b"ARTICLEAntimicrobial resistance (AMR) isAntimicrobial stewardship (AMS) has one of the most pressing One Healthnever been more important.challenges of our time. Antibiotics areThe Three Rs: a mindset for everydaya finite resource. With no new classes of antibiotics licensed for veterinaryAt its core, AMS is about preserving use since the 1970s, we are relying on athe efficacy of antibiotics for the limited and increasingly fragile resource.future. As RCVS Specialist in Veterinary Dermatology, Tim Nuttall explains in In the UK, an estimated 66,730 seriousKrkas latest podcast series:antibiotic-resistant infections were reported in human healthcare in 2023,If we don't preserve the efficacy of up from around 60,000 in 2019. Lookingthese drugs, we are going to see a crisis ahead, global modelling studiesand possibly be moving back into a highlight the importance of sustainedpost-antibiotic era. And this is a true One action, with projections suggesting AMRHealth problem.could have an even more significant In veterinary practice, AMS means impact on public health by 2050 if leftmaking informed, responsible unaddressed. prescribing decisions about antibiotic For the veterinary profession this isuseprescribing only when necessary not just a theoretical concern. Fromand replacing, reducing and refining recurrent skin infections to urinaryantibiotic use. These Three Rs of AMS tract issues, inappropriate prescribingprovide a practical framework for decisions can accelerate theguiding antibiotic use (Table 1).development of resistance. Replace Reduce RefineU se alternatives toReduce antibioticDiagnose bacterial antibiotics prescribingaudit andinfectionsbenchmarkPractise preventative care Reduce owner expectationsUse the right drug for the for antibiotic treatment right bugTreat the underlyingUse 1st tier & narrow-disease spectrum antibioticsUse symptomatic treatmentJustify the use of 2nd orlet the immune system3rd tier & broad-spectrum tackle the infection antibioticsUse antiseptics Treat to clinical cureavoid over-treatingTable 1. The three Rs of antimicrobial stewardshipInforming the right choice Tim explains that cytology should always Making the right antibiotic choice startsbe performed prior to culture. As well with confirming whether a bacterialas confirming the presence of infection, infection is present. This involves athe most likely bacteria involved can structured approach: be identified based on morphology - 1. Check clinical signs are consistent withfor example, staphylococci form pairs, a bacterial infection groups of four and irregular clumps, while 2. Use in-house cytology to confirmstreptococci and enterococci form pairs infectionthat align into chains. Cytology also shows the relative numbers of bacteria 3. Use bacterial culture and antimicrobialpresent at the site of infection and helps sensitivity testing where needed with interpretation of culture results. In www.inspiredvet.co.uk33"