The drugs don’t work

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A world-first pilot trial aimed at improving antimicrobial stewardship has been launched in CanberraA world-first pilot trial aimed at improving antimicrobial stewardship has been launched by two Canberra vets. Samantha Trenoweth reports.

Small animal veterinary

Practices in and around Canberra have begun a world-first pilot trial aimed at improving antimicrobial stewardship and helping to preserve the efficacy of life-saving antibiotics for the future. The team behind the ground-breaking trial are Dr Stephen Page (chair of the Australian Veterinary Association’s Therapeutics Advisory Committee), and ACT vets Dr Alison Taylor and Dr Michael Archinal.

“Stephen Page cornered me at the last PANPACS (Pan Pacific Veterinary Conference),” Dr Archinal quips. “He floated the idea of a trial and asked if I was interested in becoming involved. He’s a very hard man to say no to.”

Dr Archinal was already aware that “antibiotic resistance had become a major emerging problem globally” and Dr Page was concerned that, “while antimicrobial resistance from animals appears to be a significantly smaller risk in Australia than in other nations, the veterinary profession must accept its responsibility in working alongside human health professions to fight resistance at every opportunity.”

A trial seemed an ideal way for the veterinary community to show its support, and also safeguard its access to antibiotics in the future. “We rely on antibiotics to treat animals and prevent suffering,” Dr Page explains. “It is critical that they are able to retain access to the essential medications they need, and that they prescribe them responsibly.”

Getting started

When Dr Archinal returned home from the conference, he approached his business partner, Dr Alison Taylor. Between them, they oversee five veterinary practices in the Canberra area, employing around 20 full-time vets. (They were also joint finalists for Australian of the Year in 2016 for their work with dogs in remote Indigenous communities, so they’re an indefatigable pair.)

“Most vets I know are already aware of the importance of antimicrobial stewardship, but they think, what can I do? When we came up with the idea of a more formalised approach, it gave them something they could  do.” – Dr Michael Archinal

Dr Archinal asked Dr Taylor how she would feel about involving their business in the management of Page’s proposed trial and she couldn’t have been more enthusiastic. By coincidence, her brother is a pharmacist in charge of antimicrobial stewardship at a hospital, so it was an area in which she was already interested.

“I’ve been touched in a number of ways by the need for all of us to work together to preserve the value of antibiotics,” Taylor explains. “It’s crucial, whether you treat hamsters or humans. I have family members who work in infection control in hospitals, and I know others with chronic illnesses which are becoming resistant to the treatments currently available.

“For all those reasons, I was keen to see whether my vet friends and I could do something valuable and meaningful to contribute to the fight against antibiotic resistance.”

Why Canberra?

The next step was a lunch at which the two Canberra vets and Dr Page began the planning or, as Dr Archinal puts it: “This time, we both had our arms twisted, and away we went.”

They realised that there hadn’t been any major trials like this one anywhere in the world and, says Dr Archinal, “because the Canberra veterinary community get on so well together and we’re kind of geographically isolated, we thought this was something we could run with and make a go of.”

The pilot trial, which kicked off in April, will last for one year. The veterinary practices involved have made a commitment to follow the program for the full 12 months and, during that time, to adopt a standard practice policy on antimicrobial stewardship. This essentially involves adhering strictly to the AIDAP (Australasian Infectious Diseases Advisory Panel) antibiotic prescribing guidelines.

Vets have completed a survey at the outset to gauge their attitudes and their antibiotic prescribing habits. They have made a commitment to complete an online training program, which has been designed to remind them of the basics of responsible antibiotic prescription. They will be surveyed again after six months, and at the completion of the pilot trial.

The practices that participate will also use specially designed communication tools to help explain their approach on antibiotics to clients.

The response

“The response has been overwhelming,” says Dr Archinal. “The standard of practice here is very high. Most vets I know are already aware of the importance of antimicrobial stewardship, but they think, what can I do? When we came up with the idea of a more formalised approach, it gave them something they could do and everybody was well on board. We had people driving hundreds of kilometres to the launch. It shows you the depth and strength of commitment in the veterinary profession.”

Evaluation will include assessing the level of awareness of antimicrobial stewardship in participating practices and noting whether there have been changes in antibiotic prescribing in the practices as a result of the pilot trial. “I think there is already an excellent awareness of these issues in the veterinary community in Australia,” says Dr Archinal. “So we’re working to improve that even further. But also, we want to use this data to show the wider community our responsible approach to antibiotic prescribing.”

He is concerned that, as public and scientific awareness of antibiotic resistance grows, vets “could eventually have restrictive prescribing guidelines imposed upon us.” Dr Archinal believes that studies like this one (and he hopes there will be more of them) could prevent that sort of action. That’s just one result.

“We would also like to come out of this with a nice little educational package that we could make available nationally,” he says. “People could use the package to become accredited as responsible antimicrobial prescribing practices. Ultimately, perhaps we could even make that module available internationally.”

What’s next?

Drs Archinal, Taylor and Page also would like to see the trial expand beyond the ACT and beyond small animal practices.

“At the moment only companion animals are involved in the trial,” says Dr Archinal, “but it would be nice if someone in the large animal sphere picked up on it as well. That would be fantastic. And you never know, it may even rub off on the human medical profession, which would be a great thing.” This is an issue in which everybody’s contribution counts. “You can act on a small, individual scale and have a big impact,” he concludes, and that’s what he hopes vets around Australia will do.

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