Practice Policy

• Develop protocols for antimicrobial usage based on common clinical scenarioas
• Classify key antibiotics as PROTECTED or AVOIDED

Reduce Prophylaxis

Develop rational protocols for prophylaxis

• Define prophylaxis for surgical procedures whether CLEAN, CONTAMINATED or HIGH RISK

Rationalise disease control

• For common conditions eg the neonate and Streptococcus equi var equi
• Utilise HBLB codes for management of infectious diseases

Other options

Reduce or replace antimicrobials with other methods for bacterial reduction

• Utilise wound debridement / lavage

• Consider topical preparations or local intravenous administration

Types of drug and bacteria

Select appropriate drugs based on empirical use guidelines

• Use cytology where possible 
• Consider the dose and pharmacokinetics of the drugs selected
• Avoid empical use of the highest priority critically important antimicrobials
• The macrolides (eg azithromycin)
• The fluoroquinolones (eg enrofloxacin)
• The 3rd and 4th generation cephalosporins (ceftiofur and cefquinome)

Employ narrow spectrum drugs wherever possible

• e.g. penicillin, rather than drug combinations.

Culture and sensitivity

Use bacterial culture promptly

• Especially when
• clinical response is less than expected
• when long term therapy is suspected 

Treat effectively

Enough drug for long enough then stop 

• Standardise dosing frequency and dose rates across the practice
• Sometimes dosing intervals licenced in the marketing authorisation differ from current clinical evidence.
• Review the veterinary literature to determine optimal dosing here. 

Monitor antimicrobial use, compliance and resistance

• Undertake a clinical audit of antimicrobial use within your practice 
• Formulate a policy to record the use of protected antimicrobials in your practice 

• Formulate a policy to review antimicrobial susceptibility from any cultures obtained within the practice
• Audit emerging antimicrobial resistance and consider adapting guidelines for empirical use.

Educate

Inform your team and your clients 

• Ensure that protocols and changes to protocols are cascaded through the entire team 

• Educate your clients to reduce pressure for antimicrobial prescribing