Responsible antibiotic usage, battling antibiotic resistance!
Antibiotics are very useful drugs and are often one of the main means for vets to treat animals with various diseases caused by bacteria. However, drug resistance and the OCCURRENCE OF ‘SUPERBUG’ IS A GROWING PROBLEM around the world, and it is definitely no exception in the veterinary world. Moreover, pet owners often do not realise that these ‘superbug’ not only can affect our pets, but worse, they can often develop and pass between humans, pets and wildlife, getting stronger over time.
HONG KONG’S HIGH ANTIBIOTIC RESISTANCE RATE
The rate of antibiotic resistance has risen significantly over the past decades, and unfortunately, Hong Kong is among the cities in the world with the highest rate of bacterial resistance. This is mainly due to years of inappropriate and over usage of antibiotics, and often complicated by the easy access to antibiotic medications at over-the-counter pharmacies by people without medical prescriptions.
HOW RESISTANCE HAPPENS
The resistance generally happens when the bacteria is exposed to an antibiotic for a prolonged period, and at an inappropriately low dosage. This allows the selection of bacteria with resistance to replicate, while susceptible bacteria are killed off. (The main mechanisms employed by the bacteria are Chromosomal and plasmid mediated mutation, but these will not be discussed in detail here)
PREVENTION VS TREATMENT
It is always better to prevent infection, rather than to treat the infection with antibiotics. Basically, this means that we should always be trying our best ( as vets and as pet owners ) to AVOID THE USAGE OF ANTIBIOTICS AS MUCH AS POSSIBLE, and to employ necessary means to prevent the occurrence of antibiotic resistant.
Here are some recommendations,
1. PERFORM TESTS BEFORE INITIATING TREATMENT
- This is probably ONE OF THE SIMPLEST AND MOST IMPORTANT THINGS THAT WE CAN DO to prevent antibiotic resistance, and to make sure our pets can get better on treatment!
- Pet owners often wonder why veterinarians nowadays perform all kinds of tests, while in the good old days, an injection plus a week of antibiotic tablets was all that was needed! And No, performing these tests are not for financial reasons! But rather, it is because nowadays we have much better medical/scientific understandings, and realise that performing these tests actually help prevent the unnecessary usage of antibiotics, reduce the rate of resistance, and most of all reduce the chance of treatment failure.
This means, our patients will have a better chance at getting better, and at the same time, we contribute to stopping the development of antibiotic resistance.
- The main tests we do are usually:
*CYTOLOGY (looking at samples under the microscope). This helps us identify the presence of bacteria, and gives us an educated guess of what the infection could be.
*CULTURE AND SENSITIVITY TESTS. We collect samples and send to the lab, where they will incubate the sample to grow colonies of the bacteria, and sensitivity test will then be performed to identify the correct antibiotic to use.
2. TOPICAL VS SYSTEMIC ANTIBIOTICS
- If topical treatment is sufficient to treat an infection, then it should always be chosen over systemic Antibiotic (eg. for local ear and skin infection)
- If possible, owners should wear gloves while applying these topical antibiotics.
3. Administer the CORRECT DOSAGE AND DOSE FREQUENCY
- Owners should always follow veterinarian’s instruction on giving antibiotic treatment to their pets, and inform the vets if there is any reason that the treatment has to be altered or stopped.
- Discuss with the vets on whether antibiotic is needed as a treatment when your pet gets ill, it never hurts to ask!
4. Effective SANITATION, HYGIENE, and preventative measures
5. REGULAR CLEANING AND DISINFECTION OF ANIMAL HOSPITAL. And of course, we do this at HKIVC.
6. NEVER GET ANTIBIOTIC MEDICATIONS FROM PHARMACY WITHOUT PRESCRIPTION!
7. AVOID ABUSING HIGHER TIERED ANTIBIOTICS (Cabapenem , Vancomycin etc), good reasons are always needed before using these drugs (for more info, please see PROTECT POSTER at BSAVA)
#CHANGING IDEAS
In the past, Antibiotic treatment courses were usually around 10-14 days for mild infection, and up to 4-6 weeks for deeper infections ( eg. kidneys and chest infection ). However, there are changing ideas in the human medical world, suggesting that there may be similar treatment effectiveness with shorter treatment course (5-7days), and probable less risk of AB resistance development with that.
This is definitely an area that we should keep our eyes on, and hopefully newer research will soon tell us what is best practice! For now, we assess each case individually and decide accordingly.
For more info :
Antimicrobial resistance Surveillance section (2017- )
https://www.chp.gov.hk/en/features/47850.html
PROTECT ME guideline
https://www.bsava.com/Resources/Veterinary-resources/PROTECT-ME
WHO Global Action Plan on Antimicrobial Resistance (2015- )
https://www.who.int/antimicrobial-resistance/global-action-plan/en/
