Antimicrobial Prescription Behavior in Equine Asthma Cases: An International Survey.
Abstract: Equine asthma is considered a non-infectious respiratory disease characterized by inflammation and hypersensitivity. Given the importance of antimicrobial stewardship, an international survey was designed to investigate the use of antimicrobials in asthmatic horses and the factors influencing prescription behavior. An online survey was distributed in six languages by international mailing lists and social media from December 2020 to January 2022. Of the 434 responses recorded, 249 veterinarians working in 25 countries finished the survey. These included 79 ECEIM/ACVIM diplomats. A total of 204 respondents confirmed national regulations concerning antimicrobial use in their country. Knowledge of the asthma definitions as presented in the revised ACVIM consensus statement was greater in veterinarians treating over 95% of equine patients compared to veterinarians treating more species, based on 10 questions (answers consistent with the consensus statement in 7 (IQR 5-9) and 4 (IQR 3-6) questions, respectively, (p < 0.001)). A total of 131 respondents stated to use antimicrobials (at least 'sometimes') in at least one of the three presented cases consistent with equine asthma. Trimethoprim-Sulfa combinations, penicillin(s), and tetracyclines were prescribed most (by 105, 53 and 38 veterinarians, respectively). Aminoglycosides, cephalosporins and fluoroquinolones were also selected (22, 15, 9 veterinarians respectively). Tetracyclines and cephalosporins are prescribed more often by veterinarians working without national regulations (p 0.019 and p 0.035, respectively). The most selected factors influencing prescription behavior were: 'tracheal wash culture' (62% of 131 veterinarians using antimicrobials in these cases), 'whether other horses in the barn have similar complaints' (60%), and 'response to other forms of therapy' (53%). In conclusion, insight into prescription behavior is the first step towards minimizing and optimizing antimicrobial use.
Publication Date: 2024-01-30 PubMed ID: 38338101PubMed Central: PMC10854497DOI: 10.3390/ani14030457Google Scholar: Lookup
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- Journal Article
Summary
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Equine respiratory illness similar to human asthma is typically non-infectious, yet a global survey found that vets in 25 countries still often prescribe antibiotics to treat it. Understanding why can help minimize antibiotic misuse and contribute to antimicrobial steward—vital given the rise in antibiotic-resistant infections.
Survey Methodology
- The researchers designed an online survey to investigate antibiotic use in horses diagnosed with the equivalent of human asthma.
- The questionnaire was available in six languages and was circulated internationally using email lists and social media.
- The survey was active from December 2020 to January 2022.
- Out of the 434 responses they received, 249 complete ones were from vets working in 25 different countries.
- Some respondents (79) were Diplomats of the European College of Equine Internal Medicine or American College of Veterinary Internal Medicine.
Survey Findings
- 204 veterinarians confirmed that their countries have national regulations regarding the use of antibiotics.
- Veterinarians dealing almost exclusively with horses were more familiar with the revised definitions of equine asthma provided in the consensus statement by the American College of Veterinary Internal Medicine.
- Despite equine asthma being typically a non-infectious disease, the survey showed that 131 vets administered antibiotics to treat it at least ‘sometimes’.
- The antibiotics generally prescribed included Trimethoprim-Sulfa combinations, penicillin, and tetracyclines. Some vets also selected aminoglycosides, cephalosporins, and fluoroquinolones.
- Veterinarians in countries without antibiotics regulations more frequently prescribed tetracyclines and cephalosporins.
- The most common factors influencing the prescription behavior were tracheal wash culture results, whether other horses in the barn showed similar symptoms, and response to other treatments.
Conclusion
- Understanding veterinarians’ prescription behaviors is the first step in minimizing inappropriate antibiotic use and promoting good antimicrobial stewardship.
- Addressing this issue is crucial to fight the growing problem of antibiotic resistance in both human and veterinary healthcare.
Cite This Article
APA
van den Brom-Spierenburg AJ, Mureșan AN, Westermann CM.
(2024).
Antimicrobial Prescription Behavior in Equine Asthma Cases: An International Survey.
Animals (Basel), 14(3).
https://doi.org/10.3390/ani14030457 Publication
Researcher Affiliations
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM Utrecht, The Netherlands.
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, 400372 Cluj-Napoca, Romania.
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM Utrecht, The Netherlands.
Conflict of Interest Statement
The authors declare no conflicts of interests.
References
This article includes 60 references
- Bullone M, Lavoie JP. The equine asthma model of airway remodeling: From a veterinary to a human perspective.. Cell Tissue Res. 2020;380:223–236.
- Woodrow JS, Sheats MK, Cooper B, Bayless R. Asthma: The Use of Animal Models and Their Translational Utility.. Cells 2023;12:1091.
- Murray CS, Lucas SJ, Blakey J, Kaplan A, Papi A, Paton J, Phipatanakul W, Price D, Teoh OH, Thomas M. A real-life comparative effectiveness study into the addition of antibiotics to the management of asthma exacerbations in primary care.. Eur. Respir. J. 2021;58:2003599.
- Ramakrishnan S, Couillard S. Antibiotics for asthma attacks: Masking uncertainty.. Eur. Respir. J. 2021;58:2100183.
- Normansell R, Sayer B, Waterson S, Dennett EJ, Del Formo M, Dunleavy A. Antibiotics for exacerbations of asthma (Review). Cochrane Database Syst. Rev. 2018;6:CD002741.
- Beuther DA, Martin RJ. Antibiotics in asthma.. Curr. Allergy Asthma Rep. 2004;4:132–138.
- Lakshman R. Are macrolides beneficial in treating childhood asthma?. Arch. Dis. Child. 2020;105:306–309.
- Kwong C, Bacharier L. Microbes and the Role of Antibiotic Treatment for Wheezy Lower Respiratory Tract Illnesses in Preschool Children.. Curr. Allergy Asthma Rep. 2017;17:34.
- Stefan MS, Meng-Shiou S, Spitzer KA, Pekow PS, Krishnan JA, Au DH, Lindenauer PK. Association of Antibiotic Treatment with Outcomes in Patients Hospitalized for an Asthma Exacerbation Treated with Systemic Corticosteroids.. JAMA Intern. Med. 2019;179:333–339.
- Jackson DJ, Sykes A, Mallia P, Johnston SL. Asthma exacerbations: Origin, effect, and prevention.. J. Allergy Clin. Immunol. 2011;128:1165–1174.
- Mainguy-Seers S, Vargas A, Labrecque O, Bédard C, Hélie P, Lavoie JP. Randomised study of the immunomodulatory effects of azithromycin in severe asthmatic horses.. Vet. Rec. 2019;185:143.
- Mainguy-Seers S, Boivin R, Pourali Dogaheh S, Beaudry F, Hélie P, Bonilla AG, Martin JG, Lavoie JP. Effects of azithromycin on bronchial remodeling in the natural model of severe neutrophilic asthma in horses.. Sci. Rep. 2022;1:446.
- Husulak ML, Manning ST, Meachem MD, Burgess HJ, Epp TY, Montgomery JB. Does antimicrobial therapy improve outcomes in horses with severe equine asthma and a positive tracheal wash bacterial culture?. Can. J. Vet. Res. 2018;82:184–191.
- . The Core Element of Hospital Antibiotic Stewardship Programs 2019.. .
- Jewell MJ, Leyenaar JA, Shieh M-S, Pekow PS, Stefan M, Lindenauer PK. Unnecessary antibiotic prescribing in children hospitalised for asthma exacerbation: A retrospective national cohort study.. BMJ Qual. Saf. 2021;30:292–299.
- Hardefeldt LY. Overview of the use of antimicrobial drugs for the treatment of bacterial infections in horses.. Equine Vet. Educ. 2021;33:602–611.
- . Critically Important Antimicrobials for Human Medicine.. .
- . PROTECT ME.. .
- Hardefeldt LY. Australian Veterinary Prescribing Guidelines.. .
- . Australian Strategic and Technical Advisory Group on Antimicrobial Resistance Importance Ratings and Summary of Antibacterial Uses in Humans and Animal Health in Australia, Commonwealth of Australia.. .
- Hughes LA, Pinchbeck G, Callaby R, Dawson S, Clegg P, Williams N. Antimicrobial prescribing practice in UK equine veterinary practice.. Equine Vet. J. 2013;45:141–147.
- Weese JS, Sabino C. Scrutiny of antimicrobial use in racing horses with allergic small airway inflammatory disease.. Can. Vet. J. 2005;46:438–439.
- Wilson A, Mair T, Williams N, McGowan C, Pinchbeck G. Antimicrobial prescribing and antimicrobial resistance surveillance in equine practice.. Equine Vet. J. 2023;3:494–505.
- Dona D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Implementation and impact of pediatric antimicrobial stewardship programs: A systematic scoping review.. Antimicrob. Resist. Infect. Control. 2020;9:3.
- Akkerman AE, Kuyvenhoven MM, van der Wouden JC, Verheij TJM. Prescribing antibiotics for respiratory tract infections by GPs: Management and prescriber characteristics.. Br. J. Gen. Pract. 2005;55:114–118.
- Coenen S, Michiels B, van Royen P, van der Auwera J-C, Denekens J. Antibiotics for coughing in general practice: A questionnaire study to quantify and condense the reasons for prescribing.. BMC Fam. Pract. 2002;3:16.
- Stefan MS, Spitzer KA, Zulfiqa S, Heineman BD, Hogan TP, Westafer LM, Pulia MS, Pinto-Plata VM, Lindenauer PK. Uncertainty as a critical determinant of antibiotic prescribing in patients with an asthma exacerbation: A qualitative study.. J. Asthma. 2022;59:352–361.
- Hardefeldt LY. Antimicrobials used for surgical prophylaxis by equine veterinary practitioners in Australia.. Equine Vet. J. 2018;50:65–72.
- Kinnison T, Cardwell JC. Conflict Between Direct Experience and Research-Based Evidence Is a Key Challenge to Evidence-Based Respiratory Medicine on British Racing Yards.. Front. Vet. Sci. 2020;7:266.
- Schwechler J, van den Hoven R, Schoster A. Antimicrobial prescribing practices by Swiss, German and Austrian equine practitioners.. Vet. Rec. 2016;178:216.
- Couëtil LL, Cardwell JM, Gerber V, Lavoie JP, Léguillette R, Richard EA. Inflammatory Airway Disease of Horses-Revised Consensus Statement.. J. Vet. Intern. Med. 2016;2:503–551.
- Dupuis-Dowd F, Lavoie JP. Airway smooth muscle remodelling in mild and moderate equine asthma.. Equine Vet. J. 2022;54:865–874.
- Couëtil LL, Hoffman AM, Hodgson J, Buechner-Maxwell V, Viel L, Wood JLN, Lavoie JP. Inflammatory Airway Disease of Horses—ACVIM Consensus Statement.. J. Vet. Intern. Med. 2007;21:356–361.
- Dekker ARJ, Verheij TJM, van der Velden AW. Inappropiate antibiotic prescription for respiratory tract indications: Most prominent in adult patients.. Fam. Pract. 2015;4:401–407.
- Elwyn G, Gwyn R, Edwards A, Grol R. Is ‘shared decision-making’ feasible in consultations for upper respiratory tract infections? Assessing the infuence of antibiotic expectations using discourse analysis.. Health Expect. 1999;2:105–117.
- Petersen MR, Cosgrove SE, Quinn TC, Patel EU, Grabowski MK, Tobian AAR. Prescription Antibiotic Use Among the US population 1999–2018: National Health and Nutrition Examination Surveys. Open Forum Infectious Diseases 2021;pp. 1–9.
- Rzewuska M, Duncan EM, Francis JJ, Morris AM, Suh KN, Davey PG, Grimshaw JM, Ramsay CR. Barriers and Facilitators to Implementation of Antibiotic Stewardship Programmes in Hospitals in Developed Countries: Insights From Transnational Studies.. Front. Sociol. 2020;5:41.
- Fernandez-Lazaro CI, Brown KA, Langford BJ, Daneman N, Garber G, Schwartz KL. late-career Physicians Prescribe Longer Courses of Antibiotics.. Clin. Inf. Dis. 2019;69:1467–1475.
- Magin PJ, Morgan S, Tapley A, Henderson KM, Holliday EG, Ball J, Davis JS, Dallas A, Davey AR, Spike NA. Changes in early-career family physicians’ antibiotic prescribing for upper respiratory tract infection and acute bronchitis: A multicentre longitudinal study.. Fam. Pract. 2016;4:360–367.
- Schnepf A, Bienert-Zeit A, Ertugrul H, Wagels R, Werner N, Hartmann M, Feige K, Kreienbrock L. Antimicrobial usage in horses: The use of electronic data, data curation, and first results.. Front. Vet. Sci. 2020;7:216.
- Rule EK, Boyle AG, Redding EE. Antimicrobial prescribing patterns in equine ambulatory practice.. Prev. Vet. Med. 2021;193:105411.
- Wahlström R, Hummers-Pradier E, Stålsby Lundborg C, Muskova M, Lagerløv P, Denig P, Oke T, Chaput de Saintonge DM. Variations in asthma treatment in five European countries-judgement analysis of case simulations.. Fam. Pract. 2002;5:452–460.
- Lagerløv P, Veninga CC, Muskova M, Hummers-Pradier E, Stalsby Lundborg C, Andrew M, Haaijer-Ruskamp FM. Asthma management in five European countries: Doctors’ knowledge, attitudes and prescribing behaviour. Drug Education Project (DEP) group.. Eur. Respir. J. 2000;15:25–29.
- . Official Note to Update the Government Decision Regarding Forming the National Committee on the Prevention and Limiting of Healthcare Associated Infections.. 2021.
- . Antimicrobial Consumption Dashboard (ESAC-Net) 2022.. .
- Vallin M, Polyzoi M, Marrone G, Rosales-Klintz S, Tegmark Wisell K, Stålsby Lundborg C. Knowledge and Attitudes towards Antibiotic Use and Resistance—A Latent Class Analysis of a Swedish Population-Based Sample.. PLoS ONE 2016;11:e0152160.
- Pirie RS, Collie DDS, Dixon PM, McGorum BC. Inhaled endotoxin and organic dust particulates have synergistic proinflammatory effects in equine heaves (organic dust-induced asthma). Clin. Exp. Allergy J. Br. Soc. Allergy Clin. Immunol. 2003;33:676–683.
- Wood JLN, Newton JR, Chanter N, Mumford JA. Inflammatory airway disease, nasal discharge and respiratory infections in young British racehorses.. Equine Vet. J. 2005;3:236–242.
- Christley RM, Hodgson DR, Rose RJ, Wood JL, Reids SW, Whitear KG, Hodgson JL. A case-control study of respiratory disease in Thoroughbred racehorses in Sydney, Australia.. Equine Vet. J. 2001;3:256–264.
- . Union Product Database.. .
- . Drug Approvals and Databases.. .
- Allen SE, Verheyen KLP, O’Neill DG, Brodbelt DC. Use of antimicrobials licensed for systemic administration in UK equine practice.. Equine Vet. J. 2023;5:808–819.
- . OIE List of Antimicrobial Agents of Veterinary Importance.. .
- . Categorisation of Antibiotics in the European Union.. .
- Mair TS, Parkin TD. Audit of antimicrobial use in eleven equine practices over a five-year period (2014–2018). Equine Vet. Educ. 2022;34:404–408.
- Bullone M, Murcia RY, Lavoie JP. Environmental heat and airborne pollen concentration are associated with increased asthma severity in horses.. Equine Vet. J. 2016;4:479–484.
- Herzog A, Bachman J. Effects of Questionnaire Length on Response Quality.. Public Opin. Q. 1981;45:549–559.
- Pimentel J. Some Biases in Likert Scaling Usage and its Correction.. Int. J. Sci. Basic. Appl. Res. 2019;45:183–191.
- Brown A, Inceoglu I, Lin Y. Preventing Rater Biases in 360-Degree Feedback by Forcing Choice.. Organ. Res. Methods. 2017;20:121–148.
- Veninga CC, Lagerløv P, Wahlström R, Muskova M, Denig P, Berkhof J, Kochen MM, Haaijer-Ruskamp FM. Evaluating an educational intervention to improve the treatment of asthma in four European countries. Drug Education Project Group.. Am. J. Respir. Crit. Care Med. 1999;4:1254–1262.
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