title: Antimicrobial selection and dosing in the treatment of wounds in the United Kingdom.
abstract: BACKGROUND
  Antimicrobial stewardship within the veterinary profession is recognised by governing and professional bodies as being important; the attitudes and behaviour of veterinary surgeons merit investigation.
  
  
  OBJECTIVE
  To investigate levels of protected antimicrobial use and accuracy of antimicrobial dosing in a common clinical scenario in equine practice.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Antimicrobial use was evaluated retrospectively in 113 cases subsequently referred to a single referral hospital for the treatment of limb wounds over a 20-month period. Antimicrobial classification (first-line, alternative or protected) was made according to guidelines produced by the British Equine Veterinary Association. These guidelines also served as the reference for recommended dose rates.
  
  
  RESULTS
  Systemic antimicrobials were administered prior to referral in 94/113 (83.2%) horses, of which 8 (8.5%) received the protected third or fourth generation cephalosporins or fluoroquinolones. Forty-eight of 87 (55.2%) horses for which complete dosing data were available received antimicrobials at ≤90% of the recommended dose. Practitioners who held a postgraduate clinical qualification or worked in purely equine practice were no more or less likely to use protected antimicrobials (P = 0.06 and P = 0.64, respectively) or administer inadequate doses (P = 0.75 and P = 0.85, respectively). Veterinary surgeons with more experience were less likely to use protected antimicrobials (P<0.001); however, with the small case numbers, this finding should be interpreted with caution. Heavier horses were more likely to be under-dosed (P<0.002).
  
  
  CONCLUSIONS
  This study highlights the administration of certain classes of antimicrobials in situations where their use is unlikely to be justified. If these findings reflect more general attitudes and behaviour then greater awareness of, and compliance with, recommendations for responsible antimicrobial use are required among equine practitioners. Bodyweight ought to be measured or estimated using validated objective techniques prior to systemic medications being administered.
authors.affiliation: Liphook Equine Hospital, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Ross
authors.affiliation: School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington Campus, UK.
authors.forename: M
authors.initials: M
authors.lastname: Duz
authors.affiliation: Liphook Equine Hospital, UK. daverendle@me.com.
authors.forename: D I
authors.initials: DI
authors.lastname: Rendle
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control / Q000662:veterinary*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006734:Horse Diseases / Q000453:epidemiology / Q000517:prevention & control*; D006736:Horses / Q000293:injuries*; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology / Q000662:veterinary*
chemical_list: D000900:Anti-Bacterial Agents
keywords: antimicrobial; horse; resistance; stewardship; synovial sepsis; wound