When considering how antibiotic use can be optimised within the practice, firstly review disease avoidance or infection control practices and guidance for animal keepers to avoid unnecessary use.  It is very important to identify underlying cause of recurrent infections (which may not be bacterial) and treat appropriately

Systemic antibiotic use might be avoidable and alternatives to antibiotics may be indicated.

Create/review a treatment guidance or empirical prescribing policy:

• Practise evidence-based medicine where possible, using testing (culture/cytology) where appropriate, and encourage clients to agree to sampling to inform current treatment and support future prescribing
• Agree first and second line antibiotic treatments against bacteria likely to be causing common clinical conditions in the types of animals usually seen in the practice, and to which the bacteria are likely to be sensitive
• Always use narrow spectrum antibiotics first
• Define antibiotic course lengths, using cytology to help
• Consider alternatives to antibiotics:
  
  • topical treatment where feasible

Symptomatic Treatment

As in human medicine, there will often be conditions in animals for which antibiotic treatment is likely to be ineffective and/or inappropriate. Always encourage and promote testing for underlying causes of disease conditions. As part of practice policy, agree and define conditions for which antibiotics are likely to be ineffective but where symptomatic treatment (e.g. pain relief or anti-inflammatories) may be indicated.

Treatment Failures

Although treatment failures are relatively rare in first opinion practices, there is growing evidence of reflection in veterinary medicine of the experience in human medicine, where resistant organisms were first isolated in hospital patients, however increasingly patients are presenting to their general practitioners with resistant isolates. 

Multi-resistant bacteria have been isolated in farm and companion animals.

Treatment failures and adverse reactions should always be reported to the Veterinary Medicines Directorate