A Practical Approach to Antimicrobial Stewardship for Practices and Practitioners

摘要

Antimicrobial resistance has been identified as a major public health challenge by the U.S. government, foreign governments, and international organizations.1'2 Because antimicrobial use is a major driver of resistance, there must be a strong emphasison improving how antimicrobials, especially antibiotics, are used (known as antimicrobial stewardship, AS). In human outpatient practice, CDC estimates that at least 30% of antibiotic prescriptions are unnecessary.3 Inappropriate and over-prescribing insmall animal medicine is likely to be at least as prevalent.4 In fact, one publication reports that 40% of dogs receiving an antibiotic prescription in a single hospital had no clinical evidence of infection.5 In addition to over-prescribing, there is evidence of inappropriate antibiotic spectrum selection. One paper reports that only 0.5% of 1148 cats receiving the long-acting injectable third-generation cephalosporin cefovecin (a broad-spectrum antibiotic) had specimens submitted for diagnostic culture.6 Because antimicrobial resistance is a problem that impacts our small animal patients and also poses a wider risk to public health, there is a clear and urgent need to improve AS in small animal medicine.