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Home / Equine Research Bank / Vet Rec / Modification of empirical antimicrobial regimens in large an...
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.

References

This article includes 30 references
  1. Prescott JF, Boerlin P. Antimicrobial use in companion animals and Good Stewardship Practice.. Vet Rec 2016 Nov 12;179(19):486-488.
    doi: 10.1136/vr.i5908pubmed: 27837070google scholar: lookup
  2. Weese JS, Giguère S, Guardabassi L, Morley PS, Papich M, Ricciuto DR, Sykes JE. ACVIM consensus statement on therapeutic antimicrobial use in animals and antimicrobial resistance.. J Vet Intern Med 2015 Mar-Apr;29(2):487-98.
    doi: 10.1111/jvim.12562pmc: PMC4895515pubmed: 25783842google scholar: lookup
  3. Tarrant C, Krockow EM, Nakkawita WMID. Moral and Contextual Dimensions of “Inappropriate” Antibiotic Prescribing in Secondary Care: A Three-Country Interview Study. Frontiers in Sociology 2020;5.
    doi: 10.3389/fsoc.2020.00007google scholar: lookup
  4. Gjelstad S, Straand J, Dalen I, Fetveit A, Strøm H, Lindbæk M. Do general practitioners' consultation rates influence their prescribing patterns of antibiotics for acute respiratory tract infections?. J Antimicrob Chemother 2011 Oct;66(10):2425-33.
    doi: 10.1093/jac/dkr295pubmed: 21784782google scholar: lookup
  5. De Briyne N, Atkinson J, Pokludová L, Borriello SP, Price S. Factors influencing antibiotic prescribing habits and use of sensitivity testing amongst veterinarians in Europe.. Vet Rec 2013 Nov 16;173(19):475.
    doi: 10.1136/vr.101454pmc: PMC3841786pubmed: 24068699google scholar: lookup
  6. Silva BN, Andriolo RB, Atallah AN, Salomão R. De-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock.. Cochrane Database Syst Rev 2013 Mar 28;2013(3):CD007934.
    doi: 10.1002/14651858.CD007934.pub3pmc: PMC6517189pubmed: 23543557google scholar: lookup
  7. Kollef M. Appropriate empirical antibacterial therapy for nosocomial infections: getting it right the first time.. Drugs 2003;63(20):2157-68.
    doi: 10.2165/00003495-200363200-00001pubmed: 14498753google scholar: lookup
  8. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.. Clin Infect Dis 2016 May 15;62(10):e51-77.
    doi: 10.1093/cid/ciw118pmc: PMC5006285pubmed: 27080992google scholar: lookup
  9. Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy.. Mayo Clin Proc 2011 Feb;86(2):156-67.
    doi: 10.4065/mcp.2010.0639pmc: PMC3031442pubmed: 21282489google scholar: lookup
  10. Kollef MH. Providing appropriate antimicrobial therapy in the intensive care unit: surveillance vs. de-escalation.. Crit Care Med 2006 Mar;34(3):903-5.
    doi: 10.1097/01.CCM.0000202128.30405.60pubmed: 16505677google scholar: lookup
  11. Olofsson SK, Cars O. Optimizing drug exposure to minimize selection of antibiotic resistance.. Clin Infect Dis 2007 Sep 1;45 Suppl 2:S129-36.
    doi: 10.1086/519256pubmed: 17683017google scholar: lookup
  12. Redding LE, Lavigne S, Aceto H, Nolen-Walston R. Characterization of antimicrobial prescription frequency and diversity in a large animal veterinary medical teaching hospital.. Prev Vet Med 2019 Jul 1;168:66-74.
    doi: 10.1016/j.prevetmed.2019.04.012pubmed: 31097125google scholar: lookup
  13. D'Agata EM, Dupont-Rouzeyrol M, Magal P, Olivier D, Ruan S. The impact of different antibiotic regimens on the emergence of antimicrobial-resistant bacteria.. PLoS One 2008;3(12):e4036.
    doi: 10.1371/journal.pone.0004036pmc: PMC2603320pubmed: 19112501google scholar: lookup
  14. Smith DR, Gaunt PS, Plummer PJ, Cervantes HM, Davies P, Fajt VR, Frey E, Jay-Russell MT, Lehenbauer TW, Papich MG, Parker TM, Phipps EC, Scheftel JM, Schnabel LV, Singer RS, Whaley JE, Wishnie JK, Wright LR, Costin M. The AVMA's definitions of antimicrobial uses for prevention, control, and treatment of disease.. J Am Vet Med Assoc 2019 Apr 1;254(7):792-797.
    doi: 10.2460/javma.254.7.792pubmed: 30888282google scholar: lookup
  15. Dolente BA, Lindborg S, Russell G. Emergency case admissions at a large animal tertiary university referral hospital during a 12-month period. J Vet Emerg Crit Care 2008;18:298–305.
    doi: 10.1111/j.1476-4431.2008.00305.xgoogle scholar: lookup
  16. MacGregor RR, Graziani AL. Oral administration of antibiotics: a rational alternative to the parenteral route.. Clin Infect Dis 1997 Mar;24(3):457-67.
    doi: 10.1093/clinids/24.3.457pubmed: 9114201google scholar: lookup
  17. Garnacho-Montero J, Escoresca-Ortega A, Fernández-Delgado E. Antibiotic de-escalation in the ICU: how is it best done?. Curr Opin Infect Dis 2015 Apr;28(2):193-8.
    doi: 10.1097/QCO.0000000000000141pubmed: 25692272google scholar: lookup
  18. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery.. Am J Health Syst Pharm 2013 Feb 1;70(3):195-283.
    doi: 10.2146/ajhp120568pubmed: 23327981google scholar: lookup
  19. Southwood LL. Principles of antimicrobial therapy: what should we be using?. Vet Clin North Am Equine Pract 2006 Aug;22(2):279-96, vii.
    doi: 10.1016/j.cveq.2006.04.004pubmed: 16882476google scholar: lookup
  20. Ibargüen-Mondragón E, Mosquera S, Cerón M, Burbano-Rosero EM, Hidalgo-Bonilla SP, Esteva L, Romero-Leitón JP. Mathematical modeling on bacterial resistance to multiple antibiotics caused by spontaneous mutations.. Biosystems 2014 Mar;117:60-7.
    doi: 10.1016/j.biosystems.2014.01.005pubmed: 24467935google scholar: lookup
  21. Barlow GD, Nathwani D. Sequential antibiotic therapy.. Curr Opin Infect Dis 2000 Dec;13(6):599-607.
    doi: 10.1097/00001432-200012000-00004pubmed: 11964828google scholar: lookup
  22. Tepekule B, Uecker H, Derungs I, Frenoy A, Bonhoeffer S. Modeling antibiotic treatment in hospitals: A systematic approach shows benefits of combination therapy over cycling, mixing, and mono-drug therapies.. PLoS Comput Biol 2017 Sep;13(9):e1005745.
    doi: 10.1371/journal.pcbi.1005745pmc: PMC5600366pubmed: 28915236google scholar: lookup
  23. Toombs-Ruane LJ, Riley CB, Kendall AT, Bolwell CF, Benschop J, Rosanowski SM. Antimicrobial Susceptibilities of Aerobic Isolates from Respiratory Samples of Young New Zealand Horses.. J Vet Intern Med 2015 Nov-Dec;29(6):1700-6.
    doi: 10.1111/jvim.13600pmc: PMC4895690pubmed: 26289293google scholar: lookup
  24. Boyle AG, Timoney JF, Newton JR, Hines MT, Waller AS, Buchanan BR. Streptococcus equi Infections in Horses: Guidelines for Treatment, Control, and Prevention of Strangles-Revised Consensus Statement.. J Vet Intern Med 2018 Mar;32(2):633-647.
    doi: 10.1111/jvim.15043pmc: PMC5867011pubmed: 29424487google scholar: lookup
  25. Giguere S, Afonso T. Antimicrobial Drug Use in Horses. Antimicrobial therapy in veterinary medicine 5th edn John Wiley & Sons, 2013: 457–72.
  26. Nielsen P, Rasmussen F. Influence of age on half-life of trimethoprim and sulphadoxine in goats.. Acta Pharmacol Toxicol (Copenh) 1976 Feb;38(2):113-9.
    doi: 10.1111/j.1600-0773.1976.tb03104.xpubmed: 946374google scholar: lookup
  27. Soback S, Ziv G, Kurtz B, Paz R. Clinical pharmacokinetics of five oral cephalosporins in calves.. Res Vet Sci 1987 Sep;43(2):166-72.
    doi: 10.1016/S0034-5288(18)30767-7pubmed: 3317582google scholar: lookup
  28. Giguere S. Principles of Antimicrobial Drug Selection and Use. Antimicrobial therapy in veterinary medicine John Wiley & Sons, 2013: 105–15.
  29. Prescott J. Beta-lactam Antibiotics: Cephalosporins. Antimicrobial therapy in veterinary medicine 5th edn John Wiley & Sons, 2013: 153–73.
  30. Giguere S. Antimicrobial Action and Interaction: An Introduction. Antimicrobial therapy in veterinary medicine 5th edn John Wiley & Sons, 2013: 1–10.

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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