Antimicrobial Stewardship
Undoubtedly, the invention of antibiotics has saved millions of lives. However, the overuse and indiscriminate prescriptions for minor issues are believed to be creating an epidemic of problems from superbugs to intestinal dysbiosis (1,2). Scientists are now educating and implementing large-scale antimicrobial projects to address this growing issue (3,4).
While the overuse of antibiotics in human medicine is harmful, it is even worse in veterinary practice, a 2015 review of veterinary practice states,
“One of the most effective strategies to manage AMR (antimicrobial resistance) in human hospitals is to reduce the overall consumption of antimicrobial agents and rationalize the use of the most valuable drugs (e.g., carbapenems, fourth-generation cephalosporins, glycopeptides), which are generally reserved for empirical treatment of life-threatening infections or infections that cannot be treated otherwise on the basis of susceptibility data. This strategy is almost completely flipped in small animal practice, where the listed drugs are not authorized and the most powerful veterinary antimicrobials, namely b-lactamase– resistant penicillins, cephalosporins, and fluoroquinolones, are widely used as empiric first-line agents in primary care, including treatment of mild or self-limiting infections (5).”
The current growing epidemic of multi-drug resistant bacteria in cats and dogs include:
1. Staphylococcus pseudintermedius
2. Pseudomonas aeruginosa
3. Staphylococcus aureus
4. Klebsiella pneumoniae
5. Acinetobacter baumannii
6. carbapenemase-producing E coli
'The term “antimicrobial stewardship” is used to describe the multifaceted and dynamic approaches required to sustain the clinical efficacy of antimicrobials by optimizing drug use, choice, dosing, duration, and route of administration while minimizing the emergence of resistance and other adverse effects. The word stewardship implies the obligation to preserve something of enormous value for future generations and resonates in a way that “prudent use” or “judicious use” does not (5)."
Slide: Antibiotics more susceptible to pathogens
In 1954 Marjorie Hohnhoff & C. Phillip Miller took two sets of mice and exposed them to salmonella enteriditis. The control group had a normal microbiome, and the experimental group was given a dose of streptamyacin three days before injection of Salmonella enteriditis. The antibiotic-treated mice became infected with only three organisms of salmonella. It took 100,000 organisms of salmonella enteriditis to infect the healthy mice. Indicating a diverse microbiome is protective against pathogens (1). A 2018 study on dogs found that there are also more susceptible to e.coli after antibiotics (2).
Slide: Side effects of antibiotics
Since then, there have been hundreds of studies showing antibiotics disrupt the microbiome and create a myriad of issues. The canine microbiome is considered to be similar to humans and mice in that some data may be extrapolated for comparison (1). Some of these side effects include:
1. Nutrients depletion: Antibiotics destroy the bacteria that assimilates many nutrients in the body such as, vitamins B1, B2, B6, B8, B12, C, E, K, magnesium, and zinc. (2,3)
2. Decreased Diversity: (4, 5, 6, 7)
3. Intestinal permeability: (
4. Inhibits heavy metal detoxification (9)
5. Create Superbugs (10, 11, 12)
6. Mitochondrial damage: (13,14)
7. Increase risk of foodborne pathogens (15)
8. Increased Allergies (16, 17, 18)
9. Fungus overgrowth (20)
and other associations such as increased anxiety (21), IBS (22), obesity (23, 24), disrupted circadian rhythm (25, 26), tendon rupture (27), and much more.
Slide: CDC Center for Disease Control:
The CDC states that the overuse of antibiotics in humans is one in three with some groups claiming it is as high a 70% (1).
Slide American Veterinary Medical Association AVMA:
The AVMA states that over-prescription of antibiotics in companion animals is estimated to be one in two. Other groups are claiming this number is much higher (1).
Slide: AVMA House of Delegates:
A unanimous vote by the American Veterinary Medical Association (AVMA) House of Delegates in January to enact a policy on antimicrobial stewardship has been touted as a “call to action” for the profession to advocate for preserving antimicrobial effectiveness (1).
Slide: Be a Proactive Pet Parent
With hundreds of rescue dogs taken to dozens of different vets in the DC area, our Rescue has seen firsthand the over-prescription of antibiotics. We take a strong stand against ‘just-in-case” prescriptions and broad-spectrum antibiotics without even basic testing. One such example included a big box veterinarian pushing antibiotics because we mentioned a foster dog had accidents in the house at the foster home in the evening. This patient was a six-month-old puppy. The vet claimed it could be giardia and it was better for the organization to give the antibiotics. Since we deal with hundreds of dogs needing to be potty trained – especially new puppies, we refused and noted there were no other symptoms and the dog had solid waste during walks. The arguments got intense until we finally demanded a giardia test as the vet implied the organization was irresponsible. Not only did the test come back negative but when we moved the foster dog to another foster home, we found out the dog having accidents weren’t even our foster but the resident dog committing ‘protest poop’ against having a visitor. Knowing the lifelong damage antibiotics can have on the gut microbiome when administered to young animals we were glad we stood our ground when literally being bullied into irresponsible prescriptions. Other incidents have even included holistic vets wanting to prescribe antibiotics to canine atopic dermatitis dogs as a ‘just in case’ for bacterial infections. We have treated all our CAD cases without antibiotics because it exasperates the underlying issue of intestinal dysbiosis and instead uses botanical antimicrobials and antifungals with huge success. The first line of defense should not be the blanket prescription of antibiotics. Even when an issue is identified, using targeted topical antibiotics would be a less invasive approach to managing problems. There is a significant lag in antimicrobial education in the veterinary industry. This does not mean one should never use antibiotics. They are life-saving when used appropriately. However, our experience with hundreds of dogs is that antibiotics appear to be the first line of defense for most of the vet appointments we have had. That said, many excellent veterinarians understand the importance of antimicrobial stewardship. We believe this issue is a significant contributor to various chronic illnesses along with other factors under the Hygiene Hypothesis.