A Cross-Sectional Survey of the Knowledge, Attitudes, and Practices of Antimicrobial Users and Providers in an Area of High-Density Livestock-Human Population in Western Kenya

Background: Antimicrobial resistance (AMR) is one of the most important global health crises in recent times and is driven primarily by antimicrobial consumption. In East Africa, there is a paucity of data regarding the knowledge, attitudes, and practices (KAP) related to antimicrobial use (AMU). We investigate the ways in which antimicrobial users in the veterinary sector accessed veterinary antimicrobials, and common behaviors of veterinary antimicrobial users and prescribers associated with AMU and AMR.Methods: In total, 70 farmers, staff at 49 agricultural-veterinary antimicrobial shops (agrovet staff) and 28 veterinary animal healthcare workers or veterinary surgeons (veterinary professionals) were interviewed in Busia county, western Kenya in 2016 using a standard questionnaire as a framework for structured interviews. Data recorded included participant demographics, level of education, access to and sources of veterinary antimicrobials, prescribing patterns, and knowledge of AMR and antimicrobial withdrawal periods.Results: The majority of antimicrobials were accessed through informal means, purchased from agroveterinary shops; more than half of staff did not hold nationally mandated qualifications to advise on or sell veterinary antimicrobials. Approximately 40% of veterinary antimicrobials were sold without a prescription and it was noted that both price and customer preference were important factors when selling antimicrobials in almost all agrovet shops. Knowledge of the dangers associated with AMR and AMU were mostly superficial. Treatment failure occurred often, and there was a lack of differentiation between AMR and simply treatment failure.Conclusion: In this study area in East Africa with high-density human and livestock populations, AMU was primarily for maintenance of livestock health. These findings have highlighted several aspects surrounding inappropriate access to antimicrobials, and as such require attention from policy makers concerned with AMR in both livestock and human medicine sectors. Improving prescribing practices and ensuring a minimum level of general education and awareness of prescribers, as well as expanding the role of agrovet staff in antimicrobial stewardship programmes, may help begin to mitigate the maintenance and transmission of AMR, particularly amongst livestock.

A Cross-Sectional Survey of the Knowledge, Attitudes & Practices of Antimicrobial Users and Providers in an Area of High-Density Livestock-Human Population in Western Kenya

Background Antimicrobial resistance (AMR) is one of the most important global health crises in recent times and is driven primarily by antimicrobial consumption. In East Africa, there is a paucity of data regarding the knowledge, attitudes and practices related to antimicrobial use (AMU). Here we investigate the ways in which antimicrobial users in the veterinary sector accessed veterinary antimicrobials, and common behaviours of veterinary antimicrobial users and prescribers associated with AMU and AMR. Methods In total, 70 farmers, staff at 49 agricultural-veterinary antimicrobial shops (agrovet staff) and 28 veterinary animal healthcare workers or veterinary surgeons (veterinary professionals) were interviewed in Busia county, western Kenya in 2016 using a standard questionnaire as a framework for structured interviews. Data recorded included participant demographics, level of education, access to and sources of veterinary antimicrobials, prescribing patterns and knowledge of AMR and antimicrobial withdrawal periods. Results The majority of antimicrobials were accessed through informal means, purchased from agroveterinary shops; more than half of staff did not hold nationally mandated qualifications to advise on or sell veterinary antimicrobials. Approximately 40% of veterinary antimicrobials were sold without a prescription and it was noted that both price and customer preference were important factors when selling antimicrobials in almost all agrovet shops. Knowledge of the dangers associated with AMR and AMU were mostly superficial. Treatment failure occurred often, and there was a lack of differentiation between AMR and simply treatment failure. Conclusion In this study area in East Africa with high-density human and livestock populations, AMU was primarily for maintenance of livestock health. These findings have highlighted several aspects surrounding inappropriate access to antimicrobials, and as such require attention from policy makers concerned with AMR in both livestock and human medicine sectors. Improving prescribing practices and ensuring a minimum level of general education and awareness of prescribers, as well as expanding the role of agrovet staff in antimicrobial stewardship programmes, may help begin to mitigate the maintenance and transmission of AMR, particularly amongst livestock.

Antimicrobial Use in Animals in Timor-Leste Based on Veterinary Antimicrobial Imports between 2016 and 2019

Monitoring veterinary antimicrobial use is part of the global strategy to tackle antimicrobial resistance. The purpose of this study was to quantify veterinary antimicrobials imported into Timor-Leste between 2016 and 2019 and describe the antimicrobial import profile of importers. Data were obtained from import applications received by the Ministry of Agriculture and Fisheries (MAF) of Timor-Leste. Import quantities were analysed by antimicrobial class, importance for human medicine, recommended route of administration and type of importer. An average of 57.4 kg (s.d. 31.0 kg) and 0.55 mg/kg (s.d. 0.27 mg/kg) animal biomass of antimicrobials was imported per year. Tetracyclines (35.5%), penicillins (23.7%), and macrolides (15.9%) were the commonly imported antimicrobial classes. Antimicrobials imported for parenteral administration were most common (60.1%). MAF was the largest importer (52.4%). Most of the critically important antimicrobials for human medicine were imported by poultry farms for oral administration and use for growth promotion could not be ruled out. In conclusion, the use of antimicrobials in animals in Timor-Leste is very low, in keeping with its predominantly subsistence agriculture system. Farmer education, development of treatment guidelines, and strengthening of the veterinary service is important for addressing the potential future misuse of antimicrobials especially in the commercial poultry industry.

Assessment of Drivers of Antimicrobial Use and Resistance in Poultry and Domestic Pig Farming in the Msimbazi River Basin in Tanzania

Uncontrolled use of drugs both in humans and animals coupled with environmental contamination exacerbate the development and spread of antimicrobial resistance. This paper assessed the drivers of antimicrobial use and resistance in poultry and domestic pig farming and the environment. Questionnaires, in-depth interviews, and focus group discussions (FGDs) were used to collect information regarding demographic characteristics, knowledge, practices, attitudes, and perceptions of the drivers of antimicrobial use and resistance in animal farming and the environment. We found a higher proportion of usage of veterinary antimicrobials for prophylactic purposes (87.6%) in animal farming, than for therapeutic purposes (80.5%). The degree of farming experience was significantly (p < 0.05) related to the knowledge on the source of antimicrobial use, methods used in disease diagnosis, access to veterinary services, stocking of antimicrobials at home, and presence of agriculture activities that involve the use of manure. Uncontrolled disposal of wastes from households, disposal of human and veterinary drugs, and weak implementation of the legal framework was identified as the major contributors to the environment. The high usage of veterinary antimicrobials and the environmental contamination identified requires multisectoral interventions, as well as a review of government strategies, policies, and regulations on antimicrobial use.

Quantification, description and international comparison of antimicrobial use on Irish pig farms

Background There is concern that the use of antimicrobials in livestock production has a role in the emergence and dissemination of antimicrobial resistance in animals and humans. Consequently, there are increasing efforts to reduce antimicrobial use (AMU) in agriculture. As the largest consumer of veterinary antimicrobials in several countries, the pig sector is a particular focus of these efforts. Data on AMU in pig production in Ireland are lacking. This study aimed to quantify AMU on Irish pig farms, to identify the major patterns of use employed and to compare the results obtained to those from other published reports and studies. Results Antimicrobial use data for 2016 was collected from 67 Irish pig farms which represented c. 35% of national production. The combined sample population consumed 14.5 t of antimicrobial by weight of active ingredient suggesting that the pig sector accounted for approximately 40% of veterinary AMU in Ireland in 2016. At farm level, median AMU measured in milligram per population correction unit (mg/PCU) was 93.9 (range: 1.0–1196.0). When measured in terms of treatment incidence (TI200), median AMU was 15.4 (range: 0.2–169.2). Oral treatments accounted for 97.5% of all AMU by weight of active ingredient and were primarily administered via medicated feed to pigs in the post weaning stages of production. AMU in Irish pig production in 2016 was higher than results obtained from the national reports of Sweden, Denmark, the Netherlands and France but lower than the United Kingdom. Conclusions Pig production in Ireland is an important consumer of veterinary antimicrobials. The quantities and patterns of AMU on Irish pig farms are comparable to pig production in other European countries but higher than some countries with more advanced AMU reduction strategies. This AMU is characterised by a high proportion of prophylactic use and is primarily administered to pigs post weaning via medicated feed. Further studies to better understand the reasons for AMU on Irish pig farms and strategies to improve health among weaner pigs will be of benefit in the effort to reduce AMU.

Assessment of drivers of antimicrobial use and resistance in pig and poultry farming in the Msimbazi River Basin in Tanzania

Background Uncontrolled use of antimicrobials both in humans and animals coupled with environmental contamination by effluents, toxic chemicals, and heavy metals exacerbate the development and spread of antimicrobial resistance. This paper assessed the drivers of antimicrobial use and resistance in poultry and domestic pig farming and the environment in a densely populated area, with wide-ranging human activities in Tanzania. Methods This was a cross-sectional study conducted from June to September 2019 in the Msimbazi River basin in Eastern Tanzania, which covers an area of 271km2 and harbours a population of approximately 1.2 million. Questionnaires, in-depth interviews, and focus group discussions (FGDs) were used to collect information regarding demographic characteristics, knowledge, practices, attitudes, and perceptions of the drivers of antimicrobial use and resistance in animal farming and the environment. Descriptive statistics and the chi-square tests were used to analyse data from the survey and p<0.05 was considered as statistically significant. The FGDs and interviews were transcribed, coded into categories, and analysed manually. Results We found a higher proportion of usage of veterinary antimicrobials for prophylactic purposes (87.6%), especially tetracycline and quinolones in poultry and pigs farming, than for therapeutic purposes (80.5%). The farming experience was significantly (p<0.05) related to the knowledge on the source of antimicrobial use, methods used in disease diagnosis, access to veterinary services, stocking of antimicrobial at home, and presence of agriculture activities that involve use of manure. Additionally, a significant relationship (p<0.05) existed between the level of education and the practicing group treatment, inadequate extension officers, and inadequate knowledge on infection prevention and control of animal diseases. Uncontrolled disposal of wastes from households, uncontrolled disposal of human and veterinary drugs, and weak implementation of the legal framework was identified as the major pollutants of the environment. Conclusion The high usage of veterinary antimicrobials and environmental contamination taking place in the Msimbazi Basin requires agent multisectoral interventions, including implementation of long-term sustainable training programs aiming at reducing farmers' reliance on antimicrobials, as well as a review of government strategies, policies, and regulations on AMU.

The Role of Pharmaceutical Companies in Antimicrobial Stewardship: A Case Study

Rising levels of antimicrobial resistance pose serious dangers to patients, population health, food security, and economic stability worldwide. In response to this threat, the United Nations and the World Health Organization have called for multisectoral, multidisciplinary action, recognizing that human, animal, and environmental health are interdependent. Although the pharmaceutical industry clearly has a leading role in developing novel antimicrobials and vaccines, it is also active in many areas supporting antimicrobial stewardship. This article describes why pharmaceutical companies invest in antimicrobial stewardship, outlines why they are well suited to help address this issue, and provides examples of how the pharmaceutical industry can support the responsible use of antimicrobials. Merck & Co., Inc. (Kenilworth, NJ, USA), a large, globally operating pharmaceutical company that develops and markets both human and veterinary antimicrobials and vaccines is used as a case study for illustrating industry involvement in antimicrobial stewardship efforts.

Awareness of Veterinary Drug Retail Outlets on Antimicrobial Resistance and its Containment Strategy in Ethiopia

A cross-sectional study was conducted from January to March 2018 to assess the awareness of veterinary drug retail outlets on Antimicrobial Resistance (AMR) and the availability of veterinary antimicrobials in these facilities. Qualitative and quantitative data were collected using a structured questionnaire from a total of 108 retail outlets. The study revealed that there is a difficulty to treat infectious diseases of animals because of AMR which is reported by 70 (64.8%) of the respondents. 80.6% of the respondents believe that use of wrong antimicrobial is the possible cause of AMR and 79.6% use of counterfeit or poor quality antimicrobials, and 70.4% owners self-prescription of medicines for their animals. 59 (54.6%) of them also answered poor husbandry practices such as overcrowding, poor hygiene and sanitation, and poor feeding practice are the possible causes of AMR while 8 (7.4%) and 9 (8.3%) of the respondents do not know the reason for the AMR development and possible solutions for AMR containment, respectively. Only 24 (22.2%) of the dispensers have taken training on antimicrobial selection, use, resistance and resistance containment. Even though antimicrobials such as Oxytetracycline are available in around 90% of the retail outlets, only 70 (64.8%) of the retail outlets receive an average of 14 prescriptions (ranging from one to 200) per week from public and private clinics which shows a practice of antimicrobials dispensing without prescription. Therefore, strong mainstreaming strategies to prevent and control AMR should be developed and implemented. Antimicrobials prescription and dispensing practice should also be well regulated to avoid irrational prescription and dispensing practices.

Successful treatment of Yersinia pseudotuberculosis hepatitis in a cat presenting with neurological abnormalities

Case summary A 3-year-7-month-old female neutered domestic shorthair cat was presented for further investigation of acute-onset neurological abnormalities, including marked decreased mentation, ataxia and abnormal cranial nerve responses, with concurrent marked pyrexia (40ºC). Initial blood testing was non-specific with mild-to-moderate increases in alanine aminotransferase (ALT) (194 IU/l; reference interval [RI] 17–62 IU/l), aspartate aminotransferase (AST; 150 IU/l [RI 0–51 IU/l]) and total bilirubin (20 µmol/l; RI 0–11 µmol/l), and neutropenia (1.17 ×109/l; RI 2.5–12.5 ×109/l). Brain MRI and cerebrospinal fluid analysis were unremarkable and Toxoplasma serology was negative. Worsening of hepatic biochemical parameters (ALT 265 IU/l, AST 205 IU/l, total bilirubin 42.9 µmol/l) led to further investigations for liver disease, including ultrasound, fine-needle aspirate cytology, histology, fluorescent in situ hybridisation and culture of liver tissue and bile, resulting in a diagnosis of Yersinia pseudotuberculosis hepatitis. The cat was treated with a combination of potentiated amoxicillin (62.5 mg PO q12h), marbofloxacin (5mg PO q24h) and combined s-adenosyl methionine (SAMe)/silybin (90 mg PO q24h), and made a full recovery. Follow-up over 14 months identified a persistent mild increase in ALT, despite no apparent ongoing disease. Relevance and novel information Yersinia pseudotuberculosis hepatitis should be considered as a differential diagnosis in cats presenting with acute-onset neurological signs, and, when diagnosed, can be successfully treated with a combination of marbofloxacin, potentiated amoxicillin and SAMe/silybin. This is the first such case treated successfully with licensed veterinary antimicrobials and the first instance where Y pseudotuberculosis hepatitis has presented with primarily neurological clinical signs.