Systematic review of the factors affecting cat and dog owner compliance with pharmaceutical treatment recommendations

Assessing Illinois companion animal veterinarians' antimicrobial prescription practices and the factors that influence their decisions when treating bacterial infections in dogs and cats

AIMS

Judicious antimicrobial use in companion animal practice is critical for maintaining the effectiveness of antimicrobial agents against bacterial infections and reducing the selection of antimicrobial-resistant bacteria. This study aimed to provide insights into companion animal veterinarians' antimicrobial treatment recommendations for common bacterial infections in dogs and cats and describe the factors influencing their prescription choices.

METHODS AND RESULTS

An online survey using QualtricsXM® software was administered between September and November 2022 to companion animal veterinarians who were Illinois State Veterinary Medical Association members. Descriptive and text analyses were conducted to assess the participants' responses. A total of 78 surveys were included in the analysis. Skin infections were ranked as the most common bacterial infections for which veterinarians prescribed antimicrobial agents, followed by ear, urinary tract, respiratory, and enteric infections. The severity of clinical symptoms and the results of bacterial culture and susceptibility tests were the most influential factors for veterinarians when making antimicrobial prescription choices. Veterinarians were aware of the current antimicrobial prescription guideline recommendations when prescribing antimicrobials empirically to nine hypothetical scenarios of bacterial infections. According to the results of the text analysis that assessed veterinarians' responses to an open-ended question, regarding their challenges when prescribing antimicrobial agents, the pairwise correlation of word frequencies within each response showed the highest correlations between the words 'owner' and 'compliance', 'administration' and 'route', 'cost' and 'culture', and 'patients' and 'acceptance'.

CONCLUSIONS

The study results can support animal health stakeholders in the development of antimicrobial stewardship programmes to promote appropriate antimicrobial use and limit the emergence of antimicrobial resistance.

The Single-Dose Pharmacokinetics of a Compounded Levetiracetam Formulation and Bioequivalence to a Commercial Formulation in Healthy Dogs

Levetiracetam (LEV) is an anti-epileptic drug used extra-label in dogs. Commercially available extended-release formulations (LEV-ER), administered twice daily, cannot be crushed or split, limiting their use in small dogs. A compounded LEV-ER formulation (PO-COMP) can purportedly be partitioned without loss of extended-release properties. The aims of this study were to establish the pharmacokinetic parameters of PO-COMP, divided at the tablet score, and determine the bioequivalence of partitioned PO-COMP to an intact commercially available Food and Drug Administration-approved human oral generic formulation of LEV-ER (PO-COMM). In a randomized crossover design, 12 healthy dogs received a single IV dose (30 mg/kg) of IV-COMM, a single oral dose (500 mg) of intact PO-COMM, or a single oral dose (500 mg) of partitioned PO-COMP and underwent serial measurement of plasma LEV concentrations over 24 h. PO-COMP was bioequivalent to PO-COMM using the 90% confidence interval method for maximum concentration (-3.2% difference [CI -7.4% to -1.1%]) and area under the curve (-14.4% difference [CI -17.8% to 10.8%]). PO-COMP may improve medication adherence and seizure control relative to immediate-release LEV, which requires three times daily dosing. Efficacy studies of PO-COMP are warranted.

Factors Associated with Medication Noncompliance in Dogs in New Zealand

Client compliance with prescribed medication instructions to treat their pets is a concern. This study describes factors associated with the noncompliance of dog owners with veterinary recommendations for medication, as well as client-reported barriers and aids to administering medications. A cross-sectional survey of dog owners' compliance with veterinary medication recommendations was performed from 9 January 2019 to 18 July 2020. A convenience sample of owners who prescribed medication for their dogs during or following elective veterinary examination was surveyed regarding medication administration experience and compliance. Owners were followed up to determine if the course of medication had been completed. Compliance data were analyzed descriptively. Logistic regression was performed with compliance as the outcome. Medication noncompliance was recorded for 47% (71/151) of owners. Increasing dog age was associated with better owner compliance (p < 0.05). Pet owners who used "nothing" as an aid to medicating were less likely to be noncompliant (p < 0.05). Forty-seven percent (71/151) of owners reported that "nobody" showed them how to administer the medication. One-third of dog owners (47/151) reported challenges in medicating their pets. The most common reason cited by clients reporting challenges was a resistant pet. Demonstration of medication administration techniques and discussion about available aids to medicating a pet may improve client compliance.

Development and validation of a quality of life and treatment satisfaction measure in canine osteoarthritis

Introduction

Canine osteoarthritis (OA) causes pain and mobility impairment. This can reduce dog quality of life (QoL), owner QoL and owners' satisfaction with, and adherence to, treatments. No existing canine OA-specific instrument assesses all three impacts. This study aimed to develop and psychometrically evaluate an owner-completed canine OA-specific measure of dog QoL, owner QoL and owner treatment satisfaction; the "Canine OA Quality of Life and Treatment Satisfaction Questionnaire" (CaOA-QoL-TS).

Methods

The CaOA-QoL-TS was developed using a conceptual model derived from a meta-synthesis of published literature followed by cognitive interviews with ten owners of dogs with OA, to evaluate content validity.

Results

Based on interview findings, ten items were reworded, four removed, and two added; resulting in 26 items that all owners understood and considered relevant. The recall period and response options were well understood and appropriate to almost all owners. To evaluate its psychometric properties, the CaOA-QoL-TS (draft 26-item version) was administered, across six timepoints in a phase 4 field study, to owners of OA treated dogs, recruited from veterinary practices (N = 93). Inter-item correlations suggested items clustered into three distinct domains: Dog QoL, Owner QoL and Treatment Satisfaction, as hypothesized. Confirmatory factor analysis supported deletion of two items and calculation of the three domain scores, with acceptable model fit. The resulting 24-item CaOA-QoL-TS instrument demonstrated strong internal consistency and good to excellent test-retest reliability. Convergent validity was supported by moderate to strong correlations with concurrent measures. Known groups validity was supported by statistically significant differences between groups categorized by owner global impression of QoL. Ability to detect change was demonstrated through statistically significant improvements over time in Owner and Dog QoL, with larger within-group effect sizes reported for the mean of 'improved' dogs compared to the mean of 'stable' dogs. Only a small sample of dogs worsened throughout the study. Anchor-based analyses supported-0.9 and-1.0-point within-group responder definitions for dog and owner QoL domains, respectively.

Discussion

Findings support the content validity of the CaOA-QoL-TS in canine OA. The 24-item CaOA-QoL-TS is a reliable and valid instrument to measure owner and canine QoL and TS and is sensitive to improvements following OA treatment.

Description of the fasted serum metabolomic signature of lean and obese cats at maintenance and of obese cats under energy restriction

This study aimed to investigate the serum metabolomic profile of obese and lean cats as well as obese cats before and after energy restriction for weight loss. Thirty cats, 16 obese (body condition score 8 to 9/9) and 14 lean (body condition score 4 to 5/9), were fed a veterinary weight loss food during a 4-week period of weight maintenance (L-MAINT and O-MAINT). The 16 obese cats were then energy restricted by a 60% energy intake reduction with the same food for a 10-week period (O-RESTRICT). Fasted serum metabolites were measured using nuclear magnetic resonance and direct infusion mass spectrometry after the maintenance period for L-MAINT and O-MAINT cats and after the energy restriction period for O-RESTRICT and compared between groups using a two-sided t-test. Obese cats lost 672 g ± 303 g over the 10-week restriction period, representing a weight loss rate of 0.94 ± 0.28% per week. Glycine, l-alanine, l-histidine, l-glutamine, 2-hydroxybutyrate, isobutryric acid, citric acid, creatine, and methanol were greater in O-RESTRICT compared to O-MAINT. There was a greater concentration of long-chain acylcarnitines in O-RESTRICT compared to both O-MAINT and L-MAINT, and greater total amino acids compared to O-MAINT. Glycerol and 3-hydroxybutyric acid were greater in O-MAINT compared to L-MAINT, as were several lysophosphatidylcholines. Thus, energy restriction resulted in increased dispensable amino acids in feline serum which could indicate alterations in amino acid partitioning. An increase in lipolysis was not evident, though greater circulating acylcarnitines were observed, suggesting that fatty acid oxidation rates may have been greater under calorie restriction. More research is needed to elucidate energy metabolism and substrate utilization, specifically fatty acid oxidation and methyl status, during energy restriction in strict carnivorous cats to optimize weight loss.

Guardians' perceptions of caring for a dog with canine cognitive dysfunction

BACKGROUND

Canine cognitive dysfunction (CCD) is a neurodegenerative disease that is difficult to diagnose, as its clinical signs are similar to those of other age-related conditions. The experience of caring for a senior dog with or without CCD is not well described.

METHODS

Data were collected via an online survey. Using a mixed methods design, the level of CCD and burden of care were measured using validated tools, and open-ended questions gathered qualitative data. A general linear model showed the factors associated with guardian burden of care.

RESULTS

Sixteen percent of guardians experienced a clinically significant burden of care. Factors associated with burden of care included severity of CCD, sleep location, guardian employment, household size, dog age, guardian age and the dog taking medication. Few dogs with CCD were prescribed CCD medications to ameliorate clinical signs. Euthanasia, strong attachment mitigating burden and the complexities of caregiving were themes presented by guardians.

LIMITATIONS

Measures are based on self-reports and as such the usual limitations apply.

CONCLUSIONS

The burden of caring for an older dog is greater if they have CCD. More attention to the treatment of senior dogs, including medications to reduce clinical signs of CCD, could improve the welfare of older dogs and decrease the clinical burden experienced by guardians.

Once-a-day oral treatment with phenobarbital in cats with presumptive idiopathic epilepsy

OBJECTIVES

Phenobarbital (PB) q12h is the most common treatment recommendation for cats with recurrent epileptic seizures. Medicating cats may be challenging and result in decreased quality of life for both cat and owner. The aim of this retrospective study was to evaluate treatment with oral PB q24h in cats with presumptive idiopathic epilepsy.

METHODS

Nine cats with presumptive idiopathic epilepsy, receiving oral PB q24h, were included in a retrospective descriptive study.

RESULTS

Seizure remission was achieved in 88% (8/9) of the cats and good seizure control in 12% (1/9) of the cats, treated with a mean dose of oral PB of 2.6 mg/kg q24h (range 1.4-3.8 mg/kg). No cats required an increase of their PB frequency at any time during a mean follow-up period of 3.5 years (range 1.1-8.0 years). No cats displayed side effects or issues with compliance at the last recorded follow-up.

CONCLUSIONS AND RELEVANCE

Once-a-day administration of PB for feline epilepsy was safe and resulted in satisfactory seizure control for the nine cats included in this study. The results of this study justify exploring this topic further in larger prospective studies.

Online survey of owners' experiences of medicating their cats at home

OBJECTIVES

The aim of this study was to use an online survey to obtain information from cat owners about their experiences of medicating their cats.

METHODS

An online survey containing 35 questions on experiences of medicating cats was circulated to cat owners globally.

RESULTS

In total, 2507 surveys from 57 countries were analysed; 1724 from 'cat owners' and 783 from 'cat owners+' (respondents with significant cat experience, including veterinary professionals). Around half (50.7%) of cat owners were 'sometimes' or 'never' provided with information or advice on how to administer medication; however, 91.8% of those given information found it 'somewhat' or 'very' useful. Around half (53.6%) of owners sought information from the internet about how to administer medication. Total cat owners (cat owners and cat owners+) administered liquids (61.3%), pastes (45.3%) or tablets (39.5%) directly into their cat's mouth; fewer (22.6-24.1%) hid these medications in food. Total cat owners rated tablets significantly harder to administer than liquids; 53.0% chose liquids as their first-choice formulation while 29.3% chose tablets. Insulin injections and 'spot-ons' were significantly easier to administer than any oral medications. Over half (51.6%) of owners reported that medicating their cat(s) had changed their relationship with them; 77.0% reported that their cat(s) had tried to bite or scratch them when medicating. Other challenges included the cat(s) spitting out tablets (78.7%), refusing medication in food (71.7%) and running away (52.7%). Of the owners who failed to complete a course of medication (35.4%), 27.8% stopped near the end of the course, while 19.3% stopped after a few doses, in both cases as medicating was too difficult.

CONCLUSIONS AND RELEVANCE

Owners appreciate being provided with information about the administration of medication. Frequent challenges when medicating cats include potential human injury and damage to the owner-cat relationship. Pharmaceutical companies should provide a range of formulations to ease compliance. Veterinary clinics should provide information/demonstrations and internet links when prescribing medications.

Preliminary validation of a novel tool to assess dog welfare: The Animal Welfare Assessment Grid

Animal welfare monitoring is a vital part of veterinary medicine and can be challenging due to a range of factors that contribute to the perception of welfare. Tools can be used, however; there are few validated and objective methods available for veterinary and animal welfare professionals to assess and monitor the welfare of dogs over their lifetime. This study aimed to adapt a framework previously validated for other species, The Animal Welfare Assessment Grid (AWAG), for dogs and to host the tool on an accessible, easy to use online platform. Development of the AWAG for dogs involved using the scientific literature to decide which factors were relevant to score welfare in dogs and to also write the factor descriptors. The primary tool was trialed with veterinary professionals to refine and improve the AWAG. Content validity was assessed by subject matter experts by rating the validity of the factors for assessing dog welfare using the item-level content validity index (I-CVI) and scale-level content validity index based on the average method (S-CVI/Ave). Construct validity was evaluated by users of the tool scoring healthy and sick dogs, as well as healthy dogs undergoing neutering procedures. Mann Whitney tests demonstrate that the tool can differentiate between healthy and sick dogs, and healthy and healthy dogs post elective surgery. Test re-test reliability was tested by users conducting multiple assessments on individual dogs under non-changing conditions. Inter-rater reliability was assessed by two users scoring an individual dog at the same time in veterinary referral practice. Repeated measures ANOVA for test re-test and inter-rater reliability both show no statistical difference between scores and that the scores are highly correlated. This study provides evidence that the AWAG for dogs has good content and construct validity, alongside good test re-test and inter-rater reliability.

Knowledge, attitudes and influencers of cat owners in North America around antimicrobials and antimicrobial stewardship

Objectives

The primary aims of this study were to determine preferences of North American cat owners when they are prescribed an antimicrobial for their cat with regard to cost, method of administration and the importance of antibiotics for treating infections in people, and to establish baseline knowledge, attitudes and influencers of cat owners on antimicrobial resistance and stewardship.

Methods

An online questionnaire was used for data collection from two cat-owner groups: US cat owners and Canadian cat owners. Participants were queried on antimicrobial resistance and stewardship, and their preferences for their own cat when prescribed an antimicrobial, with respect to cost, method of drug administration and the importance of a drug for treating infections in people. Responses were evaluated through conjoint analysis and Likert-type questions. Data were analyzed using descriptive and analytic statistics.

Results

A total of 630 complete responses were included in the final analysis. Cost (37%) and method of administration (38%) were of similar participant preference when assessed using conjoint analysis. The importance of a drug for treating infections in people was lower priority (21%). The majority of cat owners preferred an antimicrobial that was ‘very important’ in treating human infections. A low proportion (21%) of participants responded that antimicrobial use in pets posed a risk to humans. Participants with a university education were more likely to respond that antimicrobial use in pets was a concern for people (31%; P <0.001).

Conclusions and relevance

Cat owners prioritize antimicrobial cost and method of administration equally. Few cat owners recognized the human antimicrobial resistance risks associated with antimicrobial use in pets.

Owner compliance in canine epilepsy

BACKGROUND

Poor medication compliance by human epilepsy patients is one of the leading causes of treatment failure and increased seizure frequency. The aim of this cross-sectional study was to analyse owner compliance in pharmacological treatment of canine idiopathic epilepsy and to identify factors associated with poor compliance.

METHODS

The number of antiseizure drug tablets was recorded to determine if the patient received sufficient tablets to cover the time period between prescriptions and to assess compliant prescription cycles. Additionally, compliance was assessed by an online survey of owners.

RESULTS

For the prescription monitoring data from 94 cases from three small animal practices in the United Kingdom revealed an overall median compliance of 56%. Thirt-three per cent of owners were >80% compliant, while 21% were 100% compliant. During a non-compliant prescription cycle, a patient missed a median of 6 days (0.11-519 days) of treatment. Patients on polytherapy had higher compliance rates than on monotherapy (p = 0.031). The survey (229 respondents from online canine epilepsy groups) showed that low daily dosing was associated with better compliance (p = 0.049).

CONCLUSION

Owner compliance was subpar in this study and could represent a significant issue in epilepsy management, which needs to be considered by veterinary surgeons when treating canine epilepsy.

Safety, Tolerability, and Proof-Of-Concept Study of OKV-119, a Novel Exenatide Long-Term Drug Delivery System, in Healthy Cats

Background: Glucagon-like peptide-1 (GLP-1) is an incretin hormone that plays an important role in glucose homeostasis and food intake. In people, GLP-1 receptor agonists (GLP-1RAs) are commonly used for the treatment of type 2 diabetes mellitus (DM) and obesity; however, non-adherence to injectable medications is common. OKV-119 is an investigational drug delivery system intended for subdermal implantation and delivery of the GLP-1RA exenatide for up to 6 months.

Hypothesis/Objectives: Develop protocols for the subcutaneous (SC) insertion and removal of OKV-119 and to evaluate its tolerability, in vivo drug-releasing characteristics, and weight-loss effects in cats.

Animals: Two cadaveric and 19 purpose-bred cats.

Methods: In cadavers, OKV-119 insertion protocol and imaging were performed at three SC locations. The safety and tolerability of OKV-119 implants were assessed in a small (n = 4 cats) 62-day study. Weekly plasma exenatide concentrations and body weight were measured in a 42-day proof-of-concept study designed to evaluate OKV-119 prototypes implanted in cats (n = 15).

Results: In anesthetized cats, the duration of insertion and removal procedures was 1–2 min. OKV-119 was easily identified on radiographs, and well-tolerated without any apparent implant site reactions. Following implantation, exanatide plasma concentrations were observed for up to 35 days. Plasma exenatide concentrations were correlated to weight loss.

Conclusion and clinical importance: Our findings suggest that OKV-119 could be easily inserted and removed during a routine clinic visit and can be used to safely and effectively deliver exenatide. Future studies of OKV-119, configured to release exenatide for a longer extended months-long duration, are warranted to determine whether the combination of metabolic improvements and beneficial weight-loss, coupled with minimal impact on pet-owner's lifestyle, lead to improved outcomes for obese cats and feline DM patients.

Single-dose pharmacokinetics of mycophenolic acid following administration of immediate-release mycophenolate mofetil in healthy Beagle dogs

Mycophenolic acid (MPA) is an immunomodulating agent commonly used in human medicine for the treatment of immune-mediated diseases. There is growing evidence that the immunomodulating properties of mycophenolate mofetil (MMF), a prodrug of MPA, are therapeutically beneficial for the treatment of immune-mediated diseases in dogs. A narrow therapeutic index and high inter-and intra-patient pharmacokinetic (PK) variability complicate the use of MMF. A better characterization of MPA pharmacokinetics is needed to help establish dosing regimens and standardized treatment protocols for canine patients. The purpose of this study was to evaluate the pharmacokinetics of MPA in dogs. MMF oral suspension (10 mg/kg) was administered to five healthy beagle dogs. Serial blood samples were collected from 0 to 18 hours after administration. The simultaneous quantification of MPA, and its metabolites MPA-7-O-glucuronide (MPAG), and acyl glucuronide (AcMPAG) was determined by liquid chromatography (LC)-mass spectrometry (MS)/MS. MPA peak concentrations were achieved rapidly (median Tmax of 0.5 h). Concentrations fell through 3 hours post-dose and then plateaued around 20% of Cmax. The mean elimination half-life was rapid (5.8 hours) and notable variability was observed in all PK parameters. The PK profiles for the MPAG and AcMPAG metabolites followed a similar pattern as MPA concentration. Future repeat-dose studies will be needed to evaluate steady-state PK parameters and to define therapeutic MPA dose levels.

Retrospective Analysis of Heartworm (Dirofilia immitis) Prevention Medication Compliance and Economic Value in Dogs in Veterinary Practices in Australia

Background: Canine heartworm (HW) is endemic in Australia. Prevention usually involves monthly topical or oral preventives, or annual injections of extended-release moxidectin (ProHeart SR-12^*1), hereafter referred to as injectable moxidectin (IM). Poor compliance can leave dogs susceptible to infection. This pharmacoeconomics study used retrospective transactional data from 52 Australian veterinary practices to examine the economic value of compliance, revenue, and patient retention associated with veterinarian-sourced canine HW prevention.

Methods: This longitudinal descriptive study utilized anonymized transaction records of 228,185 dogs identified to have visited a veterinary practice at least twice in the period 2010–2015. Purchase compliance against a benchmark of 12 months HW protection per year was measured for IM or monthly HW (MHW) preparations each year and for consecutive years. The average annual cost per dog by preventative modality was also determined.

Results: Between 2010 and 2015, of the 228,185 dogs identified, 73.0% recorded either zero or one purchase of HW preventive from their veterinary clinic; 18.7% recorded at least two IM purchases, and 10.6% purchased MHW prevention at least twice. Single-year purchase compliance was 92.8–96.9% for IM vs. 26.9–36.5% for dogs receiving MHW products. Consecutive-year purchase compliance was 76.7% for IM and 24.4% for MHW medications. Dog owners spent $AU108.29/dog/year (Australian dollars) on IM vs. $AU131.96/dog/year on MHW prevention products, which may have treated other parasites concurrently, although repeat MHW purchasers only purchased enough to cover an average of 7.2 months per year. Dogs recording at least two HW prevention transactions generated more revenue for veterinary practices/dog/year compared to dogs with less than two. Finally, dogs receiving IM, especially those that started at <15 months old, had the highest retention rate in this population.

Conclusions: In the 5 years from 2010 to 2015, 73% of dog owners who visited a veterinary practice at least twice made less than two purchases of HW preventatives from the veterinary practice. For those with at least two preventative purchases, 76.7% of dogs receiving IM and 24.4% of dogs prescribed with MHW products purchased enough doses to provide continuous protection over the observation period.