Skip to main content
Download PDF

Antimicrobial use for selected diseases in cats in Switzerland

BMC Veterinary Research volume 15, Article number: 94 (2019) Cite this article

Abstract

Background

Antibiotic use in human and veterinary medicine is considered a main driver of antimicrobial resistance. Although guidelines to promote appropriate use of antimicrobials in veterinary patients have been developed, antibiotic overprescription is assumed to be a common problem. The goal of this study was to investigate antimicrobial use in cats in Switzerland with acute upper respiratory tract disease (aURTD), feline lower urinary tract disease (FLUTD) and abscesses, and to assess compliance of prescription with consensus guidelines. A total of 776 cases (aURTD, n = 227; FLUTD, n = 333; abscesses, n = 216) presented to two university hospitals and 14 private veterinary practices in Switzerland during 2016 were retrospectively evaluated. Clinical history, diagnostic work-up and antimicrobial prescription (class, dosage, duration) were assessed.

Results

A total of 77% (aURTD), 60% (FLUTD) and 96% (abscesses) of the cases received antibiotic therapy; 13–24% received combination or serial therapy. The cats were treated for a median of 7 (abscesses) and 10 days (aURTD, FLUTD). Treatments with potentiated aminopenicillins (40–64%), third generation cephalosporins (25–28%), aminopenicillins (12–24%) and fluoroquinolones (3–13%) were most common. Prescriptions were judged in complete accordance with consensus guidelines in 22% (aURTD), 24% (FLUTD) and 17% (abscesses) of the cases. Antibiotics were prescribed although not indicated in 34% (aURTD), 14% (FLUTD) and 29% (abscesses) of the cases. The presence of lethargy, anorexia or fever in cats with aURTD, and the detection of bacteriuria in cats with FLUTD were significantly associated with antibiotic therapy. Although diagnostic work-up was significantly more common (aURTD: university hospitals, 58%; private practices, 1%; FLUTD: university hospitals, 92%; private practices, 27%) and the use of critically important antibiotics significantly less common at the university hospitals (aURTD, 10%; FLUTD, 14%) compared to private practices (aURTD, 38%; FLUTD, 54%), the frequency of antibiotic treatment was not different between the university hospitals and private practices.

Conclusions

Our results indicate that overprescription of antibiotics in cats in Switzerland is common and accordance with guidelines is poor. The study highlights the need to promote antimicrobial stewardship in small animal medicine.

Background

Mitigation of antimicrobial resistance has been an emerging topic that plays an important role in human and veterinary medicine. Antimicrobial resistance in bacteria is a naturally occurring phenomenon and has been subject to evolution over millions of years [1,2,3,4,5]. The frequent use of antimicrobials in human and veterinary medicine and in agriculture exerts an enormous selection pressure on bacterial populations and promotes the development of multidrug-resistant bacteria that can readily spread their resistance genes by various mechanisms [1,2,3]. Antibiotic use in veterinary medicine is discussed as one of the main drivers for resistance development. In Europe, around 8000 tons of antibiotics were sold for veterinary use in 2015, with pronounced differences between countries [6]. The amount of antibiotics used in companion animals in Europe in comparison to the amount prescribed in livestock is relatively small [6], but is not to be neglected. The close contact of pets with their owners facilitates the transmission of multidrug-resistant organisms between humans and companion animals [1, 7,8,9,10,11,12,13,14]. Furthermore, the trend for intensive medical care of dogs and cats poses a risk for nosocomial infections [15,16,17,18] and is associated with an increasing number of geriatric and immunosuppressed patients that are highly susceptible to infections with multidrug-resistant bacteria.

Based on recent data, Centres for Disease Control and Prevention estimates that approximately 30 ̶50% of antibiotic prescriptions in humans are unnecessary [19, 20]. Surveys describing antimicrobial use in dogs and cats revealed that antibiotics are frequently prescribed, in particular beta-lactam antibiotics [21,22,23,24,25,26,27,28,29,30], and that cats are especially exposed to the critically important third generation cephalosporins [21,22,23,24,25, 30,31,32,33]. Most previous studies performed in dogs and cats were based on questionnaires presenting hypothetical scenarios that have been sent out to veterinarians [22, 23, 28, 33,34,35,36,37]. These studies are commonly hampered by a selection bias, recall bias and prevarication bias, and the answers given do not necessarily reflect the actual prescribing practice. Some studies analyzed pharmacy records [38, 39] and veterinary or pet insurance databases [21, 22, 24,25,26,27, 29, 30, 32] but only few studies evaluated whether prescriptions practice was in accordance with relevant guidelines [24, 26, 27, 33, 34].

The aims of this study were to investigate the antimicrobial prescribing practice in Switzerland for indications in cats with frequent use of antibiotics, i.e., in cases of acute upper respiratory tract disease (aURTD), feline lower urinary tract disease (FLUTD) as well as abscesses, and to evaluate to what extend the prescriptions comply with recently established consensus guidelines [40, 41]. The a priori compliance with the proposed guidelines was evaluated in this study to lay the basis to monitor, in a next step, the impact of these guidelines on antimicrobial prescription patterns in Switzerland.

Results

Case characteristics

A total of 776 cats were included in the study. Case characteristics are shown in Table 1. A detailed overview of clinical symptoms, diagnostic procedures and antimicrobial prescription for each indication is given in Tables 2, 3 and 4. Cats with aURTD were significantly younger (median age: 3 years) than cats with FLUTD (median age: 8 years, p < 0.001) or cats with abscesses (median age: 7 years; p < 0.001) and more likely to be intact (aURTD and FLUTD: p < 0.001, aURTD and abscesses: p < 0.001). Furthermore, the cats presented to the university hospitals were more often pretreated with antibiotics (aURTD, 30%; FLUTD, 18%) and hospitalized (aURTD, 72%; FLUTD, 69%) when compared with the cases in private practices (pretreatment: aURTD, 4%; FLUTD, 2%; hospitalization: aURTD, 3%; FLUTD, 15%). The frequency of antibiotic prescription differed between the indications (percentage of cases treated: aURTD, 77%; FLUTD, 60%; abscesses, 96%; p < 0.001), but was not significantly associated with breed, age or sex of the cats.

Table 1 Characteristics of cats with aURTDa, FLUTDb, and abscesses presented to university hospitals or private practices
Full size table
Table 2 Diagnostic work-up and antibiotic prescription in aURTDa cases presented to university hospitals or private practices
Full size table
Table 3 Diagnostic work-up and antibiotic prescription in FLUTDa cases presented to university hospitals or private practices
Full size table
Table 4 Clinical signs, wound treatment and antibiotic prescription in cases with abscesses presented to private practices
Full size table

Antibiotic prescription for aURTD

Of 227 cats with aURTD, 175 (77%) received antibiotic therapy with the following substance classes: potentiated aminopenicillins (40%), third generation cephalosporins (28%), aminopenicillins (24%), tetracyclines (16%), fluoroquinolones (4%), amphenicols (2%), macrolides (2%), first generation cephalosporins and penicillins (1% each); 15% of the cases received combination or serial therapy. The antimicrobial combinations used were potentiated or non-potentiated aminopenicillins together with fluoroquinolones, first generation cephalosporins, tetracyclines, amphenicols or third generation cephalosporins. One cat received a triple therapy consisting of an aminopenicillin, a fluoroquinolone and a tetracycline. The cats were treated for 4 to 37 days (median of 10 days). Antibiotic therapy was significantly associated with the indications listed in the guidelines (presence of lethargy, anorexia or fever, p = 0.002). The treatment decision was judged as being compliant with the guidelines (justification score-1, JS-1) in 49 cases (22%) and not in accordance with the guidelines in 135 cases (59%; JS-2: n = 4, 2%; JS-3: n = 48, 21%; JS-4, n = 83, 36%). In the 83 cases where a complete discrepancy with the guidelines was found (JS-4), antibiotic prescription although not indicated (overprescription) occurred in 78 cases (94%) whereas 5 cases (6%) did not receive antibiotics despite indicated in the guidelines. The lack of information on the presence or absence of disease symptoms as listed in the guidelines precluded judgment in 43 cases (19%). Judgement of antimicrobial prescription was significantly more often not possible in private practices compared to the university hospitals (p = 0.001).

The diagnostic work-up and antimicrobial prescription patterns differed between private practices and university hospitals (Table 2). The aURTD cases were significantly more frequently tested by PCR for the presence of respiratory pathogens at the university hospitals (58%) compared to private practices (1%). The choice of antibiotic was significantly more often in disagreement with the guidelines (JS-3) at the university hospitals (61%) than at the private practices (12%). This was mainly due to the more common use of potentiated aminopenicillins (university hospitals, 90%; private practices, 29%) and the less common use of aminopenicillins (university hospitals, 3%; private practices, 28%) at the university hospitals compared to private practices. On the other hand, the use of critically important antibiotics was significantly more common in private practices (38%; university hospitals, 10%). The decision to use antibiotics for treatment was significantly more often in disagreement with the guidelines (JS-4) in the private practices (43%) when compared to the university hospitals (7%).

Antibiotic prescription for FLUTD

Of 333 cats with FLUTD, 200 cases (60%; 56 with bacterial cystitis, 144 with other/unknown diagnosis) received antibiotic therapy with the following substance classes: potentiated aminopenicillins (61%), third generation cephalosporins (26%), fluoroquinolones (13%), aminopenicillins (12%), first generation cephalosporins (3%), amphenicols (1%) and tetracyclines (1%); 13% received combination or serial therapy. For combination therapy, potentiated or non-potentiated aminopenicillins together with fluoroquinolones or third generation cephalosporins were used. The cats were treated for 1 to 56 days (median of 10 days). The presence of bacteriuria was significantly associated with antibiotic therapy (p < 0.001). The treatment decision was judged as being compliant with the guidelines (JS-1) in 81 (24%) and not in accordance with the guidelines in 82 (25%) cases (JS-2: n = 1, 1%; JS-3: n = 31, 9%; JS-4: n = 50, 15%). In the 50 cases with complete discrepancy to the guidelines (JS-4), antibiotics were prescribed although not indicated (overprescription) in 47 cases (94%) and cats were not treated with antibiotics despite indicated in the guidelines in 3 cases (6%). Inadequate diagnostic work-up (154 out of 170 cases, 91%) was the main reason to preclude judgment in 170 cases (51%).

Diagnostic work-up and antimicrobial prescription patterns were again different between the university hospitals and private practices (Table 3). Urine sediment analysis or bacterial culture were significantly more commonly performed at the university hospitals (92%) compared to private practices (27%). When antimicrobial prescription at the university hospitals was compared to the private practices, prescription was significantly more often graded as JS-1 (complete agreement with the guidelines; university hospitals, 44%; private practices 12%), JS-3 (choice of antimicrobial different from the guidelines; university hospitals, 17%; private practices 4%) and JS-4 (complete discrepancy with the guidelines; university hospitals, 30%; private practices 6%). The use of critically important antibiotics was significantly more common in private practices (54%) compared to the university hospitals (14%). Furthermore, judgment of antimicrobial prescription was significantly more often not possible in private practices (78%; university hospitals, 8%).

Antibiotic prescription for abscesses

Of 216 cats with abscesses, 207 cats (96%) received antibiotic therapy with the following substance classes: potentiated aminopenicillins (64%), third generation cephalosporins (25%), aminopenicillins (24%), first generation cephalosporins (6%), fluoroquinolones (3%), lincosamides (2%) and penicillins (1%); 24% received combination or serial therapy. Combination therapy was uncommon (3 cases) and antimicrobial combinations used were potentiated or non-potentiated aminopenicillins together with fluoroquinolones or third generation cephalosporins. The cats were treated for 1 to 24 (median 7) days. Local wound treatment was carried out in 156 of 216 cases (72%) and drains were placed in 33 of 216 cases (15%). Antibiotic therapy was not associated with any of the symptoms listed in the guidelines, i.e., signs of generalization, poor general condition, severely contaminated wounds, and/ or proximity to delicate tissues. Antimicrobial therapy was judged in accordance with the guidelines (JS-1) in 36 (17%) and not in accordance with the guidelines in 95 (44%) cases (JS-2: n = 16, 7%; JS-3: n = 14, 7%; JS-4: n = 65, 30%). In the 65 cases with complete discrepancy to the guidelines (JS-4), antibiotics were prescribed without indication (overprescription) in 63 cases (97%) and cats were not treated with antibiotics despite indicated in the guidelines in 2 cases (3%). Assessment of prudent use was not possible for 85 cases (39%).

Discussion

The results of this study indicate that overprescription of antibiotics in cats in Switzerland with aURTD, FLUTD and abscesses is very common. When prescription was compared to the consensus guidelines, 14–34% of all cases received antibiotics although not indicated; when only the cases were considered for which judgment of prudent use was possible, the rate of antibiotic overprescription was even higher (29–48%). The diagnostic work-up was more elaborate at the university hospitals, and critically important antibiotics were less commonly prescribed at the universities, but the prudent use pattern of prescriptions was not clearly superior when compared to private practices. This was mainly due to the very common use of potentiated aminopenicillins instead of non-potentiated aminopenicillins at the universities. On the other hand, the quality of antimicrobial prescription could often not be judged in the cases from private practices because the diagnostic work-up or the symptoms of the patients were not documented. The common discrepancy of antimicrobial prescription with recently established consensus guidelines [40, 41] at the two university hospitals is surprising considering that senior clinicians of these hospitals were involved in the drafting of the guidelines. The overall frequency of antimicrobial treatment was also not different at the university hospitals compared to private practices. However, our data indicates that the animals presented to the university hospitals were more often pretreated or hospitalized, and could thus have been in a more debilitated condition.

Only 17 ̶24% of the treatment decisions in this study were classified as JS-1 and therefore in complete accordance with the consensus guidelines. Recent studies in dogs and cats have reported an overall agreement of 0–69% with published guidelines [24, 27, 33, 34]. This overall low accordance raises the question of whether the proposed guidelines cannot be implemented in clinical practice, for example, due to poor market availability of appropriate antibiotic formulations, or whether the content is not well disseminated among veterinary practitioners.

The critically important antibiotics used in cats in this study were mostly third generation cephalosporins as well as fluoroquinolones. Third generation cephalosporins were the second most frequently prescribed antibiotic class and were used in 25–28% of the cases. This mirrors the results obtained in previous studies [21,22,23,24,25, 31,32,33] and could likely be explained by the convenient application (as a single subcutaneous injection) and the long dosing interval (2 weeks) of the authorized product in Switzerland (cefovecin, Convenia®, Zoetis, Delémont, Switzerland). A previous study evaluating electronic health records found that inability to orally medicate the cat was the most common reason given for prescribing cefovecin [42]. An online survey in veterinarians in Switzerland also revealed that the route of application was the most important factor in the choice of antimicrobial therapy in cats [43]. In our study, the prescription of critically important antibiotics was significantly more frequent in private practices compared to the university hospitals. This observation supports the hypothesis that the workplace environment is an important factor determining treatment decisions and antimicrobial use [44]. University hospitals, as training centers, may have stronger restrictions for the use of critically important antibiotics: one of the two university hospitals of this study completely forbids the use of third generation cephalosporins in its patients. On the other hand, the cats at the university hospitals were more commonly hospitalized compared to the cases in private practices, thus allowing for parenteral medication and avoiding the problem of oral application of the antibiotic drug.

Antimicrobial prescription in the absence of proper diagnostic work-up was very common in this study. In only 40% of the FLUTD cases overall, and in only 10% of the FLUTD cases in private practices, bacterial culture and susceptibility testing were carried out. In a previous study based on a questionnaire, 32.5% of companion animal practitioners in Europe reported that they frequently undertake antimicrobial susceptibility testing whereas 9.1% never demand such tests [45]. In another survey from Italy, 91% of the practitioners reported to carry out microbiological analysis, although only 20% reported to do so frequently [35]. Our results indicate that these data based on questionnaires are probably too optimistic and that bacterial culture, an essential diagnostic work-up step for cats with FLUTD, is rarely performed in private practices. In contrast, bacterial culture was performed in 87% of the FLUTD cases presented to the university hospitals, although this did not result in a less frequent prescription of antimicrobials. Interestingly, 56% of the FLUTD cases at the universities received antibiotic therapy despite the absence of bacteria in urine culture. A total of 20% of these cats were pretreated with antibiotics which could have affected the interpretation of a negative bacterial culture result. Also many of these cats suffered from urinary tract obstruction and antibiotic therapy was initiated after removal of the indwelling urinary catheter.

The trend towards more diagnostic testing at the university hospitals is also demonstrated by a more frequent use of PCR for the detection of feline calicivirus (FCV) and feline herpesvirus-1 (FHV) in cases with aURTD. These tests can be useful to support a diagnosis of viral infection and to initiate supportive measures such as the prescription of famciclovir in the case of FHV infection, and thus reduce the use of antibiotics [46]. In this study, the detection of FCV and FHV did not affect the frequency of antibiotic prescription. Overprescription of antibiotics in cats with aURTD was common: although only 29% of the cats showed symptoms that would have justified an antibiotic therapy according to the consensus guidelines, 77% of the cases received antibiotic treatment. Potentiated aminopenicillins were most often prescribed at the university hospitals, while third generation cephalosporins and aminopenicillins were most commonly used in private practices. A study revealed that amoxicillin with clavulanic acid is not superior to doxycycline when treating cats with signs of acute respiratory tract disease [47]. Our data, however, indicate that the cases presented to the university hospitals were in a more debilitated condition, because 72% of the cats with aURTD were hospitalized in comparison to 3% in private practices. Furthermore, 68% of the cats presented to university hospitals had symptoms listed in the guidelines, while at the private practices only 21% of the cats were reported to show a poor general condition, fever, lethargy and/or anorexia. The more compromised clinical condition of the patients at university hospitals could explain the common use of potentiated aminopenicillins instead of doxycycline due to the lack of a licensed injectable doxycycline preparation in Switzerland. However, potentiated instead of non-potentiated aminopenicillins were almost exclusively used at the universities. Non-potentiated and potentiated aminopenicillins are often used interchangeably although it has been shown that the use of clavulanic acid may increase AmpC-mediated resistance causing inducible organisms to become insensitive to 1st to 3rd generation cephalosporins [48, 49]. The frequent use of potentiated aminopenicillins instead of non-potentiated aminopenicillins in this study could also be due to the better availability of these products on the market, since they make up the largest part of antimicrobial compounds licensed for cats in Switzerland [50].

A total of 96% of the cats with abscesses received antibiotic treatment but only 30% of the cats presented symptoms that, according to the guidelines, would justify an antibiotic therapy. Our findings are in line with results from previous studies where frequency of antibiotic prescriptions for skin diseases such as wounds or abscesses ranged from 90 to 97% [24, 32]. In children, antibiotics might sometimes be applied instead of local wound drainage to avoid anesthesia or sedation [51]. However, 72% of the cats in this study received local wound treatment and passive drains were placed in 15% of the cats. It can be assumed that, in many of these cases, antibiotics were supplemented as a preventative measure. Studies from human medicine showed that appropriate drainage of the abscess is important and that antibiotic treatment may not be necessary [52,53,54,55]. Several guidelines for small animals state that an antibiotic treatment is not indicated if the abscess is well-defined and the animal is in a good general condition [56,57,58].

The present study has some limitations. The insufficient documentation in the databases limited the information available for review. The presence of bacteria in urine sediment analysis of an aseptically collected urine sample was considered appropriate to confirm a bacterial etiology in cases with FLUTD, although this is considered insufficient diagnostic work-up according to some guidelines due to the variable quality of interpretation, the risk of stain contamination as well as the possibility of false positive results [57, 59]. In a recent study, overall accuracy of in-house microscopic evaluation for bacteriuria in primary practice was only 64.5% when comparing results to reference bacterial cultures [60]. We decided to consider these results since former studies have reported accuracies of urine sediment analysis of 97–98% when performed by experienced laboratory personal [61,62,63,64]. Furthermore, the generally low prevalence of bacterial cystitis in cats should not result in many false positive results [65,66,67].

The assessment score used in this study leaves a margin of interpretation and the justification of antimicrobial prescription was based on consensus guidelines released in Switzerland. Results could differ to some extent when comparing prescription to guidelines from other countries. Furthermore, the limited number of cases included per practice did also not allow for a statistical analysis at a single practice level. Also, there could be a selection bias since the participation in this study was on a voluntary basis and the enrolled practices might have been more aware of antimicrobial resistance and more likely to prescribe antibiotics prudently.

Conclusions

The present study highlights the need to promote antimicrobial stewardship in small animal medicine and to implement effective intervention strategies. Particular attention should be paid to the education of veterinarians, the propagation of diagnostic work-up and the need for proper documentation to justify antibiotic treatment. Antimicrobial stewardship at universities should be urgently advanced as they serve as role models for veterinary practice. Developments on the market to provide small spectrum antibiotics for convenient application would be of particular importance in cats since the route of application is a major factor in the choice of antimicrobials in this species. Such new products will contribute to ensure that effective antimicrobials remain available in the future to combat bacterial infections in human and veterinary medicine.

Methods

Cases presented between January 1st and December 31st 2016 to the two Swiss university teaching hospitals for small animals (Vetsuisse Faculty Bern and Zurich) as well as to fourteen private veterinary practices across Switzerland were included. The private practices participated on a voluntary basis following a nationwide call. In order to identify patients matching the inclusion criteria (Table 5), the electronic records were scanned for predetermined search terms (Table 5) using search functions provided by the particular software. For practical reasons, only private practices using either OblonData® (Amacker&Partner Informatik AG, Zurich, Switzerland) or Diana SUISSE® (Diana Software AG, Zurich, Switzerland) were enrolled. A full text search was conducted and the matches were manually reviewed. All cases from the two university hospitals matching the criteria were included. From each private practice, 16 cases per indication that matched the criteria were randomly selected via the sampling function of Microsoft® Excel. In the eight private practices where less than 16 cases per indication were found, all cases were included. The number of cases was balanced by limiting the number to 16 per practice to avoid overrepresentation of larger private practices. Although not all cases were included, the random selection should ensure that the results remain representative.

Table 5 Inclusion and exclusion criteria and search terms for aURTDa, FLUTDb and abscesses
Full size table

Signalment, vaccination status, clinical history, reports on clinical examination, antibiotic pretreatment, diagnostic work-up, comorbidities, hospitalization and antimicrobial therapy (substance class, dose, frequency of application and duration of therapy) were retrieved from the medical records. The evaluated diagnostic work-up for aURTD included PCR for FCV and FHV; for FLUTD, urine sediment analysis and urine bacterial culture were assessed. Bacteriuria was defined as the presence of bacteria in the urine sediment analysis or in the bacterial culture from an aseptically collected urine sample (cystocentesis or catheterization). Complicated urinary tract infections were defined as infections that were caused by anatomical or functional changes or a comorbidity, that predispose the patient to persistent or recurrent infections or treatment failure [68]. Critically important antibiotics comprised third or higher generation cephalosporins, quinolones, macrolides, ketolides, glycopeptides and polymyxins [69]. Combination therapy was defined as the prescription of two or more antibiotic classes at the same time; serial therapy as the prescription of one antibiotic class followed by a different antibiotic class. Antimicrobial prescription was compared with the consensus guidelines summarized in Table 6 using a previously published JS with modifications shown in Table 7 [70]. The guidelines were published in December 2016 [40] and can be accessed online as the AntibioticScout tool [71]. The present study evaluated antimicrobial prescription prior to the implementation of the guidelines to use this data as a baseline for follow-up studies on the influence of the guidelines on antimicrobial prescription in Switzerland.

Table 6 Consensus guidelines [40, 41] used to evaluate prudent use of antimicrobials
Full size table
Table 7 Justification score (JSa) used to compare antimicrobial prescription to consensus guidelines
Full size table

For statistical analysis, the commercially available SPSS® software (SPSS Inc., IL, USA) was used. Descriptive statistics and comparisons of groups were conducted. Because the continuous variables were not normally distributed, the Mann Whitney U Test was used to compare the median age as well as the duration of therapy between the university hospitals and private practices. For the median age, 95% confidence intervals (CI) were calculated. The Chi square test was performed for comparison of categorical variables (case characteristics, diagnostic work-up, hospitalization, antibiotic pretreatment and antibiotic prescription) between university hospitals and private practices; frequency of antibiotic therapy between the indications; association of symptoms listed in the guidelines (for aURTD and abscesses) or the presence of bacteriuria (for FLUTD) with antibiotic therapy. The level of significance was set at p < 0.05. For the comparison of the justification scores between university hospitals and private practices the Chi square test was performed and the significance level was adapted for multiple tests using the Bonferroni correction.

Abbreviations

aURTD:

acute upper respiratory tract disease

BID:

twice daily

CI:

confidence interval

FCV:

Feline Calicivirus

FHV:

Feline Herpesvirus-1

FLUTD:

feline lower urinary tract disease

JS:

justification score

n.a.:

not applicable

n.s.:

not significant

PCR:

polymerase chain reaction

SID:

once daily

TID:

three times daily

vs:

versus

References

  1. 1.

    Holmes AH, Moore LSP, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387:176–87. https://doi.org/10.1016/S0140-6736(15)00473-0.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Blair JMA, Webber MA, Baylay AJ, Ogbolu DO, Piddock LJV. Molecular mechanisms of antibiotic resistance. Nat Rev Microbiol. 2015;13:42–51. https://doi.org/10.1038/nrmicro3380.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Bhullar K, Waglechner N, Pawlowski A, Koteva K, Banks ED, Johnston MD, et al. Antibiotic resistance is prevalent in an isolated cave microbiome. PLoS One. 2012;7:1–11.

    Article  Google Scholar 

  4. 4.

    Dcosta VM, King CE, Kalan L, Morar M, Sung WWL, Schwarz C, et al. Antibiotic resistance is ancient. Nature. 2011;477:457–61. https://doi.org/10.1038/nature10388.

    CAS  Article  Google Scholar 

  5. 5.

    Hernández J, Stedt J, Bonnedahl J, Molin Y, Drobni M, Calisto-Ulloa N, et al. Human-associated extended-spectrum β-lactamase in the Antarctic. Appl Environ Microbiol. 2012;78:2056–8. https://doi.org/10.1128/AEM.07320-11.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    European Medicines Agency, European Surveillance of Veterinary Antimicrobial Consumption 2017. (EMA/184855/2017). Sales of veterinary antimicrobial agents in 30 European countries in 2015. 2017. doi:https://doi.org/10.2809/676974.

  7. 7.

    Guardabassi L, Schwarz S, Lloyd DH. Pet animals as reservoirs of antimicrobial-resistant bacteria. J Antimicrob Chemother. 2004;54:321–32. https://doi.org/10.1093/jac/dkh332.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Guardabassi L, Loeber ME, Jacobson A. Transmission of multiple antimicrobial-resistant Staphylococcus intermedius between dogs affected by deep pyoderma and their owners. Vet Microbiol. 2004;98:23–7. https://doi.org/10.1016/j.vetmic.2003.09.021.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Weese JS, van Duijkeren E. Methicillin-resistant Staphylococcus aureus and Staphylococcus pseudintermedius in veterinary medicine. Vet Microbiol. 2010;140:418–29. https://doi.org/10.1016/j.vetmic.2009.01.039.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Johnson JR, Owens K, Gajewski A, Clabots C. Escherichia coli colonization patterns among human household members and pets, with attention to acute urinary tract infection. J Infect Dis. 2008;197:218–24. https://doi.org/10.1086/524844.

    Article  PubMed  Google Scholar 

  11. 11.

    Johnson JR, Johnston B, Clabots CR, Kuskowski MA, Roberts E, DebRoy C. Virulence genotypes and phylogenetic background of Escherichia coli serogroup O6 isolates from humans, dogs, and cats. J Clin Microbiol. 2008;46:417–22. https://doi.org/10.1128/JCM.00674-07.

    Article  PubMed  Google Scholar 

  12. 12.

    Zhang XF, Doi Y, Huang X, Li HY, Zhong LL, Zeng KJ, et al. Possible transmission of mcr-1-harboring Escherichia coli between companion animals and human. Emerg Infect Dis. 2016;22:1679–81. https://doi.org/10.3201/eid2209.160464.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Couto N, Monchique C, Belas A, Marques C, Gama LT, Pomba C. Trends and molecular mechanisms of antimicrobial resistance in clinical staphylococci isolated from companion animals over a 16 year period. J Antimicrob Chemother. 2016;71:1479–87.

    CAS  Article  Google Scholar 

  14. 14.

    Paul NC, Moodley A, Ghibaudo G, Guardabassi L. Carriage of methicillin-resistant Staphylococcus pseudintermedius in small animal veterinarians: indirect evidence of zoonotic transmission. Zoonoses Public Health. 2011;58:533–9. https://doi.org/10.1111/j.1863-2378.2011.01398.x.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Grönthal T, Moodley A, Nykäsenoja S, Junnila J, Guardabassi L, Thomson K, et al. Large outbreak caused by methicillin resistant Staphylococcus pseudintermedius ST71 in a Finnish veterinary teaching hospital - from outbreak control to outbreak prevention. PLoS One. 2014;9.

    Article  Google Scholar 

  16. 16.

    Grönlund Andersson U, Wallensten A, Hæggman S, Greko C, Hedin G, Hökeberg I, et al. Outbreaks of methicillin-resistant Staphylococcus aureus among staff and dogs in Swedish small animal hospitals. Scand J Infect Dis. 2014;46:310–4. https://doi.org/10.3109/00365548.2013.866267.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Leonard FC, Abbott Y, Rossney A, Quinn PJ, O’Mahony R, Markey BK. Methicillin-resistant Staphylococcus aureus isolated from a veterinary surgeon and five dogs in one practice. Vet Rec. 2006;158:155–9. https://doi.org/10.1136/vr.158.5.155.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Rojas I, Barquero-Calvo E, van Balen JC, Rojas N, Muñoz-Vargas L, Hoet AE. High prevalence of multidrug-resistant community-acquired methicillin-resistant Staphylococcus aureus at the largest veterinary teaching hospital in Costa Rica. Vector Borne Zoonotic Dis. 2017;17:645–53. https://doi.org/10.1089/vbz.2017.2145.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315:1864–73. https://doi.org/10.1001/jama.2016.4151.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    CDC. Antibiotic resistance threats in the United States, 2013. 2013; www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed 06 Feb 2019.

  21. 21.

    Singleton DA, Sánchez-Vizcaíno F, Dawson S, Jones PH, Noble PJM, Pinchbeck GL, et al. Patterns of antimicrobial agent prescription in a sentinel population of canine and feline veterinary practices in the United Kingdom. Vet J. 2017;224:18–24. https://doi.org/10.1016/j.tvjl.2017.03.010.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Buckland EL, O’Neill D, Summers J, Mateus A, Church D, Redmond L, et al. Characterisation of antimicrobial usage in cats and dogs attending UK primary care companion animal veterinary practices. Vet Rec. 2016;179:489. https://doi.org/10.1136/vr.103830.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    De Briyne N, Atkinson J, Borriello SP, Pokludov L. Antibiotics used most commonly to treat animals in Europe. Vet Rec. 2014;175:325.

    Article  Google Scholar 

  24. 24.

    Sarrazin S, Vandael F, Van Cleven A, De Graef E, De Rooster H, Dewulf J, et al. The impact of antimicrobial use guidelines on prescription habits in fourteen Flemish small animal practices. VLAAMS Diergeneeskd Tijdschr. 2017;86:173–82.

    Google Scholar 

  25. 25.

    Murphy CP, Reid-Smith RJ, Boerlin P, Weese JS, Prescott JF, Janecko N, et al. Out-patient antimicrobial drug use in dogs and cats for new disease events from community companion animal practices in Ontario. Can Vet J. 2012;53:291–8.

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Regula G, Torriani K, Gassner B, Stucki F, Müntener CR. Prescription patterns of antimicrobials in veterinary practices in Switzerland. J Antimicrob Chemother. 2009;63:805–11.

    CAS  Article  Google Scholar 

  27. 27.

    Escher M, Vanni M, Intorre L, Caprioli A, Tognetti R, Scavia G. Use of antimicrobials in companion animal practice: a retrospective study in a veterinary teaching hospital in Italy. J Antimicrob Chemother. 2011;66:920–7. https://doi.org/10.1093/jac/dkq543.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Pleydell EJ, Souphavanh K, Hill KE, French NP, Prattley DJ. Descriptive epidemiological study of the use of antimicrobial drugs by companion animal veterinarians in New Zealand. N Z Vet J. 2012;60:115–22.

    CAS  Article  Google Scholar 

  29. 29.

    Thomson KH, Rantala MHJ, Viita-Aho TK, Vainio OM, Kaartinen LA. Condition-based use of antimicrobials in cats in Finland: results from two surveys. J Feline Med Surg. 2009;11:462–6.

    Article  Google Scholar 

  30. 30.

    Hardefeldt LY, Selinger J, Stevenson MA, Gilkerson JR, Crabb H, Billman-Jacobe H, et al. Population-wide assessment of antimicrobial use in dogs and cats using a novel data source – a cohort study using pet insurance data. Vet Microbiol. 2018;225:34–9. https://doi.org/10.1016/J.VETMIC.2018.09.010.

    Article  PubMed  Google Scholar 

  31. 31.

    Mateus A, Brodbelt DC, Barber N, Stärk KDC. Antimicrobial usage in dogs and cats in first opinion veterinary practices in the UK. J Small Anim Pract. 2011;52:515–21.

    CAS  Article  Google Scholar 

  32. 32.

    Radford AD, Noble PJ, Coyne KP, Gaskell RM, Jones PH, Bryan JGE, et al. Antibacterial prescribing patterns in small animal veterinary practice identified via SAVSNET: the small animal veterinary surveillance network. Vet Rec. 2011;169:310. https://doi.org/10.1136/vr.d5062.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Van Cleven A, Sarrazin S, de Rooster H, Paepe D, Van der Meeren S, Dewulf J. Antimicrobial prescribing behaviour in dogs and cats by Belgian veterinarians. Vet Rec. 2018;182:324.

    Article  Google Scholar 

  34. 34.

    Hardefeldt LY, Holloway S, Trott DJ, Shipstone M, Barrs VR, Malik R, et al. Antimicrobial prescribing in dogs and cats in Australia: results of the Australasian infectious disease advisory panel survey. J Vet Intern Med. 2017;31:1100–7.

    CAS  Article  Google Scholar 

  35. 35.

    Barbarossa A, Rambaldi J, Miraglia V, Giunti M, Diegoli G, Zaghini A. Survey on antimicrobial prescribing patterns in small animal veterinary practice in Emilia Romagna, Italy. Vet Rec. 2017;181:69.

    CAS  Article  Google Scholar 

  36. 36.

    Jessen LR, Sørensen TM, Lilja ZL, Kristensen M, Hald T, Damborg P. Cross-sectional survey on the use and impact of the Danish national antibiotic use guidelines for companion animal practice. Acta Vet Scand. 2017;59:1–9. https://doi.org/10.1186/s13028-017-0350-8.

    Article  Google Scholar 

  37. 37.

    Hughes LA, Williams N, Clegg P, Callaby R, Nuttall T, Coyne K, et al. Cross-sectional survey of antimicrobial prescribing patterns in UK small animal veterinary practice. Prev Vet Med. 2012;104:309–16. https://doi.org/10.1016/j.prevetmed.2011.12.003.

    Article  PubMed  Google Scholar 

  38. 38.

    Weese JS. Investigation of antimicrobial use and the impact of antimicrobial use guidelines in a small animal veterinary teaching hospital: 1995-2004. J Am Vet Med Assoc. 2006;228:553–8. https://doi.org/10.2460/javma.228.4.553.

    Article  PubMed  Google Scholar 

  39. 39.

    Hölsö K, Rantala M, Lillas A, Eerikäinen S, Huovinen P, Kaartinen L. Prescribing antimicrobial agents for dogs and cats via university pharmacies in Finland-patterns and quality of information. Acta Vet Scand. 2005;46:87–93.

    Article  Google Scholar 

  40. 40.

    Peter R, Müntener C, Demuth D, Heim D, Mevissen M, Schüpbach-Regula G, et al. AntibioticScout: Online tool for antimicrobial stewardship in veterinary medicine. Schweiz Arch Tierheilkd. 2016;158:805–10. https://doi.org/10.17236/sat00095.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Peter R, Demuth D, Müntener C, Lampart M, Heim D, Mevissen M, et al. AntibioticScout.ch: A decision supporting tool for antimicrobial stewardship: application to companion animal medicine. Schweiz Arch Tierheilkd. 2017;159:525–33. https://doi.org/10.17236/sat00129.

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Burke S, Black V, Sánchez-Vizcaíno F, Radford A, Hibbert A, Tasker S. Use of cefovecin in a UK population of cats attending first-opinion practices as recorded in electronic health records. J Feline Med Surg. 2017;19:687–92. https://doi.org/10.1177/1098612X16656706.

    Article  PubMed  Google Scholar 

  43. 43.

    Schönenberger AC. Motivation von Kleintierärzten für die Verschreibung von Antibiotika: University of Zurich; 2012.

  44. 44.

    Mateus ALP, Brodbelt DC, Barber N, Stärk KDC. Qualitative study of factors associated with antimicrobial usage in seven small animal veterinary practices in the UK. Prev Vet Med. 2014;117:68–78. https://doi.org/10.1016/j.prevetmed.2014.05.007.

    Article  PubMed  Google Scholar 

  45. 45.

    De Briyne N, Atkinson J, Pokludová L, Borriello SP, Price S. Factors influencing antibiotic prescribing habits and use of sensitivity testing amongst veterinarians in Europe. Vet Rec. 2013;173:475.

    Article  Google Scholar 

  46. 46.

    Lappin MR, Blondeau J, Boothe D, Breitschwerdt EB, Guardabassi L, Lloyd DH, et al. Antimicrobial use guidelines for treatment of respiratory tract disease in dogs and cats: antimicrobial guidelines working group of the International Society for Companion Animal Infectious Diseases. J Vet Intern Med. 2017;31:279–94. https://doi.org/10.1111/jvim.14627.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Litster AL, Wu CC, Constable PD. Comparison of the efficacy of amoxicillin-clavulanic acid, cefovecin, and doxycycline in the treatment of upper respiratory tract disease in cats housed in an animal shelter. J Am Vet Med Assoc. 2012;241:218–26. https://doi.org/10.2460/javma.241.2.218.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Jacoby GA. AmpC Β-Lactamases. Clin Microbiol Rev. 2009;22:161–82.

    CAS  Article  Google Scholar 

  49. 49.

    Kitzis MD, Ferré B, Coutrot A, Acar JF, Gutmann L. In vitro activity of combinations of beta-lactam antibiotics with beta-lactamase inhibitors against cephalosporinase-producing bacteria. Eur J Clin Microbiol Infect Dis. 1989;8:783–8.

    CAS  Article  Google Scholar 

  50. 50.

    CliniPharm. Institute for Veterinary Pharmacology and Toxicology, Zurich. 2019. https://www.vetpharm.uzh.ch/wir/00002678/7780__f.htm. Accessed 15 Nov 2018.

  51. 51.

    Mistry RD, Shapiro DJ, Goyal MK, Zaoutis TE, Gerber JS, Liu C, et al. Clinical management of skin and soft tissue infections in the U.S. emergency departments. West J Emerg Med. 2014;15:491–8. https://doi.org/10.5811/westjem.2014.4.20583.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Llera JL, Levy RC. Treatment of cutaneous abscess: a double-blind clinical study. Ann Emerg Med. 1985;14:15–9. https://doi.org/10.1016/S0196-0644(85)80727-7.

    CAS  Article  PubMed  Google Scholar 

  53. 53.

    Rajendran PM, Young D, Maurer T, Chambers H, Perdreau-Remington F, Ro P, et al. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother. 2007;51:4044–8. https://doi.org/10.1128/AAC.00377-07.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Hankin A, Everett WW. Are antibiotics necessary after incision and drainage of a cutaneous abscess? Ann Emerg Med. 2007;50:49–51.

    Article  Google Scholar 

  55. 55.

    Duong M, Markwell S, Peter J, Barenkamp S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med. 2010;55:401–7. https://doi.org/10.1016/J.ANNEMERGMED.2009.03.014.

    Article  PubMed  Google Scholar 

  56. 56.

    Bergvall K, Greko C, Ingman J, Larsson CI, Mannerfeldt T, Odensvik K, et al. Swedish Veterinary Association Guidelines for the clinical use of antibiotics in the treatment of dogs and cats. 2010. http://www.svf.se/Documents/S%C3%A4llskapet/Sm%C3%A5djurssektionen/Policy%20ab%20english%2010b.pdf

  57. 57.

    Jessen LR, Damborg PP, Spohr A, Schjøth B, Wiinberg B, Houser G, et al. Antibiotic use guidelines for companion animal practice. The Danish Small Animal Veterinary Association, SvHKS, Nov. 2012. https://www.ddd.dk/sektioner/familiedyr/antibiotikavejledning/Documents/AntibioticGuidelines%20-%20v1.4_jun15.pdf.

  58. 58.

    Holloway S, Trott D, Shipstone M, Barrs V, Malik R, Burrows M. Antibiotic prescribing detailed guidelines. Australasian Infectious Diseases Advisory Panel; 2013. https://www.ava.com.au/sites/default/files/AVA_website/pdfs/AIDAP%20prescribing%20guidelines.pdf.

  59. 59.

    Weese JS, Blondeau JM, Boothe D, Breitschwerdt EB, Guardabassi L, Hillier A, et al. Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: antimicrobial guidelines working group of the International Society for Companion Animal Infectious Diseases. Vet Med Int. 2011;2011:1–9. https://doi.org/10.4061/2011/263768.

    Article  Google Scholar 

  60. 60.

    Sørensen TM, Bjørnvad CR, Cordoba G, Damborg P, Guardabassi L, Siersma V, et al. Effects of diagnostic work-up on medical decision-making for canine urinary tract infection: an observational study in Danish small animal practices. J Vet Intern Med. 2018;32:743–51.

    Article  Google Scholar 

  61. 61.

    Way LI, Sullivan LA, Johnson V, Morley PS. Comparison of routine urinalysis and urine gram stain for detection of bacteriuria in dogs. J Vet Emerg Crit Care. 2013;23:23–8. https://doi.org/10.1111/vec.12012.

    Article  Google Scholar 

  62. 62.

    O’Neil E, Horney B, Burton S, Lewis PJ, MacKenzie A, Stryhn H. Comparison of wet-mount, Wright-Giemsa and gram-stained urine sediment for predicting bacteriuria in dogs and cats. Can Vet J. 2013;54:1061–6.

    PubMed  PubMed Central  Google Scholar 

  63. 63.

    Swenson CL, Boisvert AM, Kruger JM, Gibbons-burgener SN. Evaluation of modified Wright-staining for accurate detection of bacteriuria in dogs. J Am Vet Med Assoc. 2004;224:1282–9.

    CAS  Article  Google Scholar 

  64. 64.

    Brložnik M, Šterk K, Zdovc I. Prevalence and resistance patterns of canine uropathogens in regard to concurrent diseases. Berl Munch Tierarztl Wochenschr. 2016;129:340–50. https://doi.org/10.2376/0005-9366-15109.

    Article  PubMed  Google Scholar 

  65. 65.

    Defauw PA, Van de Maele I, Duchateau L, Polis IE, Saunders JH, Daminet S. Risk factors and clinical presentation of cats with feline idiopathic cystitis. J Feline Med Surg. 2011;13:967–75. https://doi.org/10.1016/j.jfms.2011.08.001.

    Article  PubMed  Google Scholar 

  66. 66.

    Kruger JM, Osborne CA, Goyal SM, Wickstrom SL, Johnston GR, Fletcher TF, et al. Clinical evaluation of cats with lower urinary tract disease. J Am Vet Med Assoc. 1991;199:211–6.

    CAS  PubMed  Google Scholar 

  67. 67.

    Buffington CA, Chew DJ, Kendall MS, Scrivani PV, Thompson SB, Blaisdell JL, et al. Clinical evaluation of cats with nonobstructive urinary tract diseases. J Am Vet Med Assoc. 1997;210:46–50.

    CAS  PubMed  Google Scholar 

  68. 68.

    Orenstein R, Wong ES. Urinary Tract Infections in Adults. Am Fam Physician. 1999;59:1225–1234, 1237.

  69. 69.

    World Health Organization. WHO list of critically important antimicrobials for human medicine (WHO CIA list). 2017. http://who.int/foodsafety/publications/antimicrobials-fifth/en/. Accessed 11 Nov 2018.

  70. 70.

    DePestel DD, Eiland EH, Lusardi K, Destache CJ, Mercier RC, McDaneld PM, et al. Assessing appropriateness of antimicrobial therapy: in the eye of the interpreter. Clin Infect Dis. 2014;59(Suppl 3):S154–61. https://doi.org/10.1093/cid/ciu548.

    CAS  Article  PubMed  Google Scholar 

  71. 71.

    AntibioticScout. Institute for Veterinary Pharmacology and Toxicology, Zurich. 2019. http://www.vetpharm.uzh.ch/abscout/. Accessed 15 Nov 2018.

Download references

Acknowledgements

We thank all private practices and clinics which participated in this study. The authors thank D. Demuth for technical support and helpful discussions. This study was the doctoral thesis of K. Schmitt.

Funding

This research was supported by the Swiss National Science Foundation (NRP72 grant 407240_167054). The funding body had no role in the design of the study and collection, analysis and interpretation of data and in writing the manuscript.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding authors on reasonable request.

Author information

Affiliations

  1. Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland

    K. Schmitt & B. Willi

  2. Institute of Veterinary Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland

    K. Schmitt, C. Lehner, R. Peter, C. R. Müntener & H. Naegeli

  3. Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland

    C. Lehner & S. Schuller

  4. Veterinary Public Health Institute (VPHI), Vetsuisse Faculty, University of Bern, Bern, Switzerland

    G. Schüpbach-Regula

  5. Division of Pharmacology and Toxicology, Vetsuisse Faculty, University of Bern, Bern, Switzerland

    M. Mevissen

Authors
  1. K. Schmitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Lehner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Schuller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Schüpbach-Regula
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Mevissen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Peter
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. R. Müntener
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H. Naegeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. B. Willi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HN, BW and SS conceived the study. BW, SS and RP were responsible for the coordination of the study. CL and KS carried out the data collection. GS was responsible for the statistical analyses. BW and KS drafted the manuscript. HN, SS, MM, GS, CL and CRM edited the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to H. Naegeli or B. Willi.

Ethics declarations

Ethics approval and consent to participate

All data collected in this study were generated as part of the diagnostic work-up and treatment of the patients. Permissions were obtained to access the data. Formal ethical approval was not required due to the retrospective nature of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schmitt, K., Lehner, C., Schuller, S. et al. Antimicrobial use for selected diseases in cats in Switzerland. BMC Vet Res 15, 94 (2019). https://doi.org/10.1186/s12917-019-1821-0

Download citation

Keywords

  • Antibiotic prescription
  • Antimicrobial stewardship
  • Resistance
  • Guidelines
  • Acute upper respiratory tract disease
  • Feline lower urinary tract disease
  • FLUTD
  • Abscess
  • Infection

BMC Veterinary Research

ISSN: 1746-6148

Contact us

\