For educators - teacher resources
We have adapted the ESCMID antimicrobial prescribing competencies for use in veterinary teaching and compiled some teaching resources (see below).
Competencies for veterinary antimicrobial prescribing and stewardship
Section 1
| Competency | Consensus |
|---|---|
| Every graduating veterinarian must know: | |
| 1.1.1 | The nature and classification of micro-organisms that commonly cause infections in common animal species |
| 1.1.2 | The common microbiological aetiology of animal infections and the ways in which microorganisms are commonly acquired in community and hospital settings |
| 1.1.3 | The differences between colonisation and infection |
| 1.1.4 | That an inflammatory response can be due to both infectious and non-infectious causes |
| Every graduating veterinarian must know how to: | |
| 1.2.1 | Take a thorough history and perform a physical examination to diagnose common infections and to assess their severity |
| 1.2.2 | Use and interpret investigations that can help in informing diagnosis of an infection and in monitoring the response to treatment |
Section 2
| Competency | Consensus |
|---|---|
| Every graduating veterinarian must understand: | |
| 2.1.1 | How and where to access relevant guidance on antimicrobial prescribing and stewardship |
| 2.1.2 | When not to prescribe antimicrobials |
| 2.1.3 | That best practices for some infections may not include antimicrobial treatment |
| Every graduating veterinarian must understand how to select the appropriate antimicrobial, using relevant guidance, when possible, as well as the key elements of initiating prescribing an antimicrobial: | |
| 2.2.1 | Obtaining relevant microbiological cultures or relevant tests before commencing treatment |
| 2.2.2 | The timing of antimicrobial administration in different situations |
| 2.2.3 | The choice and dose of agent, and the route of administration |
| 2.2.4 | The duration of treatment, review dates and stop dates |
| Every graduation veterinarian must understand the key elements of continuing and rationalising antimicrobial therapy: | |
| 2.3.1 | Changing antibiotics according to microbiology results and clinical condition, ideally to a narrower spectrum (de-escalation), or, if needed, to a broader spectrum (escalation) |
| 2.3.2 | Reviewing antibiotic therapy at 48 to 72 hours and regularly thereafter in hospitalised patients, and in appropriate situations in the community |
| 2.3.3 | Stopping antimicrobials if there is no evidence of infection based on clinical findings and investigations |
| Every graduating veterinarian must understand: | |
| 2.4.1 | The need to document the important details of the antimicrobial treatment plan in the record, and how to transfer notes to other veterinarians |
| 2.5.1 | That empirical treatment should be guided by local antimicrobial susceptibility patterns, where available |
| 2.5.2 | The clinically relevant spectrum of activity for commonly prescribed antimicrobials |
| 2.5.3 | The basic principles of pharmacokinetics and pharmacodynamics |
| When prescribing an antimicrobial, every graduating veterinarian must know: | |
| 2.6.1 | The antimicrobial class that the agent belongs to, and the contraindications to its use |
| 2.6.2 | The name and class of antimicrobial being prescribed, if prescribing by trade name |
| 2.6.3 | When prescribing an antimicrobial, every graduating veterinarian must know the limitations affecting the usefulness of compounded medicines and potential issues related to drug stability. |
| Every graduating veterinarian must understand: | |
| 2.7.1 | Single prophylactic dosing for surgical and other procedures for which prophylaxis has been shown to be effective, and that additional prophylactic antimicrobial doses can occasionally be needed |
| Every graduating veterinarian must know: | |
| 2.8.1 | Common antimicrobial and drug/food interactions |
| 2.8.2 | Common side-effects of antimicrobials, how to monitor for them, and what to do when they are suspected |
| 2.9.1 | Any legal requirements for prescribing antimicrobials in their country, and comply with these when prescribing |
| 2.9.2 | Every graduating veterinarian must know the legislation regulating extra-label use of medications in their region |
Section 3
| Competency | Consensus |
|---|---|
Every graduating veterinarian must understand that: | |
| 3.1.1 | Antimicrobials need to be used responsibly to prevent the emergence and spread of antimicrobial resistance |
| 3.1.2 | Optimising antimicrobial use can limit the common side-effects and collateral damage related to treatment (e.g. their disruptive effects on the normal host flora, which may lead to infection with resistant pathogens) |
| 3.1.3 | It is important to avoid unnecessary uses of antimicrobials, especially those with a broad spectrum |
| 3.1.4 | Transmission of microorganisms in community and veterinary hospital settings can significantly amplify antimicrobial resistance |
| 3.1.5 | Every graduating veterinarian must understand the legislation and risks associated with the use of antimicrobials for prophylaxis and growth promotion. |
| Every graduating veterinarian must: | |
| 3.2.1 | Understand local antimicrobial stewardship policies based on national (or, where these do not exist, international) evidence-based guidelines |
| 3.2.2 | Every graduating veterinarian must be aware of the national (or, where these do not exist, international) importance ratings of antimicrobials. |
| 3.3.1 | Understand and engage with any locally or nationally agreed quality measures for assessing antimicrobial prescriptions (e.g. compliance with guidance, adverse events, reviews of antibiotic therapy at 48 & 72 hours in hospitalised patients) |
| Every graduating veterinarian must know how to communicate with nurses & technicians, owners, farmers and other animal workers, and other healthcare professionals about: | |
| 3.4.1 | When antimicrobials are not needed |
| 3.4.2 | Complying with the duration and frequency of administration of their prescribed antimicrobials |
| Every graduating veterinarian must: | |
| 3.5.1 | Recognise that it is a duty of care to co-operate with others with more expertise than oneself, such as antimicrobial stewardship experts, when such expertise is needed and available |
AMS teaching resources CIMVE
Australian Vet Prescribing Guidelines
Evidence-based guidelines with research underpinning the guidelines are listed.
ASTAG
Australian Government group that advises on AMR-related issues.
Antibiotic Scout
No English translation.
British Veterinary Association's responsible use policy
Policy document.
Center for Educational Technologies
Requires registration. Designed to help teach vet students the essential knowledge and skills to support judicious use of antimicrobials in clinical practice.
Decision tree for urinary tract infections
When to consider antibiotics.
Minnesota University
has a large number of resources, including a webinar, a handbook and resources for a variety of different animals.
Ohio State
Antimicrobial use guidelines in a free online book format.
Ontario Vet College
A lot of information for many antibiotics, eg activity, stewardship, dosing, adverse effects, etc.
Prescribing guidelines with printable posters
Including the traffic light system for antibiotic choice and other useful links.
Prudent use of antibiotics
Swedish vet guidelines on prudent use of antibiotics.
RUMA
Responsible use of medicine in agriculture.
sodapop
Students consider the source and organism before they decide to treat; then they consider the antimicrobials to which the organism is susceptible with regard to contraindications in the patient; and, ultimately, the options are weighed and a plan is formulated.
Texas AM University
Texas A&M University Antimicrobial Pharmacokinetics in Animals.
UK vet school good practice in antimicrobial stewardship
UK vet schools council good practice in antimicrobial stewardship.
VetBact
Basic bacteriology.