b'ARTICLEIn the UK, anmixed cultures for example, interpretingSupporting responsible prescribing the results alongside cytology means it isWhen indicated, the selection of an estimated66,730 possible to target treatment to the mostantibiotic should always be guided by serious antibiotic- important bacteria. the site and severity of infection, the resistant infectionslikely pathogens involved, and the results Did you know?of cytology or culture where available. were reported inAntimicrobial stewardship does not human healthcareCulture and sensitivity testing ismean never using broader-spectrum poorly predictive of treatmentor second-line antibiotics - it means in 2023 success when selecting topicalreserving them for situations where they antibiotics. Cytological diagnosis isare clinically justified, and ensuring their the preferred approach. use is backed by clinical reasoning and diagnostic tests.Cost can sometimes be a barrier to best practice, particularly if the most appropriate product is prohibitively expensive for the client. Generic pharmaceuticals can support responsible prescribinghelping to maintain compliance, reduce under-dosing and avoid the temptation to prescribe a broader-spectrum product based on price rather than clinical need.When is empirical therapy appropriate? Topical therapy First episode of infectionNo systemic antimicrobial therapy within preceding 3 monthsSimple infections e.g. surface or Current challenges in practice superficial pyodermaDespite growing awareness andCytology shows bacteria with widespread support for the principles ofpredictable antibiotic susceptibility AMS, there are barriers to implementinge.g. staphylococci in skin infectionsit consistently in practice. In firstAntimicrobial resistance is unlikelyopinion clinics, where consultations are typically limited to 10-15 minutes, it can be tempting to reach for antibioticsCommunicating with confidenceas a safe option - especially whenEffective client communication the diagnosis is uncertain. But quickis fundamental to antimicrobial fixes can come at a long-term cost,stewardship (AMS). Yet it can be one selecting for resistance and increasingof the most challenging aspects of the likelihood of treatment failure due toresponsible prescribing. However, as Tim resistance later. explains, owner demand for antibiotics A key strategy is to build cytology intois often overestimated, with research everyday workflow - making microscopessuggesting that quite a lot of the accessible, ensuring all the clinical teamdemand is perceived rather than real. are trained and encouraging routine use.For example, a pyrexic dog is treated Tim advises, Have the tape, slides, stainswith both an NSAID and an antibiotic and microscope ready to go. If its quickand subsequently improves. The owner and easy, it becomes part of the consultassumes the antibiotic was key to flow, not an afterthought. recovery, so next time the dog presents 34www.inspiredvet.co.uk'