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Objective: To describe patterns of antimicrobial prescriptions for sporadic urinary tract infections (UTIs) in dogs in the United States from 2010 through 2019, including times before and after publication of International Society for Companion Animal Infectious Disease (ISCAID) guidelines., Sample: 461,244 qualifying visits for sporadic UTIs., Procedures: Veterinary electronic medical records of a private corporation consisting of > 1,000 clinics across the United States were examined to identify canine visits for potential sporadic UTI between January 1, 2010, and December 31, 2019. Proportions of antimicrobial prescriptions were graphed by month and year to identify changes in prescription patterns over time. Interrupted time series analysis was performed for the aminopenicillins., Results: A total of 461,244 qualifying visits were examined, with 389,949 (85%) of these resulting in at least 1 antimicrobial prescription. Over the 10-year period, the proportion of visits resulting in no antimicrobial prescription increased (14% in 2010 to 19.7% in 2019). Proportions of prescriptions for amoxicillin (38% to 48%) and amoxicillin-clavulanic acid (2.5% to 10%) also increased. Log-linear regression supported that changes in proportions of amoxicillin and amoxicillin-clavulanic acid prescriptions occurred following the 2011 ISCAID guidelines publication, with the proportion of amoxicillin prescriptions increasing by 13% per year (95% CI, 12% to 14%; P < 0.01) and the proportion of amoxicillin-clavulanic acid prescriptions increasing by 0.5% per year (95% CI, 0.2% to 0.8%; P < 0.01). Use of fluoroquinolones and third-generation cephalosporins remained constant., Clinical Relevance: Results suggest that efforts to guide antimicrobial use in veterinary clinical practice are having positive effects in this private veterinary company, though continued efforts are warranted.

In this review, the availability and deficiencies of current antimicrobial agents for companion animals in the United States are described. Although several active agents are FDA-approved for small animals, there are many unmet needs. These needs are greatest for cats, for the treatment of antibiotic drug-resistant infections, and to treat new or emerging pathogens that were not considered on older labels. The older agents approved before 1997 are often outdated, unavailable, or have inaccurate labeling. Subsequently, veterinarians treat dogs and cats with many unapproved antimicrobial agents that are licensed for human use. Although these drugs may be effective, there are also concerns that this use can produce drug-resistant bacteria that may be a public health risk. Although this concern is real, there is also evidence that any antimicrobial use in small animals can produce resistant fecal bacteria and stewardship principles should aim at reducing any unnecessary antibiotic use. This could be accomplished by avoiding some of the older, ineffective, or outdated agents described in this paper. There is a need for incentives to approve new agents that will be more appropriate for treating infections in companion animals without increasing the risk of drug-resistant bacteria that could potentially be transferred to humans and the environment and create a public health risk., (© 2020 John Wiley & Sons Ltd.)

Objective: To determine opinions of faculty members with clinical appointments, clinical veterinarians, residents, and interns at a US veterinary teaching hospital regarding antimicrobial use and antimicrobial-resistant infections., Design: Cross-sectional survey., Sample: 71 veterinarians., Procedures: An online questionnaire was sent to all veterinarians with clinical service responsibilities at the North Carolina State University veterinary teaching hospital (n = 167). The survey included 23 questions regarding demographic information, educational experiences, current prescribing practices, and personal opinions related to antimicrobial selection, antimicrobial use, restrictions on antimicrobial use, and antimicrobial resistance., Results: Of the 167 veterinarians eligible to participate, 71 (43%) responded. When respondents were asked to rate their level of concern (very concerned = 1; not concerned = 5) about antimicrobial-resistant infections, most (41/70 [59%]) assigned a score of 1, with mean score for all respondents being 1.5. Most survey participants rated their immediate colleagues (mean score, 1.9) as more concerned than other veterinary medical professionals (mean score, 2.3) and their clients (mean score, 3.4). Fifty-nine of 67 (88%) respondents felt that antimicrobials were overprescribed at the hospital, and 32 of 69 (46%) respondents felt uncomfortable prescribing at least one class of antimicrobials (eg, carbapenems or glycopeptides) because of public health concerns., Conclusions and Clinical Relevance: Findings indicated that veterinarians at this teaching hospital were concerned about antimicrobial resistance, thought antimicrobials were overprescribed, and supported restricting use of certain antimicrobial classes in companion animals. Findings may be useful in educating future veterinarians and altering prescribing habits and antimicrobial distribution systems in veterinary hospitals.