While antibacterials are essential medicines for treating bacterial infections, it is important to remember that their use leads to selection of resistant strains of bacteria. Resistance may be inherent, evolved (by chromosomal DNA changes) or acquired (by plasmid transfer).

It is important that the veterinary profession uses antibacterials responsibly in order to:

• Minimize the selection of resistant veterinary pathogens (and therefore safeguard animal health)
• Minimize possible resistance transfer to human pathogens
• Retain the right to prescribe certain antibacterials.

Following these guidelines will help to maximize the therapeutic success of antibacterial agents while at the same time minimizing the development of antibacterial resistance, thereby safeguarding antimicrobials for future veterinary and human use. These guidelines should be read in conjunction with the updated BSAVA Guide to the Use of Veterinary Medicines , the PROTECT ME guidance and individual drug monographs (www.bsavalibrary.com).

Following the PROTECT ME guidance can help reduce resistance:

Prescribe only when necessary  Consider non-bacterial disease (e.g. viral infection), nutritional imbalance or metabolic disorders where antibacterial therapy would be redundant. Remember also that some bacterial disease will self-resolve without antibacterials. Offer a non-prescription form (see Appendix 15) to support a decision not to prescribe antibacterial therapy.

Reduce prophylaxis Antibacterials are not a substitute for surgical asepsis and the need for prophylactic antibacterials in surgery should be carefully considered. Prophylactic antibacterials are only appropriate in a few medical cases (e.g. immunocompromised patients).

Offer other options Consider therapeutic alternatives (e.g. lavage and debridement of infected material, analgesia, cough suppressants, fluid therapy or nutritional modification). Use topical preparations as these reduce the selection pressure on resident intestinal flora (the microbiome). Use effective hygiene techniques and antiseptics to prevent infections.

Treat effectively Before prescribing antibacterials, consider which bacteria are likely to be involved and how effectively the chosen drug will penetrate the target site. Use the shortest effective course and avoid underdosing. Ensure compliance with appropriate formulation and clear instructions.

Employ narrow spectrum Unnecessarily broad-spectrum antibacterials could promote antibacterial resistance, whilst selecting narrow-spectrum antibacterials limits the effects on commensal bacteria. Use culture results to support de-escalation (switching to a narrower spectrum antibacterial) whenever possible.

Culture appropriately A sample for culture should be collected before starting antibacterial therapy. Culture is essential when prolonged (>1 week) treatment courses are anticipated, when resistance is likely (e.g. hospital-acquired infections) and with life-threatening infections. If first-line treatment fails, do not use another antibacterial without culture and sensitivity results (avoid cycling antibacterials).

Tailor practice policy to patients A customised practice policy can guide antibacterial selection to address the bacterial infections and resistance patterns that you encounter, minimizing inappropriate use. Complete the tick boxes in your PROTECT ME poster to highlight YOUR practice’s first-line approach to each condition.

Monitor culture results Track and record culture profiles and update your practice policy accordingly. Monitor for preventable infections (e.g. postoperative) and alter practices if needed. Audit your own antibacterial use, particularly of critically important antibacterials (e.g. fluoroquinolones and cefovecin).

Educate others Share this important message to reduce the threat from multi-resistant strains of bacteria and improve the health of pets and people.