Knowledge Award Audio Overview: cefovecin audit by Gower Veterinary Surgery

Hi, I’m Jenny. I’m one of the vets in Gower Vets in Swansea. We have received an RCVS Knowledge Award for our reduction of cefovecin use in practice. We initially identified that cefovecin was being used quite frequently in our practice and in some cases not appropriately. We wanted to ensure it was being used only when truly indicated.

So our aim was to reduce its use in practice, to ensure it was only prescribed in appropriate cases, and to achieve correct dosing in 100% of our patients. We conducted a full audit cycle starting in late 2023. We identified all patients who had received cefovecin over specific time periods.

For each case, we reviewed whether use was justified by culture and sensitivity or by exceptional circumstances and whether dosing was correct. In November and December 2023, we found 24 cases of cefovecin use. Only 23 % of these cases were appropriately justified and dosing was correct in only 71 % of cases.

This clearly showed both overuse and inconsistency in how the drug was being prescribed by the team. We implemented a clear standard operating procedure (SOP) for cefovecin prescribing. This included only prescribing the drug when supported by culture and sensitivity or by clear exceptional circumstances, documenting the justification for use in the clinical notes and ensuring accurate dosing based on up-to-date patient weights.

To support this, we created a decision-making flowchart and shared guidance via meetings and on Teams. We also encouraged a wider cultural shift towards antimicrobial stewardship. We then reordered this at three months and again at 18 months. The results were very encouraging.

The number of cases where it was used reduced from 24 to just five, three months later, and then four, 18 months later. Appropriate use increased to 100% over the 18 month period, and correct dosing also reached 100%. Overall, this represented an 83% reduction in the drug’s use with sustained proven improvement over a long period of time.

This project has led to significant and lasting change in how our team approaches antibiotic prescribing. We saw a clear reduction in category B antibiotic use and improved clinical decision making with greater consistency across the team. These changes were importantly sustained over 18 months, demonstrating real behavioural and cultural change.

There were some challenges along the way. It had been widely used in the practice, so changing habits required a real cultural shift. Some clients also already knew of the injection or maybe received it before, so we needed confident communication to explain our decision making. This was overcome through whole team engagement, clear guidance and education.

In summary, this demonstrates how a structured approach using data, setting clear targets and supporting the team can lead to meaningful and sustained improvements in antimicrobial stewardship. This has been a very rewarding project and has fundamentally changed how we view and use antibiotics in our practice.