Why we need to alter our attitude to antibiotics

Last month we supported the World Health Organisation’s World Antibiotic Awareness campaign.

The increase in the frequency of bacterial resistance to antibiotics is a One Health concern. If this important class of drugs becomes ineffective it will have a serious impact on the health of both humans and animals. It seems fitting, then, to discuss the topic of antibiotics in relation to veterinary practices and caring for your pet. In this blog, we take a closer look at this and how, specifically, individuals may need to alter their stance on antibiotics for the benefit of their animals. This applies to pet owners and veterinarians as well as specialists.

For years now, in both human medicine and veterinary medicine, antibiotics have been the driving force in providing effective medical treatment for bacterial infection. Infections that were once fatal are now treatable and surgical procedures have become more advanced due to our ability to treat infections.

In recent years, however, the medical and veterinary profession have identified that the effectiveness of antibiotics against some bacteria has changed, and that the bacteria which can resist antibiotics are increasing in frequency.

To slow down the evolution of resistant bacteria and protect the efficacy of the drugs, medical professionals have had to review their approach to using these antibiotics, whilst research to find new antibiotics is on-going. These measures include trying to prescribe antibiotics only when they are necessary rather than just in case and considering alternative solutions for tackling bacterial infections.

 

What is antibiotic resistance?

Antibiotic resistance occurs when a bacteria develops mechanisms to reduce the effects of the antibiotic.

Examples would include altering the part of the bacteria the antibiotic targets so it can no longer bind to it or developing pumps that expel antibiotics from the bacteria before it can reach a sufficient concentration to have an effect. These mechanisms evolve through mutation and adaptation.

Mutations can be good or bad for the bacteria. In some cases the mutation kills the bacteria and in some cases there is no benefit. However, in others mutations may be beneficial. For example, a bacteria may acquire a mechanism in an environment containing an antibiotic. In this situation the mutated bacteria is able to survive and outcompete other bacteria and proliferate (i.e survival of the fittest – Darwinian evolution). If the antibiotic wasn’t present then the mutation for resistance wouldn’t be an advantage over other bacteria and therefore it wouldn’t outcompete.

It is normal for our bodies and our environment to contain bacteria (e.g. in our intestines and on our skin) – these are termed commensal bacteria. By using an antibiotic for longer than needed, or when it isn’t necessary, there is an unnecessary selection pressure on these commensal bacteria that could lead to the development of an antibiotic resistant strain. Therefore, optimally we prescribe antibiotics only when they are needed and only for as long as it takes for a bacterial infection to resolve.

 

How does antibiotic resistance occur?

Most people are aware of Alexander Fleming’s discovery of penicillin in 1928.

Subsequently, work was undertaken with his colleagues Florey and Chain to make the molecule useable as a drug to treat infections in people. Fleming himself noted in his early observations that bacteria could become resistant to penicillin if the drug wasn’t used optimally.

Understandably, given its significant impact on healthcare, initially penicillin was increasingly prescribed but over time it started to become less effective clinically. However, at this time, there was significant research into antibiotics and new molecules were being discovered to replace those that no longer worked. This cycle continued and the resistance to penicillin (and other antibiotic drugs) had little effect on the medical treatments available, as there were always newer molecules being made available as an alternative.

How we have reached the current situation is a complex issue, but a combination of factors have contributed. Some of these include:

• Bacterial multiplication, mutation and evolution (nature)
• The way we have used antibiotics in the past (e.g. using antibiotics in farm animal feed as growth promoters)
• Prescribing antibiotics ‘just in case’ for illnesses they were unlikely to help
• A significant reduction in antibiotic research from the late 1980’s to the early 1990’s.

 

What does this mean?

This means that, as some antibiotics are no longer as effective as they used to be, healthcare and veterinary professionals have had to adapt their approach to administering antibiotics to help preserve the efficacy of those that currently still work.

Through being more aware, as vets, vet specialists and pet owners we can ensure we all take the best possible approach to the use of antibiotics.

Research for new antibiotics is an area of focus for the scientific community and this has Government support. However, the development and approval process for any new drug takes time. Even if a new antibiotic molecule is discovered, it can take many years before it is modified and approved for safe use in a patient. So while this research is ongoing, we need to take measures to slow down the evolution of resistance and protect the efficacy of the drugs we currently have.

We should also consider that any new antibiotics discovered may be reserved for human use as opposed to antibiotics for our animals. This is a further argument to instigate measures to protect the efficacy of the antibiotics we have available for veterinary species.

 

Why is it important for veterinary medicine?

As antibacterial resistance is a growing concern in both human and animal medicine, there is some pressure to restrict veterinary use of certain antibiotics. This could have considerable implications for animal health and welfare. Veterinary professionals therefore need to be seen to be using antibacterials responsibly.

 

What can vets do to help slow down antibiotic resistance?

For vets, there are certainly options looking forward regarding how to address this issue.

There are plenty of guides and advice readily available as to how to combat potential bacterial infection. In general, though, a diligent approach to hygiene and adherence to ensuring antibiotics are only administered when completely necessary is vital. This doesn’t mean that antibiotics shouldn’t be used. We do, however, need to ensure we don’t prescribe them when we know they are not necessary. An example would be a human with a bad cold not receiving antibiotics as standard treatment as a cold is caused by a virus.

It is important that veterinary specialists know when it is appropriate to administer antibiotics, and where it is important to reduce their use. Rather than administer them ‘just in case’, alternative solutions should be adopted when possible e.g. good surgical aseptic technique. This approach can assist in ensuring antibiotics remain as effective as possible rather than being administered unnecessarily.

In both human hospitals and veterinary hospitals it is common to find guidelines with recommendations for which infections or conditions antibiotics are and are not indicated. This is called Antibiotic Stewardship.

There are some guidelines available to download here that go into detail about the right steps to take.

Our practice is a supporter of the BSAVA/SAMSoc ‘PROTECT ME’ principles. Their core principles are as follows:

P Prescribe only when necessary

R Reduce prophylaxis

O Offer other options

T Treat effectively

E Employ narrow spectrum

C Culture appropriately

T Tailor your practice policy

 

M Monitor

E Educate others

You can download our poster to display in your veterinary surgery, should you wish. This can help to spread the message and help others work towards changing their approach to administering antibiotics.

What can pet owners do to help slow down antibiotic resistance?

There are some simple ways in which you can help your pet when it comes to bacterial infection prevention.

Even just by being aware that antibiotics may not always be the answer, you will be helping vets, and vet specialists like us, to do our job by trusting our advice, and being open to alternatives. As we know antibiotic resistance is a One Health issue so taking steps to combat antibiotic resistance can help both humans and animals

Measures you can take to help reduce the incidence of infections include:

• Practising good hygiene in particular hand washing
• Showing diligence when it comes to caring for your animal day-to-day
• Keeping pet areas clean and keeping a track of your pet’s behaviour, so that you notice any changes or irregular occurrences

Furthermore, if a vet or vet specialist does administer antibiotics, always use them as prescribed and complete the course recommended by your vet.

If your vet doesn’t prescribe antibiotics, follow their advice on the expected time frame for the condition resolving and monitor your pet for signs that things may be getting worse i.e. not progressing as expected. If your pet’s recovery isn’t going as expected, then your vet can re-examine them and revise the diagnosis if necessary.

 

How Davies Veterinary Specialists can help

If you’d like some additional information on antibiotic resistance and what it may mean for you, there’s lots of information available on our website for both pet owners and veterinary professionals.

We have a series of webinars available here, these explore antimicrobial resistance and the importance of responsible prescribing for vets. Our webinars are also available on YouTube. We also have a FAQ fact sheet about antibiotic resistance on our website.

Want to know more? You can head to Davies Veterinary Specialists’ Facebook page for the latest updates and information. You can also do your bit by becoming an Antibiotic Guardian, which you can find out more about on our Facebook page or by heading to www.antibioticguardian.com.

To download a copy of the full BSAVA/SAMSoc Protect Me poster for your practice, click here.