Clinical insights: Antimicrobials in an age of resistance.

The research article discusses the growing concern of antimicrobial-resistant bacteria, particularly in the veterinary field, focusing on equine health. Antimicrobials continue to play a vital role in veterinary medicine but inappropriate use can contribute to resistance and potential legislative regulations. The article also talks about the guidelines for peri-operative antimicrobial administration in equine surgeries.

Antimicrobial Resistance in Veterinary Field

• Due to the potential risk of resistant pathogens traveling among bacteria, animals, and humans through different channels, such as the food chain, direct contact, and environmental contamination, prudent use of antimicrobials has been gaining importance in the veterinary field.
• Examples of multidrug-resistant pathogens posing major risks to both human and equine populations include methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum betalactamase (ESBL) producing Escherichia coli, MDR Klebsiella pneumoniae, and several others.
• Studies suggest that veterinarians and their staff carry a higher risk of MRSA colonization compared to the general population and nosocomial MRSA infections have been reported in equine hospitals leading to patient morbidity and significant financial losses.

Antimicrobial Use in Veterinary Medicine

• While antimicrobial use is crucial to veterinary medicine and animal welfare, inappropriate use in equine and companion animal practice could lead to similar legislative regulations as in food animal practices.
• The World Health Organization has identified certain classes of antimicrobials as critically important in human medicine and therefore reserved them for such use. Recent reviews have found that only a small percentage of prescriptions for these ‘reserved’ antimicrobials in equine practices are based on culture and sensitivity testing, highlighting the need for better adherence to stewardship advice.

Peri-operative Use of Antimicrobials in Equines

• Among equine veterinarians, antimicrobials are commonly used during the peri-operative period.
• The British Equine Veterinary Association (BEVA) has released guidelines to improve peri-operative prescribing practices, recommending different protocols for clean, contaminated, and complicated surgeries, as well as for uncomplicated contaminated wounds.
• Timing of pre-operative antimicrobial administration is critical with maximum plasma concentrations typically reached approximately 3.5 hours post-administration of intramuscular procaine penicillin G (PPG), a commonly used antimicrobial in horses.
• A hybrid administration protocol has been suggested as an effective treatment pre- and post-surgery, which appropriately balances cost and efficacy.