This article by Joanna Hedley discusses the challenges to achieving good antimicrobial stewardship in exotic pet practice.
Don’t we have to use what is licensed?
People often ask what the default antibiotic is, and the antibiotic pictured below is the common choice. Very few drugs are licensed in exotic pets and small animal species. According to the cascade, if there is no medicine authorised for a specific condition in that species, we are allowed to use a veterinary medicine authorised for use in another animal species or those authorised for human use. However, that has meant that certain antibiotics such as enrofloxacin have been used very commonly first line.
Responsible antibiotic use under the cascade (VMD 2014)
The VMD considers that it is justified to prescribe an antibiotic on the cascade, on a case-by-case basis, in the interests of minimising the development of resistance, particularly where culture and sensitivity indicate that a particular antibiotic active ingredient is effective against a bacterial pathogen and where knowledge of pharmacokinetics indicates that the selected product is likely to be safe and effective for the species and condition being treated (i.e. a narrow spectrum antibiotic over a broad spectrum antibiotic, in place of one that has a specific indication for that condition).
Antibiotic usage in reptiles
An initial round-table discussion at BVZS Conference Autumn 2015 found the most common antibiotics used were enrofloxacin and ceftazidime, for the following reasons:
- Enrofloxacin is one of only two licensed antibiotics in reptiles in UK.
- Lack of knowledge of alternatives.
- Easily obtainable in small animal practice.
- Easy to give at practical dosing intervals. Ceftazidine has a dosing interval of three days, which is a good time interval when handling reptiles.
- Clinically appear effective.
- Side-effects appear uncommon.
- Some pharmacokinetic evidence that appropriate concentrations in the blood can be achieved in selected species.
This is concerning, as ceftazidime is a third generation cephalosporin, which is a reserved antibiotic. It should only be used based on culture and sensitivity if other antibiotics are not considered the most effective.
Listen to this summary audio (transcript available here) and then discuss your thoughts in the comments section. How does this information relate to your own practice? Have you found the same challenges?