Scientific Papers

The opinions of farm animal veterinarians in Ireland on antibiotic use and their role in antimicrobial stewardship | Irish Veterinary Journal


This study offers insights in different attitudes of farm animal veterinarians in Ireland towards antibiotic use and antibiotic resistance in farm animals, and their interactions with farmers. Most of the respondents acknowledge their role in antibiotic stewardship and aim to administer them judiciously, though some respondents feel pressure to not refuse their farmer clients’ demands for antibiotics. This previous questionnaire found that most respondents were more likely to prescribe antimicrobials if the farmer wanted them and the majority of veterinarians thought that the farmer expected them. In this study, this was more common among the less experienced veterinarians. Many respondents are willing to apply antibiotics preventatively if they thought they could prevent disease, which is contrary to current EU regulations [8, 9]. Farmer education on correct antibiotic use was seen as a common reduction opportunity among respondents in the survey. Most respondents saw a reduction in antibiotic use on farm possible in the future and the cattle sector was viewed as having the biggest opportunity for reduction in antibiotic use. These key findings are considered in further detail below.

Antibiotic use

Most respondents in this survey agreed that they would not hesitate to apply antibiotics prophylactically. This is at odds with the new EU regulation which prohibits the prophylactic use of antibiotics except in well-defined cases where each of the following three criteria are met: treatment is limited to an individual (or restricted number of animals in exceptional cases), the risk of infection is very high, and the consequences are likely to be severe [9]. Prescribing behaviour among respondents in this study show a willingness to apply antibiotics preventatively if they thought that they could prevent disease. In doing so, respondents would demonstrate poor antimicrobial stewardship.

Antibiotic culture and susceptibility testing (AST) allows for a precise diagnosis of a causative bacteria and therefore, selection of the most appropriate antibiotic following this diagnosis. A 2013 study on AST frequency found that 37.8 % of EU veterinary practitioners (both farm animal and companion animal veterinarians) used AST before starting any antibiotic therapy, 9.8 % of them never requested it and 44.3 % used it on a seldom basis when prompted by a poor initial response to treatment [1617]. Table 3 illustrates this study’s respondents familiarity and use of AST. These findings suggest that AST is not used as frequently by Irish farm animal veterinarians as it is in the rest of Europe.

Treatment guidelines may be an area for development given the responses from many respondents in this survey. Currently the RUMA (Responsible Use of Medicines in Agriculture Alliance) guidelines illustrate easy-to-read guiding principles for each animal sector that can be used by farmers and veterinarians [18]. The British Veterinary Association (BVA) has also published prescribing guidelines in the form of a seven-point plan for responsible use of antibiotics in veterinary practice [19]. However, these guidelines are more general than those that are available to human doctors. For example, the Health Service Executive (HSE) in Ireland has a list of specific diseases, descriptions of these diseases, timelines before antibiotic application is appropriate and specifics of the most appropriate first-line antibiotic treatment if necessary, along with dosages and durations as well as different criteria to help medical practitioners to select different antibiotics if the specific disease becomes more complicated [20]. As illustrated in Table 5, 73.7 % of respondents agreed that they were in favour of compulsory CPD on antibiotic use for veterinarians which is a promising result.

Animal Health Ireland (AHI) has developed specific (non-mandatory) guidelines for the treatment of mastitis as part of their Cell Check programme, both to assist with mastitis control and reduce the use of intramammary antibiotics [21]. This will be discussed further below. Similar specific and easy-to- follow guidelines could aid veterinary practitioners immensely and allow for a more standardised treatment protocol for common bacterial diagnoses.

The Netherlands has had successful experience with the development and use of antibiotic formularies and, since 2013, the introduction of specific clinical guidelines (as described in [10]). These guidelines have without doubt played their part in the observed reduction in antibiotic usage, and especially the reduction in use of (HP)CIAs). In Ireland, a whole range of different antibiotics are currently being used for the same common ailments, leading to confusion amongst veterinary colleagues. Some practices tend to buy antibiotics in bulk, and this can lead to veterinarians selecting antibiotics that might not be the most appropriate for that specific disease, with the potential to contribute to the development of antibiotic resistance.

The farmer-veterinarian relationship

Many of the respondents found it difficult to be regarded as the primary advisor to their farmer clients given all the other advisors available. Respondents stated that they often encountered scenarios where disease could have been prevented if their advice had been followed. They agreed that farmers regularly apply antibiotics incorrectly. As Table 4 illustrates, 77.2% of respondents found it difficult to deviate from the routines that the farmers were accustomed to. Most of the respondents (43.9%) viewed ‘an education programme for farmers on correct antibiotic use and the need to protect them’ as the primary antibiotic reduction opportunity over ‘benchmarking of antibiotic use (tracking of vets and farmers) including sanctioning of high users’ and ‘improving biosecurity’, which followed second and third, respectively. Conclusions drawn from the Dutch survey [11] found that years of experience in practice negatively related to feelings of uncertainty in acting independently. As illustrated in Table 4, the results of this survey are similar to the Dutch findings.

Martin and co-authors [22] reflect how we are currently lacking objective data on on-farm antibiotic use in Ireland. The Animal Health Ireland (AHI) CellCheck technical working group has been considering this issue over an extended period. More and co-authors [23] have analysed national-level data in intramammary antibiotic usage on Irish dairy farms from 2003 to 2015 and have found that the sales of dry-cow mammary tubes have increased yearly. The AHI CellCheck programme is a national initiative to control the mastitis in dairy cows [24]. The collaborative programme is supported by all sectors in the dairy industry (farmers, co-operatives, processors, and national co-ordinating groups), by government and all relevant service providers (advisors and veterinarians) [25]. Its main objective is to support the improvement of somatic cell count (SCC, inflammatory cells that are an indicator of mastitis) in Ireland. The programme promotes milk recording (the collection of data from each individual herd and individual animal at milking) and the implementation of selective dry cow therapy (SDCT). All cows were traditionally treated at drying off with a long-acting treatment of intramammary antibiotics regardless of their infection status at drying off. However, the use of antibiotics in a preventative manner is not allowed under new EU legislation [8]. In contrast, with SDCT antibiotics are only administered to those cows with evidence of infection at the time of drying off. There has been progress in national milk quality with the average bulk milk tank SCC falling by 100,000 cells/ml in the past decade, and two-thirds of Irish dairy farms currently have an average annual SCC of less than 200,000 cells/mL, which is indicative of optimal mastitis control. Current estimates suggest that milk recording is conducted on 49% of Irish dairy farms [26], whereas currently Denmark have milk records for 90% of their herds [27]. The number of Irish farms completing milk recording has substantially increased in the past year by 11.7% but there is still room for improvement [26]. The DAFM has a target that 90% of Irish dairy farms will complete regular milk recording by 2030. Programmes such as CellCheck can offer collaboration opportunities involving farmers and veterinarians to help them understand their role in antibiotic stewardship and how to use them correctly and conservatively. Agriculture is a competitive industry and collaboration between all the advisors on farm could be hugely beneficial to improve farmer compliance.

With the introduction of the new EU veterinary regulations, benchmarking of individual veterinarians’ use or prescription of antibiotics as well as individual farmers’ use of antibiotics will now be possible. This has been a key factor in other EU member states, allowing for the identification of farms where use is particularly high, to guide further investigation and assistance, and sanctioning if necessary. For example. Jensen and co-authors demonstrated a causal association between a 25% decline in antibiotic use in the Danish pig population from 2009-2011 following the introduction of their ‘Yellow Card’ scheme that benchmarked high antibiotic use pig farms. This scheme contributed substantially to a reversal in the observed trend of increasing antibiotic use during 2002-2009 [28]. Benchmarking allows for comparisons to be made and conclusions drawn; the findings from this survey suggest that this will also be key to reducing antibiotic usage in Ireland.

Attitudes for the future of veterinary antibiotic use

Any behaviour change must first start with acceptance of personal responsibility, so acknowledgement of the responsibility by the respondents in this survey in the fight against antibiotic resistance is very positive. Cumulatively, 86.8 % of survey respondents agree that their goal is to reduce antibiotic use on farms as much as possible and therefore recognise their role in antibiotic stewardship.

The intensive sectors of pigs and poultry have been the focus of national attention in the past few years [29, 30], and it is understandable that a lower level of antibiotic reduction is perceived as achievable in these sectors in the future in this survey. No specialist pig practitioners took part in this survey and the respondents may have limited knowledge of this sector. The Irish pig and poultry industries have been the front runners in recording antibiotic use [29]. The new EU regulations and the electronic prescribing database being introduced by the DAFM will record antibiotic use in additional animal species, including cattle. Benchmarking of users will be achievable and therefore a strong focus on antibiotic reduction across species-specific sectors too. Collaboration and comparison of data across all agricultural sectors will allow improvements in antimicrobial stewardship to be made.

Public opinion may suggest that the more experienced or older generation veterinarians may be more likely to use more antibiotics and not see a change in antibiotic use possible. However, the results from this survey show no statistically significant difference between those veterinarians with less than or equal to seven years of experience and those that have more than seven years of experience.

Solutions

Opinions were taken on an approach to prescribing that has been adopted in the Netherlands, namely the assigning of a single prescribing practice to each farm [12]. Under this approach, Dutch farmers are obliged to obtain veterinary services and veterinary medicines from a single veterinary practice, to reduce competition between veterinary practices and ensure that the prescribing veterinarian has a comprehensive understanding of the farm and overview over its antibiotic use. In the current study, 74.7 % of respondents agreed that this would lead to a better understanding of the farm. This approach needs careful consideration in the context of the future of veterinary practice in Ireland. Respondents agreed that more regular farm visits would offer opportunities for antibiotic reduction, and this would also benefit the farmer-veterinarian relationship.

The new EU regulation allows veterinary antibiotic prescriptions to only last for five days [9] which will result in fewer antibiotics being prescribed and available to farmers. Farmers will not be allowed stores of antibiotics to have on stand-by, so less antibiotics will be used at the farmer’s discretion.

Based on the results of this survey, this will be very beneficial as the veterinarians in this study have identified farmers’ misuse of antibiotics as one of the key factors in reducing the veterinary effect on antibiotic resistance.

Strengths and limitations of the study

The response rate of 114 Irish farm animal veterinarians working with food-producing animals out of an estimated 1,000 strong workforce represents circa 11% of the Irish farm animal veterinarians’ population. As Table 1 illustrates, most of the respondents are mixed practice veterinarians. Most veterinarians in Ireland working with food producing animals also work in mixed practices (practices that cater for all animal species) [31]. There appears to be no bias in respondents for distribution of veterinarians over the different animal species.

Among participants, the average amount of years spent in practice was 9.8 years. Given that most veterinarians qualify at twenty-four years of age, this is in line with a survey conducted by DAFM in 2020, which found more veterinary practitioners in large and mixed practices in the 30-39 age bracket (190 out of 674 interviewed) than in any other age bracket [31].

By basing the bulk of the questions in this survey on previous research [11], results can be compared with the Dutch who have a similar dependence on agriculture in their economy, a similar workforce of food-animal veterinarians and have been a front runner in the fight against antibiotic resistance. Some questions are repeated through the survey, though phrased differently. This allows for consistency seen in the answers and reenforces the conclusions drawn.

With respect to the survey strategy that was utilised in this study, anonymity was seen as important, as a means to encourage participants to answer honestly. Candidates could not complete this survey without answering all the questions, thereby minimising concerns relating to missing data. A drawback of using the survey tool is the possibility of differing interpretations to the questions asked, particularly given that the questions in this survey are translated from the Dutch version [11]. Piloting with Irish veterinarians was undertaken to minimise this concern. The survey was quite long, with forty-nine questions in total, which may have led to survey fatigue, and the potential that candidates may have answered some questions with limited thought.

The survey was designed in January 2022 and distributed in February and March 2022. This was around the same time that the new veterinary regulations [6, 7] were being enforced. This is a strength of the research as antibiotic resistance was fresh in the minds of Irish veterinarians with the introduction of the new ePrescribing system and many publications about the new legislation and what it would mean.



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