Responsible AM use in the treatment of mudfever

Hi and welcome to this lecture. We’re going to talk about the challenges to achieving good antimicrobial stewardship in equine practice and we’re going to use some case examples. So this is the first lecture with case example one. This is an example case. A client calls and requests antibiotics because her horse has had mud fever or pastern dermatitis for three months with no resolution. The client becomes irate when a visit and an examination is advised, because she claims that a vet from a different practice gave antibiotics to another horse on her yard for mud fever and she doesn’t understand why she can’t just come and collect some antibiotics.

This is actually the fourth client this month who’s called with a similar issue. And the horse in question is a 15-year-old cob cross gelding. And on examination, he had multiple areas of crusting and scaling over the caudal, lateral, and medial aspect of both hind pasterns. The areas were non-painful on palpation, the horse wasn’t lame, and there’s no surrounding oedema of the limbs. There is some infolding of the skin as is visible on the photograph through the rather erratically clipped area.

Just thinking about what the potential stewardship challenges are for this particular case, the client is obviously frustrated. She feels the situation is unfair, which may lead her to become irate and potentially difficult to communicate with. And this can present its own problems, as I’m sure you’re all aware having had similar conversations with your clients in the past, I’m sure. She believes that another practitioner has followed a different protocol. She claims that another vet has given antimicrobials to another horse on her yard for mud fever. Don’t forget that we don’t actually know if that’s true, the vet may have given antimicrobials for a different condition.

The vet may not have actually given antimicrobials at all, this might just be the client telling you this in order to try and get some antimicrobials out of you. Four clients this month have presented with similar issues, this is becoming a recurring theme in your practice and you feel like you’re having this conversation over and over again. We also have to remember there may be a challenge in that this particular horse has had mud fever for three months according to the client, and she now feels like this is a long term condition that warrants more intensive therapy.

So that might present a bit of a challenge for you in that she may be reluctant for you to implement alternative treatment options.

So how is this case used to assist with antimicrobial stewardship? A practice meeting was held and the vets in the meeting reviewed the literature around pastern dermatitis and mud fever in advance, and they were then able to develop a practice protocol for the treatment of mud fever. A client information leaflet was produced and it was added to the practice web page, and a Facebook post also went out advising clients on mud fever and the current recommended treatments with a link to the new web page about antimicrobial resistance and antimicrobial stewardship. The practise utilised the BEVA Protect Me guidelines which are available on the link below.

While we’re talking about practice protocols, I’m aware that some vets were a little reluctant to create practice protocols. And all I’d say is that don’t forget these protocols are being created by you and by your colleagues in your practice and, therefore, it’s up to you in the practice to decide whether they should be rigidly followed or whether they are able to be interpreted as more of guidelines. Because we do understand that not all clinical cases fit exact protocol criteria. But, again, that is something that you should be talking about amongst your colleagues in your practice, raise your concerns, and adopt the protocols accordingly.

I think that the implementation of protocols with things like this is a really good start for antimicrobial stewardship, because it prevents any situations arising where the client might say, oh, well such and such a vet gave antibiotics lasts time, why can’t I have them this time. It protects you from situations like.

Antimicrobial stewardship in equine practice can be quite easily implemented even though it sounds complicated to begin with. There are some quite simple changes that we can all make to try and improve antimicrobial stewardship. Practice meetings were a very good place to start, because it’s no good just being a single practitioner trying to do the best you can if everyone else in the practice is doing different things. Journal clubs are fantastic and that integrates well with EBVM, evidence based veterinary medicine. Look up the dosages, look up the types of antimicrobials that are being used in the current literature and make sure that your practice protocols are up to date with what the current recommendations are.

Clinical audit isn’t always as easy as it sounds, particularly in first opinion. But you can always look back at your antimicrobial prescriptions over the last say six months, have a think about whether there were any that you felt were perhaps not necessary, or that you felt like you’d been pressured by the client into prescribing something that you didn’t feel the horse needed. And have a think and chat amongst your colleagues about whether there’s anything you can do to try and improve that. The BEVA Protect Me guidelines were really, really good place to start. And I’d strongly advise that you all have a look at those and consider implementing them in your practice.

As always, if you have any questions, please feel free to contact us.