Antimicrobial Prescription Behavior in Equine Asthma Cases: An International Survey.

Simple Summary: It is important to minimize and optimize the use of antimicrobials to prevent resistance to these medications. Resistant bacteria can cause dangerous infections in people or animals. As in people, asthma in horses is considered non-infectious, so it is not necessary to use antimicrobials. However, in this this large survey completed by 249 equine veterinarians in 25 countries, we found that, just like general practitioners sometimes prescribe antimicrobials in human cases, 53% of the responding veterinarians stated to sometimes prescribe antimicrobials in asthma cases. We also tried to find out why and it became clear that knowledge of the pathophysiology of asthma, the country/culture the veterinarian works in, and the type of practice that they work in are important factors influencing prescription behavior. On the patient level, medical factors clearly predominate, possibly because several of these could also be compatible with infectious disease. This study underlines the need for further research on antimicrobials in equine asthma, the dissemination of knowledge of the pathophysiology of equine asthma, and clear (worldwide) guidelines on antimicrobial stewardship to diminish the inappropriate use of (critically important) antimicrobials in cases of equine asthma. Equine asthma is considered a non-infectious respiratory disease characterized by inflammation and hypersensitivity. Given the importance of antimicrobial stewardship, an international survey was designed to investigate the use of antimicrobials in asthmatic horses and the factors influencing prescription behavior. An online survey was distributed in six languages by international mailing lists and social media from December 2020 to January 2022. Of the 434 responses recorded, 249 veterinarians working in 25 countries finished the survey. These included 79 ECEIM/ACVIM diplomats. A total of 204 respondents confirmed national regulations concerning antimicrobial use in their country. Knowledge of the asthma definitions as presented in the revised ACVIM consensus statement was greater in veterinarians treating over 95% of equine patients compared to veterinarians treating more species, based on 10 questions (answers consistent with the consensus statement in 7 (IQR 5–9) and 4 (IQR 3–6) questions, respectively, (p < 0.001)). A total of 131 respondents stated to use antimicrobials (at least 'sometimes') in at least one of the three presented cases consistent with equine asthma. Trimethoprim-Sulfa combinations, penicillin(s), and tetracyclines were prescribed most (by 105, 53 and 38 veterinarians, respectively). Aminoglycosides, cephalosporins and fluoroquinolones were also selected (22, 15, 9 veterinarians respectively). Tetracyclines and cephalosporins are prescribed more often by veterinarians working without national regulations (p 0.019 and p 0.035, respectively). The most selected factors influencing prescription behavior were: 'tracheal wash culture' (62% of 131 veterinarians using antimicrobials in these cases), 'whether other horses in the barn have similar complaints' (60%), and 'response to other forms of therapy' (53%). In conclusion, insight into prescription behavior is the first step towards minimizing and optimizing antimicrobial use. [ABSTRACT FROM AUTHOR]