Factors Influencing Antibiotic Prescribing Behavior and Understanding of Antimicrobial Resistance Among Veterinarians in Assam, India

Barriers to effective antimicrobial resistance management in Nigerian livestock: the role of veterinary practices and client expectations

Resistance to antimicrobials is growing faster than the discovery of new drugs. This problem has raised the global concern of a possible pandemic, as the treatment of infections in both humans and animals is becoming more difficult. This study aimed to understand the opinions of practising veterinarians on the factors responsible for increasing antibiotic resistance among animals in Nigeria. A cross-sectional study of veterinarians from 36 states (including the Federal capital territory) was conducted using a paper-based structured questionnaire survey. The questionnaire was made available to the 1,117 veterinarians who attended 2023 Nigerian Veterinary Medical Association (NVMA). A simple random selection was used to select 295 veterinarians as respondents. The data collected were coded and stored electronically in a Microsoft Excel database and anonymised for further analysis. Statistical analyses were conducted using Excel and SPSS Statistics v24.0. Most veterinarians (89.8%) agreed that the antibiogram test (AST) is important before prescription; however, only a few (4.4%) request for an antibiogram before prescriptions to clients due to the unaffordability of the test by clients (x̄=3.21), the desire for rapid results (x̄=3.06), and the lack of diagnostic laboratories nearby (x̄=2.96). As a result, 61.5% reported that clients had complained that antibiotics prescribed did not work (curative). In addition, veterinarians opined that irrational antibiotic use among animal owners (x̄=4.34), an increased number of quackery (x̄=4.10) and ease of access of the public to antibiotics at veterinary pharmacies/shops (x̄=3.86) were the leading causes of increasing antimicrobial resistance in Nigeria. The significant factors responsible for veterinarians' opinions were education (β = 0.929) and the value of conducting an antibiogram before prescription (β = 1.618) at the p ≤ 0.05 level of significance. This study revealed that irrational antibiotic use among animal owners, an increasing number of quackery and ease of access of the public to antibiotics at veterinary pharmacies/shops were the leading causes of increasing animal antimicrobial resistance in Nigeria. Therefore, this study suggests the development and implementation of policies and frameworks that promote antimicrobial stewardship and the establishment of veterinary laboratories in various communities in the country. Continuous education for veterinarians and livestock workers, especially on AMR, is also critical.

Prudent use and antimicrobial prescription practices in Ethiopian veterinary clinics located in different agroecological areas

BACKGROUND

Understanding antimicrobial prescribing (AMP) practices and their prudent use in livestock can support the implementation of stewardship programs in veterinary medicine. Empiric therapy using antimicrobials is widely practiced in resource-poor settings, including Ethiopia. This could significantly contribute to the global burden of antimicrobial resistance (AMR) and the potential accumulation of residues in food. This study assessed AMP practices in Ethiopian veterinary clinics located in different agroecological zones (AEZs) as well as adherence to antimicrobial stewardship principles (ASPs).

METHODS

Data were collected from case book records from four district veterinary clinics located in different AEZs in Ethiopia from 2015 to 2019. To identify factors associated with non-prudent AMP practices (i.e., the use of antimicrobials without therapeutic effects or benefits to the animal), data from registered clinical veterinary cases were selected using a systematic random sampling method. This led to the inclusion of approximately one-third of all records, including animal characteristics, disease symptoms and diagnosis, and details about the prescribed drugs. Descriptive statistics were used to report the proportions of drugs prescribed and adherence to the ASPs. The Chi-square test was used to establish an association between the drugs prescribed and the disease diagnoses and the districts. The factors associated with cases receiving antimicrobials and non-prudent AMP practices were also assessed using a multivariable logistic regression analysis.

RESULTS

In total, 12,438 clinical case records were considered. Approximately 97% of these cases received treatment without laboratory confirmation, and 15,243 drugs were prescribed. Among these prescriptions, 75% were for antimicrobials, with oxytetracycline (29%) and a combined formulation of penicillin-dihydrostreptomycin (19%) being the most often prescribed drugs. Overall, 19% of the cases were treated non-prudently with antimicrobials, with high incidences at Holeta (32%) and Sekoru (19%) (p < 0.001). Most cases, including viruses and other non-pathogens (100%), toxicants (97%), unknown causes (94%), fungi (70%), nutritional (64%), risk of bacterial infection (42%), and endo-ectoparasites (24%), were treated non-prudently. Cases receiving antimicrobials and non-prudent AMP were associated with Holeta and Sekoru study clinics, major clinical signs of bloat and loss of body condition, and illness due to viral infections (p < 0.05). Conversely, species of animals and cases diagnosed with multiple etiologic agents and respiratory diseases were negatively associated with prudent AMP practices (p < 0.05).

CONCLUSIONS

Much of the prescription practice observed in this study did not adhere to the ASPs; there were significant discrepancies between the prescribed drugs and disease diagnoses. Prescribing antimicrobials for unrelated diagnoses may contribute to an increase in AMR. The study thus underlines the need for mechanisms to improve accurate disease diagnosis and prescriber adherence to prudent AMP in countries with limited resources.

Transdisciplinary approaches to addressing factors that influence antimicrobial use in dairy cattle: A scoping review

Interest in antimicrobial resistance (AMR) associated with livestock farming is increasing. During the 1990s, 30-40 academic papers a year on the use of antibiotics in dairy farming were indexed on the scientific database PubMed, but this has grown to more than 200 a year in the 2020s. Most (85%) of these papers are published in veterinary or livestock science journals. There has been a corresponding increase in social science interest in why responsible antibiotic stewardship in the livestock sector is so challenging. However, most social science insights are published in journals specific to the lead authors' field(s), missing opportunities for knowledge translation to veterinary and animal science. This threatens to inhibit the transdisciplinary One Health approaches required to tackle the problem. Between 1 June and 31 December 2021, we undertook a scoping review of papers on the use of antibiotics in dairy farming indexed in PubMed, Scopus and Web of Science. Our aim was to identify studies that incorporate social science approaches and methodologies, and to note the main field of the journal in which these studies are published. Papers were most likely to be published in veterinary science, dairy science and/or livestock science journals (61, 29 and 18 respectively out of 127 papers) and were most likely to be concerned with antibiotic use, prescribing practice, and/or diagnosis (94%, 39% and 33% of included papers respectively). Only 27% of papers meeting our inclusion criteria included a qualitative approach to understanding reasons for antibiotic use. Even fewer acknowledged underlying drivers of behaviour, whereas such reasons are frequently highlighted in social science literature. Thus, to address the global health threat from antibiotic resistance, more work is needed to bring together the disparate but equally valid disciplines, methodologies and researchers working on antibiotic use in the livestock sector.

Understanding the role of veterinarians in antimicrobial stewardship on Canadian dairy farms: A mixed-methods study

The aim of this study was to describe the factors that influence dairy cattle veterinarians´ antimicrobial prescribing, their attitudes toward reducing antimicrobial use (AMU) in the dairy industry, awareness of antimicrobial resistance (AMR), and perceived barriers to improving antimicrobial stewardship (AMS) on Canadian dairy farms. We used quantitative and qualitative research methods to consider the complexity of the antimicrobial prescription decision-making process. We designed and distributed an online survey, followed by four online focus groups with practicing veterinarians. We used frequency tables and unconditional associations to analyze quantitative data, and thematic analysis to analyze qualitative data. In total, 107 participants from four Canadian provinces responded to the survey, and 26 veterinarians participated in the focus groups. Results from both studies were triangulated to draw our key findings. We found that 1) Veterinarians must weigh numerous intra-personal and contextual considerations that could be conflicting in their decision-making process for prescribing antimicrobials. 2) Although less experienced veterinarians showed greater awareness of AMR and motivation to improve AMS than more experienced veterinarians, they also reported feeling more pressure to adapt their prescribing practices to farmers' wishes than more experienced veterinarians. 3) Some veterinarians experienced conflict between prescribing antimicrobials to maintain animal health, productivity, and welfare, and AMS, which could result in blaming others for inappropriate antimicrobial use and reducing the opportunity to critically review their own prescribing practices. 4) There were strategies and barriers in common between veterinarians and farmers such as collaborative reviews of disease treatment protocols and improving preventive medicine on dairy farms. 5) The main barriers to reducing AMU on dairy farms reported by veterinarians were concerns about animal welfare and AMU on dairy farms without consultation with the veterinarian. Our results can inform the development of AMS programs in the Canadian dairy industry.

A pharmacodynamic investigation to assess the synergism of orbifloxacin and propyl gallate against Escherichia coli

Escherichia coli (E. coli) infections are becoming increasingly difficult to treat, as antibiotic-resistant variants proliferate. Studies on novel methods to combat the spread of resistance and improve the performance of current antibiotics are vital. We aimed to boost the efficacy of the antibiotic orbifloxacin (ORB) against E. coli by combining it with a phenolic component, propyl gallate (PG). The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of ORB against the E. coli KVCC 1423 resistant strain were 128 μg/ml and 256 μg/ml, respectively. However, the MIC of ORB for the remaining E. coli strains was 0.5 μg/ml–2 μg/ml. For the combination of PG and ORB, the lowest fractional inhibitory concentration (FIC) index was less than 0.5, and the combination decreased the MIC of both drugs by 74%. The time-kill assay revealed the killing properties of both the drugs and the pharmacodynamic model (PD model) confirmed the strong killing properties of the combination as compared to the individual activities of the drugs. The ratio between MIC and mutant prevention concentration of ORB against E. coli 1400306 and 1,423 were 1:32 and 1:8, respectively. The combination of ORB and PG showed strong biofilm eradication and inhibited the motility of bacteria. The cell viability of the combination was > 80%. Therefore, we believe that ORB and PG in combination could be a possible antibacterial candidate that could minimize resistance and improve antibiotic potential.