Sharp increase in vets reporting AMR concerns about the cascade, survey shows

Eighty-six per cent of vets across the UK felt that using the cascade procedure had resulted in antimicrobial prescribing decisions which did not support the principles of responsible prescribing at least once. Over half of vets in clinical practice (58%) reported that this happened often or sometimes. This is a significant increase compared to February 2018, when these figures were just 60% and 43%, respectively.

Vets who treat non-traditional companion animals (NTCAs) were most likely to report this, with more than nine in ten (94%) indicating they had experienced AMR concerns with the cascade at least once.

The cascade is a risk-based decision tree that allows veterinary surgeons to treat an animal with an alternative if there is no UK-authorised veterinary medicinal product (VMP) available for a particular condition.

The survey findings come as almost nine in 10 vets say they are worried about their inability to treat infections in animals as a result of AMR.

Commenting on the survey findings, BVA President Anna Judson said:

“We know vets want to protect antimicrobials and keep them working against serious and potentially life-threatening infections. However, there’s an ongoing concern among our members, especially colleagues who treat minor species or exotics, that it can often be difficult to balance the appropriate use of antibiotics with the cascade. In some circumstances this leads to decisions that could exacerbate antimicrobial resistance.

“Where the cascade is not offering the most appropriate solution, BVA advises vets to use their clinical judgement and consider alternative prescribing options. This should be done on a case-by-case basis and after giving full consideration to potential risks and all available evidence. For any off-licence use of antimicrobials, vets can also help extend the body of evidence around antimicrobial safety and efficacy by publishing case studies and pharmacokinetic data where possible.

“We would also like to work with Veterinary Medicines Directorate to find ways to increase licensed options for minor species and exotics, to make it easier for vets to prescribe medications based on evidence-based clinical judgement while stewarding responsible antimicrobial use.”

The question of whether the UK is making progress against the threat of AMR was also the topic of a BVA Congress expert panel discussion at London Vet Show last week, where delegates showed a real interest in efforts to tackle AMR and questions to the panel reflected the profession’s awareness about the need for continued change.

BVA encourages vets in clinical practice to take a look at the 7-point-plan poster for more advice on how to use antimicrobials responsibly: https://www.bva.co.uk/resources-support/medicines/responsible-use-of-antimicrobials-in-veterinary-practice-poster/

Notes

1. BVA is the largest membership community for the veterinary profession in the UK. We represent the views of over 19,000 vets and vet students on animal health and welfare, and veterinary policy issues to government, parliamentarians and key influencers in the UK and EU.
2. BVA’s Voice of the Veterinary Profession survey is a bi-annual survey of vets drawn from BVA members and carried out by the independent research company. The Voice of the Veterinary Profession captures the profession’s views and experiences by asking questions about animal health and welfare, public health, and trends in the veterinary profession. The panel is broadly representative of the BVA membership, which is largely in line with RCVS membership. For more information about the survey please go to www.bva.co.uk/voice
3. 541 vets responded to BVA’s Autumn 2023 Voice of the Veterinary Profession survey:
   1. More than three-quarters of vets said they are concerned about the possibility of being unable to treat infection (87%), an enforced restriction on veterinary use of antimicrobials (84%), or inability to control surgical infections (75%).
   2. Most vets feel that poor owner compliance is one of the main drivers of antimicrobial resistance (58%), followed by over-prescribing (54%) and lack of sensitivity testing (54%). Half of vets (50%) also felt that client expectations (i.e. putting pressure on vets to prescribe antibiotics) are a main driver.
   3. Pressure from clients to prescribe antibiotics had been experienced often or sometimes by 83% of vets.
   4. Eighty-six per cent of vets across the UK felt that using the cascade procedure had resulted in antimicrobial prescribing decisions which did not support the principles of responsible prescribing at least once. Over half of vets in clinical practice (58%) reported that this happened often or sometimes. This is a significant increase compared to Autumn 2021, when 74% reported this (with 52% reporting that this happened often or sometimes). It is also a significant increase compared to February 2018, when this figure was just 60% (with 43% reporting that this happened often or sometimes).

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