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Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study

The veterinary prescription of antibiotics in low- and middle-income countries (LMIC) remains largely undocumented. In Bhutan, however, the national veterinary service keeps records of their activities and prescriptions, which offer an opportunity to establish a benchmark to assess the use of these...

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Autores principales: Villanueva-Cabezas, Juan Pablo, Rinzin, Karma, Dorjee, Sithar, Tshewang, Pema, Namgyel, Ugyen, Sharma, Puspa Maya, Stevenson, Mark A., McVernon, Jodie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194083/
https://www.ncbi.nlm.nih.gov/pubmed/34124215
http://dx.doi.org/10.3389/fvets.2021.641488
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author Villanueva-Cabezas, Juan Pablo
Rinzin, Karma
Dorjee, Sithar
Tshewang, Pema
Namgyel, Ugyen
Sharma, Puspa Maya
Stevenson, Mark A.
McVernon, Jodie
author_facet Villanueva-Cabezas, Juan Pablo
Rinzin, Karma
Dorjee, Sithar
Tshewang, Pema
Namgyel, Ugyen
Sharma, Puspa Maya
Stevenson, Mark A.
McVernon, Jodie
author_sort Villanueva-Cabezas, Juan Pablo
collection PubMed
description The veterinary prescription of antibiotics in low- and middle-income countries (LMIC) remains largely undocumented. In Bhutan, however, the national veterinary service keeps records of their activities and prescriptions, which offer an opportunity to establish a benchmark to assess the use of these agents in this and other LMIC. A cross-sectional retrospective study was designed and 2,266 handwritten veterinary records from 2017 were sampled from 23 animal health premises (AHPs) to estimate individual and an overall proportion of consultations that resulted in an antibiotic prescription. The frequency of antibiotic prescription per species, type of AHP, and according to WHO's AWaRe index and OIE list of priority antimicrobials were also explored. It was estimated that 31% (95% confidence interval: 29–33%; intracluster correlation: 0.03) of the veterinary consultations resulted in an antibiotic prescription. The incidence of antibiotic prescription was highest in consultations of poultry across AHP. Across species, diarrhea and wounds were frequently treated with broad-spectrum antibiotics including sulfonamides, tetracyclines, trimethoprim + sulfa, and penicillin. Between 45% and 70% antibiotics prescribed correspond to AWaRe's access group and up to 25% to AWaRe's watch group. Over 70% of antibiotics dispensed in veterinary consultations for any species correspond to the OIE's veterinary critically important antimicrobial agents. Overall, the study demonstrated positive features of veterinary antimicrobial stewardship in Bhutan, given the conservative proportion of consultation that results in this type of prescription and the type of antibiotic prescribed. Although the veterinary service closely follows the Bhutanese Standard Treatment Guidelines, the prescription of antibiotics to key species should be closely monitored. Our study suggests that further improvements of antibiotic stewardship can be achieved through standardisation of antibiotic prescription to some species, a revision of the guidelines toward reducing the prescription of antibiotics of high relevance for human medicine, and by including details of clinical investigation, use of tests, and treatment outcomes in veterinary consultation records.
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spelling pubmed-81940832021-06-12 Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study Villanueva-Cabezas, Juan Pablo Rinzin, Karma Dorjee, Sithar Tshewang, Pema Namgyel, Ugyen Sharma, Puspa Maya Stevenson, Mark A. McVernon, Jodie Front Vet Sci Veterinary Science The veterinary prescription of antibiotics in low- and middle-income countries (LMIC) remains largely undocumented. In Bhutan, however, the national veterinary service keeps records of their activities and prescriptions, which offer an opportunity to establish a benchmark to assess the use of these agents in this and other LMIC. A cross-sectional retrospective study was designed and 2,266 handwritten veterinary records from 2017 were sampled from 23 animal health premises (AHPs) to estimate individual and an overall proportion of consultations that resulted in an antibiotic prescription. The frequency of antibiotic prescription per species, type of AHP, and according to WHO's AWaRe index and OIE list of priority antimicrobials were also explored. It was estimated that 31% (95% confidence interval: 29–33%; intracluster correlation: 0.03) of the veterinary consultations resulted in an antibiotic prescription. The incidence of antibiotic prescription was highest in consultations of poultry across AHP. Across species, diarrhea and wounds were frequently treated with broad-spectrum antibiotics including sulfonamides, tetracyclines, trimethoprim + sulfa, and penicillin. Between 45% and 70% antibiotics prescribed correspond to AWaRe's access group and up to 25% to AWaRe's watch group. Over 70% of antibiotics dispensed in veterinary consultations for any species correspond to the OIE's veterinary critically important antimicrobial agents. Overall, the study demonstrated positive features of veterinary antimicrobial stewardship in Bhutan, given the conservative proportion of consultation that results in this type of prescription and the type of antibiotic prescribed. Although the veterinary service closely follows the Bhutanese Standard Treatment Guidelines, the prescription of antibiotics to key species should be closely monitored. Our study suggests that further improvements of antibiotic stewardship can be achieved through standardisation of antibiotic prescription to some species, a revision of the guidelines toward reducing the prescription of antibiotics of high relevance for human medicine, and by including details of clinical investigation, use of tests, and treatment outcomes in veterinary consultation records. Frontiers Media S.A. 2021-05-28 /pmc/articles/PMC8194083/ /pubmed/34124215 http://dx.doi.org/10.3389/fvets.2021.641488 Text en Copyright © 2021 Villanueva-Cabezas, Rinzin, Dorjee, Tshewang, Namgyel, Sharma, Stevenson and McVernon. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Veterinary Science
Villanueva-Cabezas, Juan Pablo
Rinzin, Karma
Dorjee, Sithar
Tshewang, Pema
Namgyel, Ugyen
Sharma, Puspa Maya
Stevenson, Mark A.
McVernon, Jodie
Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study
title Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study
title_full Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study
title_fullStr Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study
title_full_unstemmed Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study
title_short Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study
title_sort antibiotic prescription in veterinary consultations in bhutan: a retrospective cross-sectional study
topic Veterinary Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194083/
https://www.ncbi.nlm.nih.gov/pubmed/34124215
http://dx.doi.org/10.3389/fvets.2021.641488
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