transfer. However, prophylactic use of antibiotics can be implemented in high infection risk cases and where the infection consequences are grave].
• Antibiotics that were regarded as the first-line by many respondents were generally the frequently prescribed antibiotics classes. [A majority of these antibiotics fall under the OIE list of antibiotics of veterinary importance. These drugs are important in specific infections and have to be preserved because of the few alternatives available].

Note: The results were obtained from a relatively small percentage of respondents and may therefore not be representative. The study nevertheless provides valuable pointers which in general confirm that much needs to be done to improve awareness.