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Finding the underlying cause

Now we know when to use delayed prescribing and de-escalation, we need to look at times where antibiotics may not be needed at all. Dr Tim Nuttall discusses the role that dysbiosis of the microbiome can play in recurrent infections. He also talks about the importance of finding and treating the underlying cause.

Most infections actually involve a dysbiosis of the microbiome. Rather than relying on repeated courses of antimicrobials to manage this, we should be looking at what the underlying reason for the dysbiosis of the microbiome is, and what is driving the infection. This way, we can avoid repetitive antimicrobial use.

Please listen to the accompanying audio for each slide as you work your way through this step:

An image with several graphs that are explained in the accompanying audio. Click to enlarge

Slide 1 audio Transcript available here

An image of dogs and cats showing the 2 sets of results from an investigation conducted twice about the percentage of dogs and cats who received specific antibiotics. Slide 2 audio Transcript available here

A screenshot of a powerpoint slide showing what dysbiosis is. Slide 3 audio Transcript available here

2 graphs describing how canine pyoderma = staphlococcal dysbiosis that are further explained in the audio. Slide 4 audio Transcript available here

2 graphs showing how antibiotics restore microbiome diversity, not eliminate staphylococci, that are further explained in the audio. Slide 5 audio Transcript available here

Some examples of how recurrent infections can come from underlying reasons. Slide 6 audio Transcript available here

It is important to manage the underlying causes of recurrent infections, to maintain a healthy microbiome. We need to think about why the infection is there and not just react to its presentation.

How do you, in your practice, approach investigating and managing recurrent infections to avoid repeated use of antibiotics? Please discuss in the comments section.

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Antimicrobial Stewardship in Veterinary Practice


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