Hello there and welcome to a, webinar on, protecting antibacterials in small animal practise. My name is Ian Ramsey. I work at the University of Glasgow, and I, and I was for many years the editor of the, BSAVA Small Animal Formulary.
And more recently have been involved in the Protect me poster, from the, the BSAVA. So I declare a little conflict of interest in both the title and in some of the, the content here. But, I hope that won't interfere too much, with what, we're going to talk about today.
I thought we'd start with the why. Why do we worry about antibacterials now, and that basically is about the development of resistance, so a quick review of that. And then we'll talk about how we protect our antibacterials in practise so that the amount of resistance in practise becomes as little as possible.
And finally, I'll finish with a summary. Antibacterials work in several different ways, depending on the type of antibacterial and to some extent, the, type of, of bacteria. Fluoroquinolones tend to, to, to work on the, the DNA, and so on and, and so forth.
The problem is the bacteria can mutate and they mutate far more rapidly than a eukaryotic cell because there's no DNA proof checking. And what this means is that when the DNA divides, in the, semi-conservative, way that, DNA divides, and new strands, complementary strands of DNA are formed. In new character cells like yours and mine, there is an error checking function that makes sure that the copy is exact.
In bacteria, that error checking doesn't happen, which makes for a very high rate of mutation, many thousands to tens of thousands times higher, than, than eukaryotic cells. And so, although the actual rate, 1 in 10 the rate of the power 7 is, is relative, might seem relatively low, when you consider that there are 10 to 12 bacteria in the average human gut, that means the, the, the bacteria mutating essentially all the time in your intestines. And there's about 40 species of bacteria in your intestines.
So, so they, they are varying pathogenicity. So some of them are more pathogenic, some are less, some are more able to, to, to mutate, some are more able to take up new mutations, and they, there are harmful bacteria, good bacteria all mixed together, and all, are, are mutating. The mutations for the most part, are damaging to the bacteria.
And as a result, those cells either don't survive or are outcompeted by healthy cells. But in some cases, those, methods of, those mutations lead to changes in the sensitivity to antibiotics, for example, by decreasing the uptake or being able to get rid of the bacteria, the, the antibacterial more quickly, for, changing the binding proteins such that the, the, the, either the, antibiotic binds more, more tightly to the binding proteins or less tightly. of course, the other big one is, enzyme inactivation.
So we, we get mutations in enzymes which allow them to inactivate the antibacterials. And whatever these changes are, these will spread. So a change within a, a bacteria will spread as that bacteria divides as long as the selection pressure is maintained, there will be a a continuation of that mutation.
So one species, one individual that becomes resistant will lead to many individuals becoming, resistant. But that's not all. The other problem is that when a bacterial cell dies, bits of DNA are left over and these may be taken up by other bacteria, so we can spread these between species.
Bacteria may also, join together, and share plasmids, and they may not be from the same species. And finally, bacteriophages may In fact, one species of bacteria, pick up a bit of bacterial DNA and take it to another species of bacteria. And in this way, the spontaneous mutations spread not just within a single species population but spread to all bacteria.
So a bacteria in your gut that is resistant to salmonella, even if that bacteria, sorry, is resistant to antibiotics, even if that bacterial species is not a bad news, it may spread that resistance to, for example, a salmonella. So if we have a population of bacteria and it undergoes a spontaneous mutation, which above about 107 is going to become likely, and then we apply an antibiotic, creating selection pressure. This will kill off the healthy cells and allow the mutated cells to proliferate, which otherwise they would not be able to do because they would be outcompeted.
This selective effect produces resistant clones, destroying bacteria, reduces the competitive effect. And then, of course, you can spread those resistance genes, both from this population to, to, to, descendants of that population, but also, to other populations. So bacteria that are resistant.
In your environment may become and lead to bacteria being resistant in your intestine, even if they're different species. And of course, as long as that selection pressure is maintained, so these bacteria will continue to multiply and develop. And what's interesting is that within that population of resistant bacteria, there will be backwards mutation back to the wild type, which is sensitive.
So as a result, as long as that selection pressure is maintained, then it will favour the mutated bacteria. But when you remove that selection pressure, then the wild type bacteria, now they have the advantage, and in time they will outcompete the mutated bacteria because nearly all mutations in the absence of selection pressure are deleterious. So practically, what, what, what, what, what does this mean?
Bacteria are becoming more resistant. Commensals in your gut can become resistant as easily as pathogens. And this resistance spreads within and between bacterial species.
And once resistant bacteria remain resistant for a long time, but not forever, they will eventually give up their resistance. The levels of resistance vary widely between populations. If you, if you look at populations attending a referral clinic, they'll be different to a primary care practise.
If you look at the populations that are, have been through surgery, they'll be different to healthy dogs and so forth. This is one survey, back, back from 2009, quite a time ago now, which, which was really the first big one looking at, me. In resistance staff pseudo intermediates and showed that anything up to 45% of dogs can carry this organism.
These were, these were healthy dogs, and cancer may be 1 or 2%. So in the natural environment environment, it can be reasonably low, but if you go into a surgical, population, then there's the population starts to, to, to look a bit different. And the thing is, we've always known this about antibiotics.
Alexander Fleming, back in 1945, identified antibacterial resistance at the same time as identifying the world's first antibacterial. And, and I think that that that's a lesson to us. Really that we knew about this problem all along.
And despite new classes of antibiotics coming along, particularly in the, in the 50s and 60s, we've always about 10 years later, seen resistance to those, anti, antibacterials. So it is unlikely that we will ever get an antibacterial, which will, not, lead to the development of resistance. New antibacterials will merely put off the issue until, The bacteria become resistant.
I once heard it, it's said by someone that has many, many antibacterials come from fungi that in, in, in the trench warfare that has existed since the dawn of life, we are in no man's land between the fungi on one hand and Bacteria on the other, and we're nothing in in that battle. They've been fighting this out, the bacteria and the fungi since life first began, and it is unlikely that we're going to to be able to to win this war. And therefore, we need to find a different method of, of dealing with this.
And of course, we do use huge amounts of antibiotic. We, we are, reducing the amount of antibiotic. The work of, ROMA, and others in reducing antibiotics has significantly reduced the amount of antibiotic.
But we still talk about tonnes of active ingredients sold across the veterinary spectrum. And of course, small animals don't, don't, don't use tonnes of antibiotics, but what we do do is use a large range of antibiotics, and although Many of the, some of these are not licenced for use and some you might regard as as being, that you shouldn't use, but this, this wide range is, is the problem. These, these are the ones that that we, we really need to think very carefully before we start using on a regular basis.
So this, this before this multi-drug resistant infections are an international problem. They are widespread throughout Western Europe, and to a lesser extent in Eastern Europe. But interestingly, Scandinavia, which has always traditionally had much Tighter controls on anti antibacterials have a much lower rate of multi-drug resistant infections.
So it is possible to achieve low rates. Of course, in some parts of the world, the rates, rates of MDR infections are even higher than in Western Europe, and the, particularly the Indian subcontinent and so forth, have a very, very serious problem, with this, with, with significant impacts for human health in the long run. So, as well as the, the practical implications that we've already been talking about, I think it's worthwhile mention this is now a major international problem with animals being imported into the UK at a very high rate.
We are going to be importing drug resistance. New antibiotics are not the long term solution. Indeed, at the moment, there are no major drug companies who are investigating new antibiotics, at least not that they've declared.
And indeed, there's not, the fact is that there's not much money in new antibiotics, so that it is, it is unlikely that we're going to see any new classes of antibiotics. And I think we have to accept that, that vets are part of the problem. We are part of the prescribing cascades, around the world, and we are definitely part of the problem.
So what are we going to do with this theoretical knowledge we have about antibacterial resistance to put it into practise? So I think the first thing we have to do is identify what are the problems in small animal practise, that we need to deal with. And the first problem is not the tonnage of antibacterials that are prescribed.
We, we simply don't, don't prescribe that much. The problem is the number of prescriptions. It's the number of patients getting a particular drug and the number of drugs given to a particular patient over the course of its life.
And of those two, it's actually more of a concern that, that the number of patients getting a drug than the number of times that a patient gets a drug. The second problem we have is that we fail to kill all the bacteria, whether they're disease causing or not, whether they're commensals or pathogens, it doesn't really matter. If we use an antibacterial, we must kill all the bacteria that are sensitive to that if we can.
And the reasons why we failed to do that is that we fail to use the right drug. We used the wrong dose. We do it for too shorter duration.
And finally, the really big one in small animal practise is the range of drugs that we use. An individual patient may in the course of, you know, a very short period of time, meet 3 or 4 different classes of antibacterial, and that's really probably the biggest problem we have compared to our professionals in, fellow professionals in large animal practise, where the range of drugs used might be much narrower. So that is something that we need to tackle.
So what we need to do is to look at, how we avoid antibacterials in the first place, if we can, if we are going to use them, what protocols we have in place to do them, how we use cultures, how we assess the results of those cultures, the significance of what we find. How we use the sensitivity profiles that we are presented with, how we make sure that we use the antibacterials in the most efficacious way possible, and that particularly also links to compliance of our owners to actually, give these antibacterials. This is the, the, the product of a dog with diarrhoea.
You can, you can see here that it starts off at the top here with this sort of liquidy brownie faeces and then moves on as the dog continues to strain round increasingly smaller and smaller quantities, getting more and more bloody. This is the big sea of colitis. Do we need antibacterials for colitis?
I think there's a lot of evidence now that many dogs, do not require antibiotics, for this situation. And yeah. It isn't your thing, then, cystitis, that again, there's lots of evidence showing that cats with cystitis very rarely have bacterial infections.
There's also lots of evidence to suggest that many vets will prescribe antibacterials for a cat with cystitis. . And indeed, it's estimated that, human doctors, about half the antibacterial prescriptions that are prescribed are unnecessary, either because the condition is not bacterial in origin, or if it is, spontaneous self-resolution will be likely.
and, and those, could be further enhanced by our use of antibacterials in routine clean surgery. This is a bone marrow aspirant. Does it need an antibacterial after you?
Cat flow. There's cat need clearly there's secondary infection there, so there are pathogenic bacteria there. It's part of the complex, but do we need to use antibacterial in every case?
And, and here the vaguely unwell little Yorkie, who's not eating, do we give antibacterials to that? And we, we know from again from surveys of human doctors that That up to 25% will admit, and probably there's a few more who are not admitting that they will prescribe antibacterials when they don't know what's wrong with their patients. They, they, they, they, they, the patient has no signs of bacterial disease, but because they need, they feel the need to close the consultation, so, so they give antibacterials.
Even if we do have infections, there are alternatives to and. Infected implants, for example, we can, drain abscesses, localised infections can be treated locally, removing devitalized skin and so forth or or help to reduce the need for systemic antibacterials. Topical antibacterials are far less likely to produce resistance because topical antibacterials are, are only exposed in a small population to the .
Antibacterial. And of course, we can use disinfectants, which are, which are, are, are chemistry essentially rather than biology, and these chemical disinfectants, as far as we know, for the most part, do not create, resistance. There are other antibacterials out there that, don't, require a can't produce resistance, yet.
And so, they can be used to. And of course, the, the, the question of probiotics, there's some good evidence, recently coming out showing that these can be effective in a number of, gastro cases of gastroenteritis, and, and, whether or not they're involved with infections, and, and these are an alternative as well. We also need to talk about protocols and policies, and these aren't just about protect me.
This is about a practise policy that defines responsibility, hygiene protocols that defines areas and activities in those areas, as well as prescribing policies. And and although we'll talk about protect me, there are a number of other prescribing policies out there. This practise policy needs to think about what is the where is the policy displayed and written down, who's supporting it, who's who's the, who's the, the, the, the go to person in your practise, who can actually deliver against that, that.
Policy and what what resources do they have to deliver that that policy? Specific interventions. So, so for example, how, where do you record your post-op wound infections?
If it's simply in the patient notes, then you have no idea about how often you are getting postop wound infections. So you wouldn't know when to start a review of why things are going wrong until you are in an absolutely catastrophic situation. So really, it's, it's a good idea if, if all bacterial cultures, if all infections or whatever are marked up on a separate sheets so that you can look at the overall picture, as well as the individual patient.
And again, what would prompt a patient review? In some practises that are very strict, certain antibacterials require two signatures. Now, now, I, I agree that might be difficult, but for example, if you're talking about, an unusual antibiotic like, Amicain or Imipenem or other human antibacterials which very few people use.
Perhaps it would be a good protocol to have two signatures for, for those so that it doesn't just accidentally happen. How, how do we check doses? do nurses in, dispensing, the, these, antibacterials?
Do, do they check the doses to make sure that we're giving enough? And finally, how do we monitor the prescribing of antibiotics? How do we know within the practise who's prescribing which antibiotics?
Do we know how resistance is monitored? Do we have a, a chart or a book somewhere where all the bacterial culture results go in and we can actually look at monitoring resistance? Other areas considered, it's sort of about the, the, the ownership of that, of areas so that the practise, hygiene policy is owned by somebody, and again, it needs to be written down, it needs to be displayed.
People will come and go in the practise, and it's important that that it's out there and it's able to be consulted by people who may not be familiar with it, identify areas where food is prepared, where animal food and human food, so that we're separating those two isolation and wards, which, which sort of cases go where. Cleanliness in the laboratory, whose job it is to clean up the laboratory, and, and when and how often, how we deal with things like, this, this necrotic horrible wound here, who, who's who, who's responsible, for ensuring, that that is, kept, the, the dressings and so forth from that. Are disposed of proper, properly.
Do we have colour schemes? So, at Glasgow, for example, if we have a dog, which has diarrhoea, then we have a different colour scheme on, on the notes, and that means that that patient, if it has to move around, everyone is aware that patient outside of that were, that, that particular area, we still know that that is a dog with diarrhoea. Cleaning protocols, whose job it is to clean the door handles, the computer surfaces, etc.
As well as the more obvious animal waste. And of course, how we handle the, the waste, particularly from animals where, where infection is considered likely. And, and again, monitoring.
So do we have a chart on the wall for, the last time the computer keyboards were cleaned and like it when you go into public toilets that somebody initials that they have cleaned the computer keyboards this week. We also need a prescribing, policy, and this for, for, for, for vets. But The, protect scheme, the protect or it is now, now the Protect me, scheme.
And this, this, is listed up here. It's about prescribing only when necessary. It's about reducing the use of antibacterials as prophylaxis, so, so not for the routine bit, not for the routine, piece of surgery, for the lump, removal, for, that sort of thing, offer other options, to, to antibacterials.
Effectively when you do use them, use them at a high dose and use them for long enough. Use where you can a narrow spectrum antibacterial. So we should be seeing more lecosamides and macrodites and so forth being prescribed.
why, why use, amoxicillin clavulanate when you can use amoxicillin, this kind of thing, culture appropriately. So that's not necessarily every time, but culturing at the right time. Tailing your practise policy and, and, and really, making sure that, that everyone in the practise is following the practise policy is probably the single biggest thing that we can all do to make sure that, antibacterials continue to work for us in the years to come.
Finally, monitoring the efficacy of the treatment, that we prescribe, so that we make sure that it is working, and, and finally, educate others and that particularly in this sense. Setting means educating owners not to expect antibacterials every time. So I hope many of you, in the UK at any rate, are, are, are.
Using this, this poster in your practise, it's recently been updated. It allows you to, select, for your practise, what is the most appropriate antibacterial in a number of different situations. It describes when you really should culture, for, for, for these things.
I The areas if there is something that, that you're not sure of. It defines a number of antibacterials like vancomycin and so forth, which really shouldn't be used in animals. It defines, defines the critically important antibiotics, so the fluoroquinolones, and the 3rd and 4th generation cephalosporins that should really only be used when you've cultured.
and it describes, a number of, the situations where perhaps you, you would want to think carefully about whether you would use antibiotics or not. It's also got a little table up there on the top right for adverse reactions to antibacterials, worthwhile remembering that there are, some, antibacterials that do cause problems. These are not completely safe drugs.
We need to think about when they cause problems, and particularly, in, in certain situations, some antibacterials are, are contraindicated. So I think it's important to, to, to make sure that your practise goes through this process, that people sign up to it and that they agree. It's better that you agree than you agree on a particular thing, and, and, and I think compromise is the order of the day by everyone, so that you end up with a policy that everybody can feel comfortable going into a consulting room and, and following.
One of the questions I get asked is, why not use comoloud first time every time, just for everything. There's a lot of merit in, in that in, in, in many, in many respects. The, the thing I would say, however, is that it is a very, very broad spectrum antibacterial.
In some countries, coamoxylav is regarded in the same breath as the fluoroquinolone. It is, it is regarded as being such a, a critically important antibiotic that it really shouldn't be used first time every time. I'm not sure we're there at that stage yet in the UK.
But I, I would encourage you to think very carefully before you go down that way. There are narrower spectrum antibiotics, particularly amoxicillin, that would work well in most situations that you would prescribe coamoxyla. So do, do think about that before you just take cooxicla first time every time.
Many of us, I think in the past one of the reasons we've been reluctant to do cultures is this feeling that we need to get on and prescribe antibiotics. But actually, there's good research showing now that taking a swab and waiting. For the culture result to come back, does not affect outcome in most circumstances.
The other big thing is that, that people, I think when they, when they hear lectures like this, they think they have to go on culture every time. It is absolutely fine not to culture on first presentation. If you are faced with a dog with sepsis, then you absolutely need to give antibiotics right here, right now, and you're not going to worry too much about the culture, coming back because you're going to have that animal on four quadrant therapy to, to do this, to deal with this situation.
But where you have Infections that have apparently not responded to the first antibacterial and you are considering changing drugs, or infections where you think you're going to need a very prolonged course of antibiotics, and this is, for example, things like endocarditis, disco spondylitis, and so forth, then far greater effort needs To be made to get a bacterial culture because you're going to be doing exposing this animal to a lot more selection pressure and therefore a much higher chance of resistance in these circumstances. So we need to think about doing cultures in those cases. But of course, if you culture something, it doesn't mean to say it's necessarily the cause.
And I think it's important to reflect on that the signs suggest infection? Is there fever? Is that high white blood cell count, is that acute phase protein response?
Is the bacteria significant in that location? And it depresses me sometimes, the number of times I see E. Coli being isolated in faeces.
And, and, and people are not sure how to say it. I mean, E. Coli is I can be pathogenic for sure, but it is a normal commensal and faeces as well.
And unless you know how, how to interpret that and and really phoning up the laboratory and, and asking them some pretty searching questions about their identification of E. Coli and faeces is, is, is, is important before we ascribe too much significance to that. And the same goes for staff who do intermediate on, on skin.
And does the bacteria explain all the signs? Is this a secondary infection and there's a primary infection underneath? Alongside that, sensitivity testing, is coming on.
The old way of this diffusion, this diffusion testing is gradually giving way to more sophisticated methods, and, with that, hopefully a, a, a better understanding of the relative resistance. To an antibiotic rather than the yes or no, which is really not a very realistic situation. Most antibacterials can eventually achieve a concentration to, to kill, a bacterial species.
It's a question of whether we can achieve that concentration to do that. Are we using antibacterials, effectively? Again, the, the, this is, this is something that's important, in terms of the idea of giving things locally.
Topical application for, isolated infection. Yeah. GI disease and you think that you do want to give antibiotics, then giving an antibiotic that stays in the gut seems to me to be a more sensible route than to give something that spreads to the, to the whole body.
And this is, and we talked about carmoxi. This is one situation where carmox cle, it's it's exact ability to be taken up from the gut is actually counting against it, unless the animal is systemically unwell. In the urinary tract, there are certain antibiotics and, and here carboxy is a very good example, which are excreted in much higher concentrations in the urine.
And therefore, in that circumstance, that makes a, a logical, sense. Where we want to optimise the effect, we, we can increase the effects by increasing the frequency. So, so rather than using caramoxicla once a day or twice a day, we can use it 3 times a day.
And indeed the intravenous dose of caroxi is 3 times a day, but you could make the oral dose 3 times a day as well, particularly where you think that this might be a difficult to treat infection. Whereas, increasing the dosing amount of things like the fluoroquinolones and metronidazole, is, is quite important. And there's been a lot of, chat about the, licenced dose of metronidazole, but it's actually good antibacterial prescribing to use metronidazole at the highest dose that you can get away with.
In order to achieve the kill, I think the, the, the, the problem, of course, is if you use too high a dose for too long, then you may start to get toxicity changes. So I think the duration of the dose as well as the actual dose amount, is important when it comes to metronniol toxicity. And we need to monitor treatment.
How long should we give, antibacterials? Well, there, there's a lot of debate about this, and, my, my, my view is that basically we should give it until the animal is clearly better. And then give a bit extra to finish the job.
Now that, that may be an old fashioned view. There are some of them that say that that you should stop and once the animal is better, and, and not carry on for that bit extra. But my, my problem with that is that I, I think whilst that might work in human beings, As our animals cannot tell us when they're feeling completely well.
So I think a margin of error, and this does not increase the risk of antibiotics and resistance that that much. It's the number of animals we prescribe it to and the number of times that we prescribe for a particular animal and the range. Once you've started carrying on with antibiotics at a high dose, for, for longer does not increase the risk of resistance.
Repeating cultures useful, obviously to, to, as, as a way to, to monitor treatment, but really that probably, is only in fairly persistent infections, and of course monitoring the patient. What we need to have discussed is what happens if the infection recurs. If the infection recurs, it is probably that you've got the right antibacterial, but the wrong course.
Either the wrong dose or the wrong wrong duration. But the fact that you have controlled that infection, and then when you've taken the antibiotics away, it has recurred, means that antibacterial is working. You're just using it in the wrong way.
If on the other hand, the infection does not respond, that means you've got the wrong drug. It may also be the wrong dose and the wrong route, but it's likely you've got the wrong drug and it is therefore reasonable in that circumstance to culture and find out the right anti antibiotic. From Scotland, of course, we have to look to Robert the Bruce, and his famous, if at first you don't succeed, try, try, try again.
That might be true if you're a great general, but is a terrible way to be a vet. If at first you don't succeed, don't try, try, try again. Think of something different to do.
If antibiotics don't work, try something else or find the bacteria and then treat that on the basis of the culture. Changing antibacterials is spectacularly unsuccessful, and really does raise the risk of resistance. I mentioned acute phase proteins, these worthwhile looking at when you're talking about chronic long term infections.
This is, this is a wee patient of Rory Bell's, my colleague Rory Bell, who had endocarditis. And if you look up in the textbooks, then, then they will say, treat with antibiotics until it's better. Or for 6 weeks.
And where this figure of 6 weeks comes from is, is, is, is not clear. And this patient actually been through repeated bouts of antibiotic treatment. Every time the, the treatment was stopped, the condition came back.
And, and what this reflects really is, a lack of the duration, of course. This is the sea. Active protein and haptoglobin and the neutrophil count in this dog.
And until this time, this, this dog had only had 4 or 5 weeks of anti antibacterials at a time before infections occurred. And what you can see here is that at week 6 and at week 9 and week 12 and week 15, there is clearly still evidence of some residual infection. And actually, Rory treated this dog.
for, for 18 weeks, in order to get resolution. Now that may seem like a long time, but it does not increase the risk of resistance to kill the bacteria that are sensitive to that antibiotic, and it was just a question of getting high enough concentrations for a long enough time to achieve that result. Changing the antibacterial wouldn't have worked.
You'd still needed to get a long course. And of course, if we're going to prescribe long courses for these hard to treat infections, then we need to look at compliance. And we know that compliance is affected by the number of medications.
So if you've got to give 6 different pills during the course of a day, then you're far less likely to be compliant. If you're going to give it 2 or 3 or 4 times, you're far less likely to be compliant compared to first. 11 time a day.
And of course your compliance, the compliance is also affected by the amount you've been taught and been told to finish the course. And that's about education. That's about us talking to our clients about finishing the courses.
It's about posters in the waiting room. It's about leaflets and so forth. The BSAVA produced.
the posters out there encouraging clients to finish the course. it's worthwhile doing all of these. We, we try to hand these out for many courses, particularly the prolonged courses of antibiotic, and, and that's, quite useful.
Nice thing is you can also put your practise logo on the, client information leaflet as well. So, We've talked about, some, discussion about why we get resistance and how we can, do, modify our practise policy and our practise in our consulting room to protect our antibacterials. Let's try to put this into, into the summary.
We're going to culture more cases more often. We're going to check that we've achieved a cure. We're going to prescribe fewer antibiotics and we're going to use a fewer range, a smaller range on a reduced number of occasions.
We're going to avoid using antibiotics on a try and see basis, and we're going to try to reduce the amount we give as prophylactically. We're not going to forget using our antiseptics and decontamination where we can. And when we do use antibiotics, we make sure that we know the difference between them, or we just follow our practise policy.
We're going to use them at higher doses, given for long enough, given frequently enough, and we're going to carry that on for some days after a clinical cure, and we make efforts to try to increase, compliance. If the treatment doesn't work, we're not going to change the antibacterial, we're going to change the approach. And that in summary is what we wanted to be doing.
Antimicrobial resistance is a problem and it will affect you. You will become contaminated with these resistant bacteria. They will spread to your bacteria.
So you will develop a rate of resistance when swabs were done at a pig veterinary conference. 80% of the pig vets there had multi-drug resistant bacteria carried in their nose. We really need to keep this in perspective.
It affects us as well as the animals. You need to know where to get help. There's lots of help out there, just ask for it.
We need to have, know, and stick to our practise policy. And if your practise doesn't have one, can I suggest you stick it on your next practise meeting, agenda, get everyone around, make them cakes, buy them beer, whatever. Let's get this, sorted out so that we are, we are all singing from the same song sheet.
And that practise policy is not just about protect me, it's about, protocols within the practise as well. Educate others, increase compliance, reduce the number of prescriptions, the BSAVA produce a non-prescription pad. This is a great way of, I'm not going to give you antibiotics because, and we, we, we, find that quite useful in some circumstances, and above all else, use antibacterial properly.
It's never wrong to give antibiotics before you get the culture results. Sorry, wrong, wrong before you get the cultural results. but, it is wrong to give antibiotics if you don't need to.
Long courses are, antibiotics, are, are, are, are not the, the, the problem, it's the frequent use rather than the long course. There will not always be another antibiotic. We are running out now.
Intensive cleaning of hospital will not stop the spread of resistant infections and isolation of resistant infections will not stop the spread within your hospital. Thank you for listening. I hope if you have any questions, that you feel able to email me at this address.
Thanks. Thank you.