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Responsible AM use in the management of respiratory disease

A case study by Helen Braid that describes how stewardship was implemented in a case where a horse presented with a respiratory illness.
Hi everyone, and welcome to this short lecture. We’re going to discuss a case example of antimicrobial stewardship in equine practice, and this is case example number two. In this example, we have a racing thoroughbred with a history of intermittent cough, both at rest and during exercise. The cough seems to have worsened over the last three weeks and a small volume of mucopurulent nasal discharge is intermittently visible from both nostrils. The trainer reports, it seems worse when it’s in the stable and is not running as well on the gallops. The horse is drinking, eating, defecating, and urinating normally, and seems bright, alert, and responsive on clinical examination.
Vaccinations for influenza and tetanus are up to date, and no other horses on the yard are coughing or have nasal discharge. The clinical examination is fairly unremarkable. The heart rate is 36, the respiratory rate is 12, rectal temperature is 37.4. There are no abnormalities on lung auscultation, and there is a very small volume of mucopurulent nasal discharge present in the external nares. The horse is bright, alert, and responsive, is eating hay during your examination, and only coughed once in 10 minutes. When exercised, the horse coughed infrequently, and no abnormal respiratory noise was noted.
This is quite a common scenario in first opinion practice. And Weese and Sabino, in 2005, actually found that with symptoms such as this, 69 percent of equine vets in their study had prescribed antibiotics for an average of just shy of 10 days. 10 percent of these were protected antimicrobials, so third generation cephalosporins. So, how is stewardship implemented in this particular case? Well, based on the study that we discussed previously, it would determine that vet knowledge might be the most crucial factor in cases such as this. And a practice meeting was held, and a practice protocol for the treatment of respiratory disease in horses was developed based on some evidence in the veterinary literature.
CPD was also arranged for those staff who wished to attend, and the practice utilised the BEVA Protect Me web pages and found this very handy log sheet for antimicrobial sales. They didn’t just use it for protected antimicrobials, they actually used it for all antimicrobial sales in relation to respiratory disease, and that then allowed them, three to six months later, to have a practice meeting, assess this log book, and perform an internal clinical audit and determine whether antimicrobial sales were actually reducing, or which cases they were necessary in, and allowed them to adapt their protocols accordingly. They also produced some client education leaflets and uploaded those to their practice website.
And these leaflets included details of common respiratory conditions, such as recurrent airway obstruction or severe equine asthma, and inflammatory airway disease alongside infectious conditions, such as strangles.
As always, if you have any questions, please feel free to contact us.

In this video, Helen Braid walks you through a case study on antimicrobial stewardship in equine practice.

The patient is a racing thoroughbred horse with a history of an intermittent cough that has worsened over the last 3 weeks and a small volume of mucopurulent nasal discharge is seen intermittently. Their clinical examination was unremarkable.

This is a common scenario that is often approached by antimicrobials. However Helen describes how antimicrobial stewardship was implemented in this case.

How would you have treated this horse at your practice, before starting this course? Has this changed now? Please discuss in the comments section.

Please find a downloadable copy of the PowerPoint slides used in the video in the downloads section below.

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Antimicrobial Stewardship in Veterinary Practice

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