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The Veterinary record2020; 187(9); e78; doi: 10.1136/vr.106039

Modification of empirical antimicrobial regimens in large animal medicine.

Abstract: Empirical antimicrobial regimens can be modified following new diagnostic information or when empirical treatment fails. Little is known about the frequency or clinical context in which these modifications occur. We characterised these modifications in a large animal hospital to identify when antimicrobial use could be optimised. Methods: Chart reviews were performed for all inpatients and outpatients administered antimicrobials at a large animal veterinary referral and teaching hospital in 2017-2018 (n=1163 visits) to determine when and why empirical regimens were modified. Multinomial logistic regression was performed to identify factors associated with reasons for modification. Results: Empirical antimicrobial regimens were modified in 17.3 per cent of visits. The main reasons were parenteral-oral conversions in horses and failure of disease prevention or treatment in ruminants. Empirical therapy for disease prevention was more likely to be modified because of complications in ruminants and in animals on the emergency/critical care service. Empirical therapy for disease treatment was more often modified for reasons other than de-escalation in ruminants and in animals with longer lengths of stay. Conclusions: Empirical antimicrobial regimens were modified infrequently and mostly for purposes of parenteral-oral conversion in horses and lack of response in ruminants. De-escalation of antimicrobials administered for disease treatment, when guided by diagnostics, is a major tenet of judicious antimicrobial use. However, more research is needed to determine when and how antimicrobial regimens administered for disease prevention should be modified.
© British Veterinary Association 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.
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Publication Date: 2020-09-29 PubMed ID: 32994359PubMed Central: PMC7799415DOI: 10.1136/vr.106039Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research article investigates the rate and context of modifications made to pre-existing antimicrobial treatments, known as empirical antimicrobial regimens, in a large-scale animal hospital. The focus of the study is to identify opportunities to optimize antimicrobial use.

Research Methodology

  • The study conducted chart reviews of all inpatients and outpatients who were administered antimicrobials at a large animal veterinary referral and teaching hospital during 2017-2018. This represented a total of 1163 visits.
  • The aim was to determine when and why the initial (empirical) antimicrobial treatment plans were modified.
  • A statistical technique known as multinomial logistic regression was employed to identify any factors that may be associated with the reasons for these modifications. This is a kind of regression analysis used to predict the probabilities of the different possible outcomes of a categorically distributed dependent variable, given a set of independent variables.

Research Findings

  • The study established that empirical antimicrobial regimens were modified approximately 17.3% of the time.
  • The primary reasons for these modifications were the need for parenteral-oral conversions in horses and cases where treatment or prevention protocols failed in ruminants (such as cows or sheep).
  • Empirical therapy for disease prevention was more likely to be modified in the context of complications in ruminant animals and animals receiving emergency or critical care.
  • In contrast, empirical therapy for disease treatment was more often modified for reasons that were not related to de-escalation, such as continued illness or complications, particularly in ruminant animals and animals with longer lengths of stay at the hospital.

Study Conclusions

  • Overall, the study concluded that modifications to empirical antimicrobial regimens are not commonplace, occurring only in about one-sixth of the cases.
  • The most common reasons for modification were the need for conversion to oral medicines in horses and lack of treatment response in ruminants.
  • The study emphasized that careful de-escalation of antimicrobial therapy guided by diagnostics is an essential principle of prudent antimicrobial use.
  • However, there is a clear need for further research on when and how to modify antimicrobial regimens administered for disease prevention.

Cite This Article

APA
Redding L, Grunwald H, Cole S, Rankin S, Nolen-Walston R. (2020). Modification of empirical antimicrobial regimens in large animal medicine. Vet Rec, 187(9), e78. https://doi.org/10.1136/vr.106039

Publication

The Veterinary record
ISSN: 2042-7670
NlmUniqueID: 0031164
Country: England
Language: English
Volume: 187
Issue: 9
Pages: e78

Researcher Affiliations

Redding, Laurel
  • Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA lredding@vet.upenn.edu.
Grunwald, Haley
  • Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA.
Cole, Stephen
  • Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA.
Rankin, Shelley
  • Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA.
Nolen-Walston, Rose
  • Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA.

MeSH Terms

  • Animals
  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / therapeutic use
  • Camelidae
  • Cattle
  • Deer
  • Drug Prescriptions / statistics & numerical data
  • Drug Prescriptions / veterinary
  • Drug Utilization Review
  • Goats
  • Horses
  • Hospitals, Animal
  • Hospitals, Teaching
  • Pennsylvania
  • Sheep, Domestic
  • Sus scrofa

Conflict of Interest Statement

Competing interests: None declared.

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Citations

This article has been cited 2 times.
  1. Rodrigues IC, Ribeiro-Almeida M, Ribeiro J, Silveira L, Prata JC, Pista A, Martins da Costa P. Occurrence of Multidrug-Resistant Bacteria Resulting from the Selective Pressure of Antibiotics: A Comprehensive Analysis of ESBL K. pneumoniae and MRSP Isolated in a Dog with Rhinorrhea. Vet Sci 2023 May 2;10(5).
    doi: 10.3390/vetsci10050326pubmed: 37235409google scholar: lookup
  2. Gandini M, Cerullo A, Franci P, Giusto G. Changes in Perioperative Antimicrobial and Anti-Inflammatory Drugs Regimens for Colic Surgery in Horses: A Single Center Report. Vet Sci 2022 Oct 4;9(10).
    doi: 10.3390/vetsci9100546pubmed: 36288159google scholar: lookup
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