Determination of knowledge levels and attitudes of clinician veterinarians working in Thrace region towards antibiotic use

Main Article Content

Sezai Arslan
Mehmet Nihat Ural
Nurullah Özdemir

Abstract

Antimicrobial resistance (AMR) has become a global problem due to widespread antimicrobial use in human and veterinary medicine. AMR affects health systems by leading to prolonged and severe illnesses, high mortality rates, and treatment failures caused by resistant microorganisms. As antibiotics are the most widely used drugs in veterinary medicine, veterinarians' knowledge, attitudes and practices regarding antibiotic use are crucial in combating AMR. In this cross-sectional study, an online questionnaire of 20 questions was administered to clinician veterinarians and members of the Trakya Chamber of Veterinarians and 60 participants answered the questionnaire. In the current survey, 98 % of veterinarians agree that AMR is an important public health problem and emphasize that focusing on rational antibiotic use in veterinary medicine is a critical area to slow the development of AMR. Only 10 % of the respondents stated that they take into account antibiotic requests from patient owners, 68.3 % stated that they rarely use off-label drugs and 16.7 % stated that they often use them. Of those respondents, 16.7 % stated that they routinely perform antibiograms. Regarding education, 41.7 % of veterinarians had received training on rational antibiotic use. When asked about their preferred type of training, 56.7 % favored online training, while 35 % preferred face-to-face sessions. The results indicate that veterinarians play a significant role in combating AMR and that more awareness and education are needed in this field.

Keywords:
Antibiotic misuse Antimicrobial stewardship Antimicrobial resistance Rational antimicrobial use Prescription habits Public health impact Veterinarians

Article Details

Author Biographies

Sezai Arslan, Tekirdag Namik Kemal University, Faculty of Veterinary Medicine, Department of Internal Medicine, Tekirdag, Türkiye

Dr.

Mehmet Nihat Ural, Istanbul Directorate of Provincial Agriculture and Forestry, Kadıköy, Istanbul, Türkiye

Dr.

Nurullah Özdemir, Tekirdag Namik Kemal University, Faculty of Veterinary Medicine, Department of Pharmacology and Toxicology, Tekirdag, Türkiye

Associate Professor

References

Galarce N, Arriagada G, Sánchez F, Venegas V, Cornejo J, Lapierre L. Antimicrobial use in companion animals: assessing veterinarians’ prescription patterns through the first national survey in Chile. Animals. 2021;11(2):348. doi: 10.3390/ani11020348.

World Health Organization. Antimicrobial resistance. 2023. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, Nisar MA, Alvi RF, Aslam MA, Qamar MU, Salamat MKF, Baloch Z. Antibiotic resistance: a rundown of a global crisis. Infection and Drug Resistance. 2018;11:1645−1658. doi: 10.2147/IDR.S173867.

Ahmad I, Huang L, Hao H, Sanders P, Yuan Z. Application of PK/PD modeling in veterinary field: dose optimization and drug resistance prediction. BioMed Research International. 2016;2016(1):5465678. doi: 10.1155/2016/5465678.

Palma E, Tilocca B, Roncada P. Antimicrobial resistance in veterinary medicine: an overview. International Journal of Molecular Sciences. 2020;21(6):1914. doi: 10.3390/ijms21061914.

Overgaauw PAM, Vinke CM, van Hagen MAE, Lipman LJA. A one health perspective on the human-companion animal relationship with emphasis on zoonotic aspects. International Journal of Environmental Research and Public Health. 2020;17(11):3789. doi: 10.3390/ijerph17113789.

Messenger AM, Barnes AN, Gray GC. Reverse zoonotic disease transmission (zooanthroponosis): a systematic review of seldom-documented human biological threats to animals. PloS One. 2014;9(2):e89055. doi: 10.1371/journal.pone.0089055.

Klous G, Huss A, Heederik DJ, Coutinho RA. Human–livestock contacts and their relationship to transmission of zoonotic pathogens, a systematic review of literature. One Health. 2016; 2:65−76. doi: 10.1016/j.onehlt.2016.03.001.

Velazquez-Meza ME, Galarde-López M, Carrillo-Quiróz B, Alpuche-Aranda CM. Antimicrobial resistance: One Health approach. Veterinary World. 2022;15(3):743−749. doi: 10.14202/vetworld.2022.743-749.

McEwen SA, Collignon PJ. Antimicrobial resistance: a one health perspective. Microbiology spectrum. 2018;521−547. doi: 10.1128/microbiolspec.ARBA-0009-2017.

World Health Organization. Global action plan on antimicrobial resistance. 2015. https://iris.who.int/bitstream/handle/10665/193736/9789241509763_eng.pdf?sequence=1

Majumder MAA, Rahman S, Cohall D, Bharatha A, Singh K, Haque M, Gittens-St Hilaire M. Antimicrobial stewardship: fighting antimicrobial resistance and protecting global public health. Infection and Drug Resistance. 2020;29(13):4713−4738. doi: 10.2147/IDR.S290835.

Akkaya B, Piyal B. During the pandemic period again “One Health” concept. Sağlık ve Toplum. 2022;32(3):23−33.

Fındık A. Antibiotic resistance in a single health approach. Doğanın Sesi. 2022;5(10):53−64.

Lloyd DH, Page SW. Antimicrobial stewardship in veterinary medicine. Microbiology Spectrum. 2018;6(3):675−697. doi: 10.1128/microbiolspec.ARBA-0023-2017.

Konar Ö, Karahan İ. Knowledge levels and behaviours of veterinarians in rational antibiotic use [master's thesis]. Balıkesir, Turquía: Balıkesir University Institute of Health Sciences; 2022.

Norris JM, Zhuo A, Govendir M, Rowbotham SJ, Labbate M, Degeling C, Gilbert GL, Dominey-Howes D, Ward MP. Factors influencing the behaviour and perceptions of Australian veterinarians towards antibiotic use and antimicrobial resistance. PloS One. 2019;14(10):e0224844. doi: 10.1371/journal.pone.0224844.

Kalam MA, Rahman MS, Alim MA, Shano S, Afrose S, Jalal FA, Akter S, Khan SA, Islam MM, Uddin MB, et al. Knowledge, attitudes, and common practices of livestock and poultry veterinary practitioners regarding the AMU and AMR in Bangladesh. Antibiotics. 2022;11(1):80. doi: 10.3390/antibiotics11010080.

Khan X, Lim RH, Rymer C, Ray P. Fijian veterinarian and para-veterinarians' behavior, attitude and knowledge toward antimicrobial use and antimicrobial resistance: a qualitative study. Frontiers in Veterinary Science. 2022;9:898737. doi: 10.3389/fvets.2022.898737.

Chipangura JK, Eagar H, Kgoete M, Abernethy D, Naidoo V. An investigation of antimicrobial usage patterns by small animal veterinarians in South Africa. Preventive Veterinary Medicine. 2017;136:29−38. doi: 10.1016/j.prevetmed.2016.11.017.

Kumar V, Gupta J, Meena HR. Assessment of awareness about antibiotic resistance and practices followed by veterinarians for judicious prescription of antibiotics: an exploratory study in eastern Haryana region of India. Tropical Animal Health and Production. 2019;51:677−687. doi: 10.1007/s11250-018-1742-0.

Mutua F, Sharma G, Grace D, Bandyopadhyay S, Shome B, Lindahl J. A review of animal health and drug use practices in India, and their possible link to antimicrobial resistance. Antimicrobial Resistance & Infection Control. 2020;9:103. doi: 10.1186/s13756-020-00760-3.

Hopman NE, Mughini-Gras L, Speksnijder DC, Wagenaar JA, van Geijlswijk IM, Broens EM. Attitudes and perceptions of Dutch companion animal veterinarians towards antimicrobial use and antimicrobial resistance. Preventive Veterinary Medicine. 2019;170:104717. doi: 10.1016/j.prevetmed.2019.104717.

Mateus AL, Brodbelt DC, Barber N, Stärk KD. Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK. Preventive Veterinary Medicine. 2014;117(1):68−78. doi: 10.1016/j.prevetmed.2014.05.007.

Odoi A, Samuels R, Carter C, Smith J. Antibiotic prescription practices and opinions regarding antimicrobial resistance among veterinarians in Kentucky, USA. PloS One. 2021;16(4):e0249653. doi: 10.1371/journal.pone.0249653.

Adekanye UO, Ekiri AB, Galipó E, Muhammad AB, Mateus A, la Ragione RM, Wakawa A, Armson B, Mijten E, Alafiatayo R, et al. Knowledge, attitudes and practices of veterinarians towards antimicrobial resistance and stewardship in Nigeria. Antibiotics. 2020;9(8):453. doi: 10.3390/antibiotics9080453.

Aworh MK, Kwaga JKP, Okolocha EC. Assessing knowledge, attitude, and practices of veterinarians towards antimicrobial use and stewardship as drivers of inappropriate use in Abuja, Nigeria. One Health Outlook. 2021;3(1):25. doi: 10.1186/s42522-021-00058-3.

Kovačević Z, Vidović J, Erdeljan M, Cincović M, Ružić Z, Galić I, Kukurić T, Stojanac N, Horvat O. Veterinary practitioners’ standpoints and comprehension towards antimicrobial use—are there opportunities for antimicrobial stewardship improvement? Antibiotics. 2022;11(7):867. doi: 10.3390/antibiotics11070867.

Rahman S, Hollis A. The effect of antibiotic usage on resistance in humans and food-producing animals: a longitudinal, One Health analysis using European data. Frontiers in Public Health. 2023;11:1170426. doi: 10.3389/fpubh.2023.1170426.

Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. The Lancet Infectious Diseases. 2019;19(1):56−66. doi: 10.1016/S1473-3099(18)30605-4.

World Organisation for Animal Health. Annual report on antimicrobial agents intended for use in animals. 7th report. 2023. https://www.woah.org/app/uploads/2023/05/a-seventh-annual-report-amu-final.pdf

World Health Organization. Critically important antimicrobials for human Medicine [PDF]. 2019. https://iris.who.int/bitstream/handle/10665/312266/9789241515528-eng.pdf?sequence=1

Organisation for Economic Co-operation and Development. Antimicrobial resistance in the EU/EEA. A one health response. Organisation for Economic Co-operation and Development [PDF]. 2022. https://www.oecd.org/health/Antimicrobial-Resistance-in-the-EU-EEA-A-One-Health-Response-March-2022.pdf

World Organisation for Animal Health. OIE List of Antimicrobial Agents of Veterinary Importance [PDF. 2021. https://www.woah.org/app/uploads/2021/06/a-oie-list-antimicrobials-june2021.pdf

Coyne LA, Latham SM, Williams NJ, Dawson S, Donald IJ, Pearson RB, Smith RF, Pinchbeck GL. Understanding the culture of antimicrobial prescribing in agriculture: a qualitative study of UK pig veterinary surgeons. The Journal of Antimicrobial Chemotherapy. 2016;71(11):3300−3312. doi: 10.1093/jac/dkw300.

Dikkatwar MS, Vaghasiya J. Antibiogram and antimicrobial stewardship program: fighting global antimicrobial resistance and rationalizing the antibiotic treatment. Journal of Young Pharmacists. 2023;15(1):41−48. doi: 10.5530/097515050436.

Smith M, King C, Davis M, Dickson A, Park J, Smith F, Currie K, Flowers P. Pet owner and vet interactions: exploring the drivers of AMR. Antimicrobial Resistance & Infection Control. 2018;7:46. doi: 10.1186/s13756-018-0341-1.

Servia-Dopazo M, Taracido-Trunk M, Figueiras A. Non-clinical factors determining the prescription of antibiotics by veterinarians: a systematic review. Antibiotics. 2021;10(2):133. doi: 10.3390/antibiotics10020133.

Cattaneo AA, Wilson R, Doohan D, LeJeune JT. Bovine veterinarians’ knowledge, beliefs, and practices regarding antibiotic resistance on Ohio dairy farms. Journal of Dairy Science. 2009;92(7):3494−3502. doi: 10.3168/jds.2008-1575.

Al Amin M, Hoque MN, Siddiki AZ, Saha S, Kamal MM. Antimicrobial resistance situation in animal health of Bangladesh. Veterinary World. 2020;13(12):2713−2727. doi: 10.14202/vetworld.2020.2713-2727.

McDougall S, Compton C, Botha N. Factors influencing antimicrobial prescribing by veterinarians and usage by dairy farmers in New Zealand. New Zealand Veterinary Journal. 2016;65(2):84−92. doi: 10.1080/00480169.2016.1246214.

Baptiste KE, Pokludová L. Mass medications: prophylaxis and metaphylaxis, cascade and off-label use, treatment guidelines and antimicrobial stewardship. In: Pokludová L, editor. Antimicrobials in Livestock 1: Regulation, Science, Practice: A European Perspective. Switzerland: Springer Nature; 2020. pp. 167−193.

Ekiri A, Häesler B, Mays N, Staerk K, Mateus A. Impact of guidelines and recommendations on the level and patterns of antimicrobial use in livestock and companion animals. Systematic review. London, UK: Piru Publications; 2019.

Miethke M, Pieroni M, Weber T, Brönstrup M, Hammann P, Halby L, et al. Towards the sustainable discovery and development of new antibiotics. Nature Reviews Chemistry. 2021;5(10):726−749. doi: 10.1038/s41570-021-00313-1.

Bergkessel M, Forte B, Gilbert IH. Small-molecule antibiotic drug development: need and challenges. ACS Infectious Diseases. 2023;9(11):2062−2071. doi: 10.1021/acsinfecdis.3c00189.

Plackett B. Why big pharma has abandoned antibiotics? Nature. 2020;586(7830):S50−S52. doi: 10.1038/d41586-020-02884-3.

World Health Organization. Global Antimicrobial Resistance and Use Surveillance System (GLASS) report 2022 [PDF]. 2022. https://iris.who.int/bitstream/handle/10665/364996/9789240062702-eng.pdf?sequence=1

Iskandar K, Murugaiyan J, Hammoudi Halat D, Hage SE, Chibabhai V, Adukkadukkam S, Roques C, et al. Antibiotic discovery and resistance: the chase and the race. Antibiotics. 2022;11:182. doi: 10.3390/antibiotics11020182.