Reduction of antibiotic use in equine non-theatre castrations

I’m a 2020 grad from Liverpool University. I work at Northwest Equine Vets and have done for nearly five years now. Northwest Equine Vets is a three clinic first opinion practice based in the Northwest of England with a mix of 16 full-time and part-time vets. For our initiative we looked at post-operative antimicrobial prescribing behaviours of non-theatre castrations within our practice. This came about for three main reasons.

During veterinary team discussions, we noticed a difference in prescribing behaviours with several vets not using post-operative antibiotics as routine. To aid clients’ expectations on antimicrobial use post-operatively and through antimicrobial stewardship, if we could change the prescribing behaviours, we would likely reduce our practices’ overall antimicrobial usage. We performed audits of the castrations.

performed between September 21 and September 24 in three annual audit cycles, including all vets employed at the practice at the time of the audit and any standing sedated and general anaesthesia performed on yard or within clinic and excluding any more invasive procedures done in theatre. The data was collated into Excel and analysed and then displayed as a graphs. The first audit cycle was to obtain a baseline of the prescribing rates.

for any changes were made. Following this, it was decided to produce a guideline for prescribing postoperative antimicrobials. We reviewed the literature to see what supporting evidence was available and concluded a single first line antibiotic perioperatively and no follow-up course seemed to be the current accepted guidance. The second audit’s target was to observe a reduction in

prescribing rates compared to the first audit and to obtain a baseline for including rationale for reasoning in clinical notes. We achieved a baseline retrospectively from the first audit. To help prepare clients for castrations and manage their expectations, we developed an advice sheet which includes our reasoning not to give a course of prophylaxis and antibiotics, which is sent to clients prior to every castration.

To aid the implementation of the changes, training was given to all staff to ensure everyone was comfortable with the clinical reason behind these changes. And additional training was given to our office staff and advising clients when booking in castrations to ensure clients understanding of the information provided and that best environmental practices are achieved, such as access to clean water. The third order was to assess an improvement in documentation of rationale.

I was presently surprised by the vast improvement in quality of clinical notes between audits, as well as how accepting clients have been in the reduction in the use of prophylactic antibiotics. The audits saw a reduction in prescribing prophylactic antimicrobials post-castration in addition to an increase in the proportion of documented reasoning. Producing antimicrobials given routinely post-castration from 44.6 % to 11.7%. The proportion of documented reasoning also improved from 11.1 % of castrations between September 21 to 22 to 63.6 % of castrations between September 23 to 24. While any practice can use these audits as an example of improving prescribing antimicrobials following castrations, the main message is if good foundations are laid and confidence is given to all members, whether clinical, non-clinical or clients, a consistent behaviour change can be achieved.