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Sarker MS, Nath SC, Ahmed I, Siddiky NA, Islam S, Kabir ME, Bupasha ZB. Knowledge, attitude and practice towards antibiotic use and resistance among the veterinarians in Bangladesh. PLoS One 2024; 19:e0308324. [PMID: 39137217 PMCID: PMC11321546 DOI: 10.1371/journal.pone.0308324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The emergence of antimicrobial resistance is a growing human and animal health concern around the world. When a number of studies have emphasized the Knowledge, Attitude and Practice (KAP) regarding antibiotic use and resistance in humans, little attention has been paid to the veterinary sector. The aim of this study was to understand the KAP towards antibiotic use and resistance among veterinarians in Bangladesh. METHODS A cross-sectional online based questionnaire survey was conducted from August to September 2020 among the registered veterinary practitioners. A self-administered Google form questionnaire consisting of 45 questions on knowledge, attitude and practice regarding antibiotic use and resistance was used. For statistical significance test we used Chi-square or Fisher's Exact test and logistic regression for factor analysis. RESULTS A total of 208 registered veterinarians participated in this study. The study involved a majority of male participants, constituting 85.1%, while 54.8% of the participants held a Masters degree. Around 52% of the veterinarians were poultry practitioners. All respondents were familiar with antimicrobials. The participants (91.4%) knew that antibiotics cannot cure viral infections, while 97.6% believed that frequent antibiotic prescriptions rendered them less effective. Participants claimed that only they were eligible to prescribe drugs for the treatment of animals, and around 80% disagreed with adding antibiotics with feed/water as a growth promoter in livestock. Of the total participants, 87% believed that a local antimicrobial guideline would be more effective than an international one. A multivariable analysis revealed that male veterinarians have 2.37 times higher knowledge regarding antimicrobial use (AMU) and antimicrobial resistance (AMR) (OR = 2.37, CI = 1.01-5.59, p = 0.05). Veterinarians engaged in government services demonstrated a 2.59 times more favorable attitude towards AMU and AMR (OR = 2.59, CI = 0.99-6.73, p = 0.05). Additionally, respondents aged 31-35 were 0.45 times more likely to exhibit good practices (OR = 0.45, CI = 0.2-1.00, p = 0.05). However, gaps in practices were highlighted in our study, suggesting training deficiencies. CONCLUSION The present study, for the first time conducted in Bangladesh, dictates that future interventions like academic courses, workshops, and seminars on antibiotic usage and resistance are needed to facilitate the knowledge, behavior and practice of veterinarians with regard to the rational use of antibiotics.
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Affiliation(s)
- Md Samun Sarker
- Bangladesh Livestock Research Institute (BLRI), Antimicrobial Resistance Action Center (ARAC), Savar, Dhaka, Bangladesh
| | - Sanjib Chandra Nath
- Bangladesh Livestock Research Institute (BLRI), Antimicrobial Resistance Action Center (ARAC), Savar, Dhaka, Bangladesh
| | - Iftekhar Ahmed
- Department of Pharmacy, Jahangirnagar University, Dhaka, Bangladesh
| | - Nure Alam Siddiky
- Bangladesh Livestock Research Institute (BLRI), Antimicrobial Resistance Action Center (ARAC), Savar, Dhaka, Bangladesh
| | - Shariful Islam
- Institute of Epidemiology, Disease Control and Research (IEDCR), Mohakhali, Bangladesh
| | - Md Ehsanul Kabir
- Bangladesh Livestock Research Institute (BLRI), Antimicrobial Resistance Action Center (ARAC), Savar, Dhaka, Bangladesh
| | - Zamila Bueaza Bupasha
- Bangladesh Livestock Research Institute (BLRI), Antimicrobial Resistance Action Center (ARAC), Savar, Dhaka, Bangladesh
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Yudhanto S, Reinhart JM, de Souza CP, Gochenauer A, Sander WE, Hung CC, Maddox CW, Varga C. Assessing Illinois companion animal veterinarians' antimicrobial prescription practices and the factors that influence their decisions when treating bacterial infections in dogs and cats. Zoonoses Public Health 2024. [PMID: 39044541 DOI: 10.1111/zph.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 05/16/2024] [Accepted: 07/11/2024] [Indexed: 07/25/2024]
Abstract
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.
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Affiliation(s)
- Setyo Yudhanto
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Jennifer M Reinhart
- Veterinary Teaching Hospital, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Clarissa Pimentel de Souza
- Veterinary Teaching Hospital, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Alexandria Gochenauer
- Veterinary Teaching Hospital, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - William E Sander
- Veterinary Teaching Hospital, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Chien-Che Hung
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
- Veterinary Diagnostic Laboratory, Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Carol W Maddox
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
- Veterinary Diagnostic Laboratory, Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Csaba Varga
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
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Thongyuan S, Tansakul N. Antimicrobial use on pig farms in Thailand: Farmer perceptions of use and resistance. Prev Vet Med 2024; 230:106287. [PMID: 39059075 DOI: 10.1016/j.prevetmed.2024.106287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/08/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024]
Abstract
Limiting the use of antimicrobial agents in intensive livestock production is a challenge due to different perceptions between the short-term benefits of antimicrobial use (AMU) by livestock producers and the long-term social costs of antimicrobial resistance (AMR) and its impact on human, animal, and environmental health. Pig farmers are key stakeholders supporting Thailand's national strategic plan on AMR which aims to reduce antimicrobial consumption in the livestock sector. Consequently, this study explored the knowledge, perceptions, attitudes, and practices of pig farmers towards AMU and AMR, expecting to provide information that would help guide policymakers in the development of a proper interventional program for antimicrobial stewardship. The qualitative approach utilized individual, face-to-face, in-depth, semi-structured interviews with the 20 owners of middle- and large-scale pig farms in eastern Thailand. The major themes identified in this finding were: (1) the use of antimicrobials on farms and the knowledge of antimicrobials; (2) AMU on pig farms (the purpose of AMU, antimicrobial prescription practices, and performing antimicrobial susceptibility testing); (3) attitudes towards prescribing practices and record keeping; (4) farm animal husbandry practices and AMU; (5) factors influencing AMU; and (6) awareness regarding AMR. Most of the pig farm owners recognized that achieving Good Agricultural Practices certification required following the legislation and regulations for AMU. Other observations were that the respondents had positive attitudes towards prescribing practices, performing antimicrobial susceptibility testing before antimicrobial therapy, and recording drug use on farms; however, there was low awareness of AMR. In addition, alternative substances, such as medicinal plants, and proper biosecurity practices were mentioned. Factors influencing AMU on pig farms were intensive enforcement of legislation and regulations, the implementation of farm management practices, the provision of information and consultancy services by veterinary professionals, farmer experience, and consumer trends.
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Affiliation(s)
- Suporn Thongyuan
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Kasetsart University, Nakhon Pathom, Thailand
| | - Natthasit Tansakul
- Department of Pharmacology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand.
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Almutairy B. Extensively and multidrug-resistant bacterial strains: case studies of antibiotics resistance. Front Microbiol 2024; 15:1381511. [PMID: 39027098 PMCID: PMC11256239 DOI: 10.3389/fmicb.2024.1381511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
The development of antibiotic resistance compromises the effectiveness of our most effective defenses against bacterial infections, presenting a threat to global health. To date, a large number of research articles exist in the literature describing the case reports associated with extensively drug-resistant (XDR) and multidrug-resistant (MDR) bacterial strains. However, these findings are scattered, making it time-consuming for researchers to locate promising results and there remains a need for a comparative study to compile these case reports from various geographical regions including the Kingdom of Saudi Arabia. Additionally, no study has yet been published that compares the genetic variations and case reports of MDR and XDR strains identified from Saudi Arabia, the Middle East, Central Europe, and Asian countries. This study attempts to provide a comparative analysis of several MDR and XDR case reports from Saudi Arabia alongside other countries. Furthermore, the purpose of this work is to demonstrate the genetic variations in the genes underlying the resistance mechanisms seen in MDR and XDR bacterial strains that have been reported in Saudi Arabia and other countries. To cover the gap, this comprehensive review explores the complex trends in antibiotic resistance and the growing risk posed by superbugs. We provide context on the concerning spread of drug-resistant bacteria by analyzing the fundamental mechanisms of antibiotic resistance and looking into individual case reports. In this article, we compiled various cases and stories associated with XDR and MDR strains from Saudi Arabia and various other countries including China, Egypt, India, Poland, Pakistan, and Taiwan. This review will serve as basis for highlighting the growing threat of MDR, XDR bacterial strains in Saudi Arabia, and poses the urgent need for national action plans, stewardship programs, preventive measures, and novel antibiotics research in the Kingdom.
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Affiliation(s)
- Bandar Almutairy
- Department of Pharmacology, College of Pharmacy, Shaqra University, Shaqra, Saudi Arabia
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Chan OS, Wu P, Cowling B, Lee E, Yeung M, St-Hilaire S, Tun H, Wernli D, Lam W. Prescribing antibiotics prudently-A survey of policy implementation drivers among physicians and veterinarians. One Health 2024; 18:100752. [PMID: 38832078 PMCID: PMC11145358 DOI: 10.1016/j.onehlt.2024.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
Background As the antimicrobial resistance (AMR) problem accelerates, humans and animals are suffering from the consequences of infections with diminishing antimicrobial treatment options. Within the One Medicine and One Health mandate, which denotes a collaborative, multisectoral, and transdisciplinary approach to improve medicine and health across human and animal sectors, we investigate how human and veterinary medical practitioners apply their medical and policy knowledge in prescribing antimicrobials. Different regions and locations establish different intermediary policies and programs to support clinicians in that pursuit. In Hong Kong, there are locally adapted programs at governance and clinical levels in the human medical field. However, there is no locally adapted veterinary antibiotic prescription guideline or stewardship program, and veterinarians adopt overseas or international professions' antimicrobial use guidelines. Such a policy environment creates a natural experiment to compare local policy implementation conditions and clinicians' knowledge, perception, and practice. Method We construct the investigative survey tool by adaptation of Knowledge, Attitude, and Practice (KAP) and Capacity, Opportunity, and Motivation-Behavior (COM-B) models. We identify, compare and contrast factors that influence clinicians' antimicrobial prescription behavior. The factors are considered both intrinsically, such as personal attributes, and extrinsically, such as societal and professional norms. Findings The absence of locally adopted antimicrobial guidelines influences AMR stewardship program implementation in local Hong Kong veterinary community. As medical allies, physicians and veterinarians share similar demographic influence, organization considerations and perception of public awareness. Both cohorts prescribe more prudently with more years-in-practice, time available to communicate with patients or caretakers, and public awareness and support.
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Affiliation(s)
- Olivia S.K. Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Peng Wu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ben Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Elaine Lee
- Agriculture, Fisheries and Conservation Department, 5/F, Cheung Sha Wan Government Offices, 303 Cheung Sha Wan Road, Kowloon, Hong Kong SAR, China
| | - Michelle Yeung
- Agriculture, Fisheries and Conservation Department, 5/F, Cheung Sha Wan Government Offices, 303 Cheung Sha Wan Road, Kowloon, Hong Kong SAR, China
| | - Sophie St-Hilaire
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, People's Republic of China
| | - Hein Tun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH-1211 Genève, Switzerland
| | - Wendy Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Ljungquist D, Andersson M, Areskog M, Andersson AM. Antibiotic Use in Dental Care of Dogs, Cats, and Rabbits in Sweden. J Vet Dent 2024; 41:192-196. [PMID: 37680039 DOI: 10.1177/08987564231189655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Antimicrobial resistance is one of the largest threats to global health. In society as well as in healthcare facilities, antimicrobial resistance is rapidly increasing with the main reason being overuse and misuse of antibiotics combined with inadequate infection prevention. For humans, dental care accounts for about 10% of all antibiotic prescriptions, making it an important target for antibiotic stewardship interventions. Corresponding figures for veterinary care are currently lacking but dental disease is frequently diagnosed in small animals. An important first step in the work towards prudent use of antibiotics is to understand antibiotic prescription habits and through that estimate the adherence to veterinary antibiotic guidelines as well as the need for education, training, and improved policies. The aim of this article is to present the results of a multicentre point prevalence survey sent to Swedish IVC Evidensia practices during autumn 2021 to recognize the use of antibiotics associated with dental treatments in dogs, cats, and rabbits. During the study period, 4.4% of the dental patients in Swedish IVC Evidensia small animal veterinary practices received antibiotics. The most used antibiotics prescribed were ampicillin, amoxicillin, and clindamycin indicating an overall high level of compliance to veterinary dental guidelines. This article demonstrates that Swedish veterinarians use antibiotics prudently in small animal dentistry and the results may be used as a future global benchmark.
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Shahi MK, Jeamsripong S. Knowledge, attitudes, and practices on antimicrobial use and antimicrobial resistance among poultry practitioner veterinarians. Front Vet Sci 2024; 11:1349088. [PMID: 38655534 PMCID: PMC11036543 DOI: 10.3389/fvets.2024.1349088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Background Antimicrobial resistance (AMR) poses a serious global threat to human and animal health. In the context of antimicrobial usage (AMU) in livestock production, veterinarians are key stakeholders. However, there is a lack of comprehensive situational analysis regarding the current Knowledge, Attitudes, and Practices (KAP) among veterinarians concerning AMU and AMR in poultry production in Nepal. Methods The primary objective of this study was to evaluate the situation of AMU and KAP regarding AMU and AMR of among poultry practitioner veterinarians in Nepal. A total of 327 respondents from 56 districts across seven provinces participated. Demographic information and AMU situation were collected and analyzed using descriptive statistics, and factors affecting KAP on AMU and AMR were performed using logistic regression analysis. Results Nearly half of veterinarians (49.2%) were from Bagmati, followed by Lumbini (16.5%) and Gandaki (8.9%) provinces. Most of the respondents (85.0%) identified themselves as male with a mean age of 31.9 ± 7.8 years, with a range of 24-74 years. A large proportion of veterinarians held a master's degree (43.8%). Regarding reasons for AMR, 51.1% of them attributed it to the irrational use of antimicrobials. Other identified reasons for AMR, including over-the-counter sales (27.8%), low-dose administration (12.3%), and low-quality antimicrobials (6.7%). Based on antibiotic prescription rates, most veterinarians (50.8%) prescribed antimicrobials at a rate of 20-40%, while 25.9% prescribed at a rate of less than 20.0 and 18.9% at a rate of 40-60%. Approximately 89.0% of veterinarians agreed that vaccination could reduce the use of antimicrobials in poultry, and 75.6% preferred narrow-spectrum antimicrobials than broad-spectrum antimicrobials. A combination of broad-spectrum antimicrobials such as colistin with amoxicillin, gentamicin, tylosin, and tetracycline was commonly used in poultry production. Discussion In logistic regression analysis, it was observed that veterinarians aged 45-60 years demonstrated significantly higher levels of knowledge concerning AMU and AMR (p = 0.02) compared to those in the 24-30 age group. This study indicates that the need for robust regulatory mechanisms in veterinary drug administration and increased awareness among veterinarians to address the AMR issue livestock production.
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Affiliation(s)
- Manoj Kumar Shahi
- Nepal Veterinary Council, Kathmandu, Nepal
- Research Unit in Microbial Food Safety and Antimicrobial Resistance, Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Saharuetai Jeamsripong
- Research Unit in Microbial Food Safety and Antimicrobial Resistance, Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
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Becker SD, Hughes DM. Patient weight has diverse effects on the prescribing of different antibiotics to dogs. Front Vet Sci 2024; 11:1358535. [PMID: 38440386 PMCID: PMC10910008 DOI: 10.3389/fvets.2024.1358535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Various factors including body weight-associated treatment cost may influence the probability of dispensing antibiotics to dogs in first-opinion practice, but their effect on specific drug choice remains unclear. Methods Multiple membership regression modeling was used to investigate the probability of dispensing 12 different antibiotics to dogs of different weights in the context of various disease presentations, using anonymized data obtained from electronic health records of 18 clinics between 2020 and 2022. Data from 14,259 dogs were analyzed. Results Treatment choice varied significantly with animal weight. Higher body weight was associated with an increased likelihood of dispensing lower cost antimicrobials such as amoxicillin and trimethoprim sulfonamide, while use of higher cost antimicrobials such as cefovecin was strongly biased to smaller animals. However, these effects were limited when restricted treatment options were available for the target condition. Conclusion This work demonstrates that anticipated financial costs may result in different treatment choices for canine patients depending on their body weight. Further work is needed to understand the impact of financial pressures on veterinarians' treatment choices, and the implications for the optimization of antimicrobial stewardship in first opinion practice.
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Affiliation(s)
- Stuart D. Becker
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Pathobiology and Population Sciences, The Royal Veterinary College, Hertfordshire, United Kingdom
| | - David M. Hughes
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Kungu JM, Tegule SS, Awke IA, Namayanja J, Namyalo E, Oposhia J, Olum W, Nyakarahuka L, Kankya C, Dahourou D, Odoi A. Antimicrobial susceptibility profiles of Staphylococcus aureus in cattle and humans in farming communities of Isingiro and Kamuli districts, Uganda. Sci Rep 2024; 14:1900. [PMID: 38253756 PMCID: PMC10803302 DOI: 10.1038/s41598-024-52035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Bacterial resistance to antimicrobials is fast becoming a big challenge as resistance to multiple drugs is rising rapidly. The emergence of resistant Staphylococcus aureus worldwide is life-threatening in both humans and animals and yet little is known about the burden of antimicrobial resistance (AMR) in developing countries including Uganda. Therefore, the aims of this study were to determine the prevalence of antimicrobial resistant S. aureus among humans and animals as well as assess the perceptions and practices of farmers in Kamuli and Isingiro districts in Uganda regarding AMR of S. aureus. A cross-sectional study was conducted between July and September 2020 in 147 randomly selected cattle-keeping households in Isingiro and Kamuli districts. A structured questionnaire uploaded in the Kobo-collect online data collection tool was used to assess farmers' perceptions and practices pertaining to AMR in each of the selected households. Nasal swabs (n = 147) were collected from both cattle and humans (farmers). Bacterial isolation and confirmation was done using Gram-staining and biochemical tests. This was followed by antimicrobial susceptibility testing (AST) using the Kirby Bauer disc diffusion method. Only 14/147 (9.5%) cattle samples and 45/147(30.6%) human samples tested positive for S. aureus. All cattle S. aureus isolates were resistant to Nitroimidazoles while 92.9% were resistant to Penicillins. None of the isolates were resistant to Fluoroquinolones and Aminoglycosides. All the 14 isolates exhibited AMR to at least one of the assessed antibiotics and 92.9% (13/14) showed evidence of multidrug resistance (MDR). Likewise, S. aureus human isolates showed high levels of resistance to Nitroimidazoles (100%) and Penicillins (93.3%), with none of the isolates having resistance to Aminoglycosides, and only one exhibiting resistance to Fluoroquinolones (2.2%). All the 45 human isolates exhibited AMR to at least one antibiotic while 93% (42/45) had MDR. Most farmers had good perceptions of AMR, with a significantly higher proportion of respondents from Isingiro than Kamuli showing a better understanding of AMR. Antibiotic prophylaxis was reported to be the least practiced measure of diseases and parasites control (17.0%), with more farmers in Isingiro (33.3%) undertaking it than those in Kamuli (1.3%) (p < 0.001). Penicillins and Nitroimidazoles were reported to be the most used antibiotics among cattle and humans. This study provides evidence of occurrence of S. aureus resistance to antimicrobials commonly used in both humans and livestock in Isingiro and Kamuli districts. Farmers had good perceptions regarding AMR as well as good antimicrobial use practices which can form a basis for mitigation of AMR.
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Affiliation(s)
- Joseph M Kungu
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.
| | - Sarah S Tegule
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Ilyas A Awke
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Edity Namyalo
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | - Luke Nyakarahuka
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Clovice Kankya
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, USA
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Fabrile MP, Ghidini S, Caligiani A, Scali F, Varrà MO, Lolli V, Alborali GL, Ianieri A, Zanardi E. 1H NMR Metabolomics on Pigs' Liver Exposed to Antibiotics Administration: An Explorative Study. Foods 2023; 12:4259. [PMID: 38231703 DOI: 10.3390/foods12234259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024] Open
Abstract
An untargeted Nuclear Magnetic Resonance (NMR) spectroscopy-based metabolomics approach was applied as a first attempt to explore the metabolome of pigs treated with antibiotics. The final goal was to investigate the possibility of discriminating between antibiotic-treated (TX group) and untreated pigs (CTRL group), with the further perspective of identifying the authentication tools for antibiotic-free pork supply chains. In particular, 41 samples of pig liver were subjected to a biphasic extraction to recover both the polar and the non-polar metabolites, and the 1H NMR spectroscopy analysis was performed on the two separate extracts. Unsupervised (principal component analysis) and supervised (orthogonal partial least squares discriminant analysis) multivariate statistical analysis of 1H NMR spectra data in the range 0-9 ppm provided metabolomic fingerprinting useful for the discrimination of pig livers based on the antibiotic treatment to which they were exposed. Moreover, within the signature patterns, significant discriminating metabolites were identified among carbohydrates, choline and derivatives, amino acids and some lipid-class molecules. The encouraging findings of this exploratory study showed the feasibility of the untargeted metabolomic approach as a novel strategy in the authentication framework of pork supply chains and open a new horizon for a more in-depth investigation.
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Affiliation(s)
- Maria Pia Fabrile
- Department of Food and Drug, University of Parma, Strada del Taglio, 10, 43126 Parma, Italy
| | - Sergio Ghidini
- Department of Food and Drug, University of Parma, Strada del Taglio, 10, 43126 Parma, Italy
| | - Augusta Caligiani
- Department of Food and Drug, University of Parma, Strada del Taglio, 10, 43126 Parma, Italy
| | - Federico Scali
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna, Via A. Bianchi 9, 25124 Brescia, Italy
| | - Maria Olga Varrà
- Department of Food and Drug, University of Parma, Strada del Taglio, 10, 43126 Parma, Italy
| | - Veronica Lolli
- Department of Food and Drug, University of Parma, Strada del Taglio, 10, 43126 Parma, Italy
| | - Giovanni Loris Alborali
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna, Via A. Bianchi 9, 25124 Brescia, Italy
| | - Adriana Ianieri
- Department of Food and Drug, University of Parma, Strada del Taglio, 10, 43126 Parma, Italy
| | - Emanuela Zanardi
- Department of Food and Drug, University of Parma, Strada del Taglio, 10, 43126 Parma, Italy
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Kubasari C, Adeapena W, Najjemba R, Hedidor GK, Adjei RL, Manu G, Timire C, Afari-Asiedu S, Asante KP. Quality of Data Recording and Antimicrobial Use in a Municipal Veterinary Clinic in Ghana. Trop Med Infect Dis 2023; 8:485. [PMID: 37999604 PMCID: PMC10675351 DOI: 10.3390/tropicalmed8110485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 11/25/2023] Open
Abstract
The recording of antimicrobial use data is critical for the development of interventions for the containment of antimicrobial resistance. This cross-sectional study assessed whether dissemination activities and recommendations made after an operational research (OR) study in 2021 resulted in better data recording and improved the use of antimicrobials in a rural veterinary clinic. Routinely collected data from treatment record books were compared between 2013 and 2019 (pre-OR) and from July 2021 to April 2023 (post-OR). The most common animals presenting for care in the the pre - and post OR periods were dogs (369 and 206, respectively). Overall, antimicrobial use in animals increased from 53% to 77% between the two periods. Tetracycline was the most commonly used antimicrobial (99%) during the pre-OR period, while Penicillin-Streptomycin was the most commonly used antimicrobial (65%) during the post-OR period. All animals that received care at the clinic were documented in the register during both periods. Whereas the diagnosis was documented in 269 (90%) animals in the post-OR period compared to 242 (47%) in the pre-OR period, the routes and dosages were not adequately recorded during the both periods. Therefore, the quality of data recording was still deficient despite the dissemination and the recommendations made to some key stakeholders. Recommendations are made for a standardized antimicrobial reporting tool, refresher training, and continuous supervisory visits to the clinic.
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Affiliation(s)
- Cletus Kubasari
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo P.O. Box 200, Ghana; (W.A.); (G.M.); (S.A.-A.); (K.P.A.)
| | - Wisdom Adeapena
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo P.O. Box 200, Ghana; (W.A.); (G.M.); (S.A.-A.); (K.P.A.)
| | | | | | - Raymond Lovelace Adjei
- Council for Scientific and Industrial Research-Animal Research Institute, Accra P.O Box 20, Ghana;
| | - Grace Manu
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo P.O. Box 200, Ghana; (W.A.); (G.M.); (S.A.-A.); (K.P.A.)
| | - Collins Timire
- International Union Against Tuberculosis and Lung Diseases, 75006 Paris, France;
| | - Samuel Afari-Asiedu
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo P.O. Box 200, Ghana; (W.A.); (G.M.); (S.A.-A.); (K.P.A.)
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo P.O. Box 200, Ghana; (W.A.); (G.M.); (S.A.-A.); (K.P.A.)
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12
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Knowledge and Attitudes of Small Animal Veterinarians on Antimicrobial Use Practices Impacting the Selection of Antimicrobial Resistance in Dogs and Cats in Illinois, United States: A Spatial Epidemiological Approach. Antibiotics (Basel) 2023; 12:antibiotics12030542. [PMID: 36978409 PMCID: PMC10044024 DOI: 10.3390/antibiotics12030542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Inappropriate antimicrobial use in animals and humans has been associated with the emergence of antimicrobial resistance, which has become a global public health concern. Veterinarians’ practice locations and their knowledge and opinions on antimicrobial resistance may influence their antimicrobial prescription practices, which could impact the emergence of antimicrobial-resistant bacteria. This study used a spatial modeling approach to identify areas where veterinarians are knowledgeable about factors that impact the selection of antimicrobial resistance. In addition, we sought to identify regions with higher- and lower-than-expected response rates to our survey to aid future antimicrobial stewardship efforts. A total of 83 veterinarians who treated dogs and/or cats across 34 different Illinois counties responded to our online survey. Most of the responders (90.9%) considered that insufficient doses or duration of antibiotic treatments contribute the most to the selection of antimicrobial resistance. A high proportion of veterinarians (78.7%) attended educational programs on antimicrobial use and resistance; however, only 46.2% were knowledgeable about the current antimicrobial resistance profiles of prevalent bacteria in their area. A mean knowledge score for each county was calculated based on the responses of veterinarians to the survey questions. Local Moran’s I statistic was used to identify counties with high and low knowledge scores. A high knowledge score area in the northeast region and a low knowledge score area in the southeast of Illinois were identified. Using scan statistics with a Poisson model that accounted for the estimated number of veterinarians in a county, a higher-than-expected response rate area was identified in central-east Illinois and a lower-than-expected area in the northeast. This study showed the effectiveness of using geographic analysis and spatial statistics to identify locations where future antimicrobial stewardship programs should focus.
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13
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Farrell S, Benson T, McKernan C, Regan Á, Burrell AMG, Dean M. Exploring veterinarians' behaviour relating to antibiotic use stewardship on Irish dairy farms using the COM-B model of behaviour change. Res Vet Sci 2023; 156:45-53. [PMID: 36780797 DOI: 10.1016/j.rvsc.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
Employing a theoretical model of human behaviour (COMB), the current study explores the factors influencing veterinarians' engagement with antibiotic use stewardship on Irish dairy farms. One-to-one semi structured interviews were carried out by telephone with 12 veterinarians whose daily work focused on dairy cattle. A thematic analysis approach was undertaken. The identified themes and sub-themes were then mapped to the COM-B model. This study identified challenges faced by veterinarians when trying to prescribe responsibly which included lack of training to encourage farmer behaviour change, issues with laboratory testing, pressures from farmers to prescribe antimicrobials, concern for animal welfare and farmers going elsewhere for prescriptions. Having a good knowledge of AMR, peers as an advice source, potential financial benefits for farmers as a result of reduced antimicrobial costs and accepting a shared responsibility for AMR, facilitate veterinarians in their role as antimicrobial stewards. The barriers and facilitators identified as influencing veterinarians' capability, opportunity and motivation to responsibly prescribe antimicrobials formed the basis for a number of practical recommendations which should be considered by advisory and policy making teams. Recommendations include; continuous training for veterinarians on AMR and alternatives to overcome the barriers faced when trying to promote reduced AMU, veterinarian peer support groups to improve confidence in their knowledge and decision making to minimise the effect of client pressures/expectations, setting up collaborative farmer and veterinarian working groups to promote a transparent working relationship and the development of affordable and efficient diagnostic and susceptibility testing.
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Affiliation(s)
- Sarah Farrell
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast BT9 5DL, United Kingdom.
| | - Tony Benson
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast BT9 5DL, United Kingdom.
| | - Claire McKernan
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast BT9 5DL, United Kingdom.
| | - Áine Regan
- Department of Agri-Food Business and Spatial Analysis, Rural Economy Development Programme, Teagasc, Mellows Campus, Athenry, Ireland.
| | - Alison M G Burrell
- Animal Health Ireland, 2 - 5 The Archways, Carrick-on-Shannon, Co. Leitrim N41 WN27, Ireland.
| | - Moira Dean
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, 19 Chlorine Gardens, Belfast BT9 5DL, United Kingdom.
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14
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da Silva-Brandao RR, de Oliveira SM, Correa JS, Zago LF, Fracolli LA, Padoveze MC, Currea GCC. Coping with in-locus factors and systemic contradictions affecting antibiotic prescription and dispensing practices in primary care-A qualitative One Health study in Brazil. PLoS One 2023; 18:e0280575. [PMID: 36662722 PMCID: PMC9857971 DOI: 10.1371/journal.pone.0280575] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance (AMR) is an increasing threat to global health. The risks and sanitary consequences of AMR are disproportionately experienced by those living in Low- and Middle-Income Countries (LMICs). While addressing antibiotic use has largely been documented in hospital settings, the understanding of social drivers affecting antibiotic prescribing and dispensing practices in the context of human and animal health in primary care (PC) in LMICs remains extremely limited. We seek to explore how in-locus and multi-level social factors influence antibiotic prescriptions and dispensing practices in the context of human and animal health in primary care in Brazil. This is a baseline qualitative One Health study; semi-structured interviews and field observations were undertaken in primary care sites located in a socioeconomically vulnerable area in the city of São Paulo, the most populated city of Brazil. Twenty-five human and animal healthcare professionals (HP) were purposely sampled. Interview data were subject to thematic analysis. Three overlapping social drivers were identified across HPs' discourses: individual and behavioral challenges; relational and contextual factors influencing the overprescription of antibiotics (AB); and structural barriers and systemic contradictions in the health system. As a result of the interaction between multilevel in-locus and structural and contextual factors, HPs experience contextual and territorial challenges that directly influence their risk perception, diagnosis, use of laboratorial and image exams, time and decision to undergo treatment, choice of AB and strategies in coping with AB prescriptions. Additionally, in-locus factors influencing antibiotic prescriptions and dispensing practices are intertwined with individual accounts of risk management, systemic contradictions and ambivalences in the national health system. Our findings suggest interventions tackling AB use and AMR in Brazil should consider the social context, the complex health system structure and current integrated programs and services in PC.
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Affiliation(s)
- Roberto Rubem da Silva-Brandao
- Nursing School, University of São Paulo, São Paulo, Brazil
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Sandi Michele de Oliveira
- Section of General Practice, Institute of Public Health, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Gloria Cristina Cordoba Currea
- Section of General Practice, Institute of Public Health, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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15
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Canine Saliva as a Possible Source of Antimicrobial Resistance Genes. Antibiotics (Basel) 2022; 11:antibiotics11111490. [DOI: 10.3390/antibiotics11111490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
While the One Health issues of intensive animal farming are commonly discussed, keeping companion animals is less associated with the interspecies headway of antimicrobial resistance. With the constant advance in veterinary standards, antibiotics are regularly applied in companion animal medicine. Due to the close coexistence of dogs and humans, dog bites and other casual encounters with dog saliva (e.g., licking the owner) are common. According to our metagenome study, based on 26 new generation sequencing canine saliva datasets from 2020 and 2021 reposited in NCBI SRA by The 10,000 Dog Genome Consortium and the Broad Institute within Darwin’s Ark project, canine saliva is rich in bacteria with predictably transferable antimicrobial resistance genes (ARGs). In the genome of potentially pathogenic Bacteroides, Capnocytophaga, Corynebacterium, Fusobacterium, Pasteurella, Porphyromonas, Staphylococcus and Streptococcus species, which are some of the most relevant bacteria in dog bite infections, ARGs against aminoglycosides, carbapenems, cephalosporins, glycylcyclines, lincosamides, macrolides, oxazolidinone, penams, phenicols, pleuromutilins, streptogramins, sulfonamides and tetracyclines could be identified. Several ARGs, including ones against amoxicillin–clavulanate, the most commonly applied antimicrobial agent for dog bites, were predicted to be potentially transferable based on their association with mobile genetic elements (e.g., plasmids, prophages and integrated mobile genetic elements). According to our findings, canine saliva may be a source of transfer for ARG-rich bacteria that can either colonize the human body or transport ARGs to the host bacteriota, and thus can be considered as a risk in the spread of antimicrobial resistance.
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16
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Grakh K, Mittal D, Kumar T, Thakur S, Panwar D, Singh L, Kumar M, Jindal N. Attitude, Opinions, and Working Preferences Survey among Pet Practitioners Relating to Antimicrobials in India. Antibiotics (Basel) 2022; 11:antibiotics11101289. [PMID: 36289947 PMCID: PMC9599001 DOI: 10.3390/antibiotics11101289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 01/17/2023] Open
Abstract
The indiscriminate usage and overuse of antimicrobials in pets or companion animals are underlying causes of antimicrobial resistance (AMR). Despite the multi-faceted global challenge presented by antimicrobial resistance, very few studies have appraised pet practitioners’ factors, such as written policy on antimicrobials, dose rate prescribed, use of critically important antimicrobials, and antimicrobial prescription in clean surgical procedures, which can contribute to AMR. In the present study, an online cross-sectional survey among randomly selected pet practitioners (n = 104) of various Indian provinces and union territories was conducted using a questionnaire comprising 33 closed-ended questions on different parameters, viz., the dosage regimen and level of compliance towards guidelines of the World Health Organization (WHO), other relevant veterinary associations, and their opinion while prescribing antimicrobials. Almost every practitioner of the 104 respondents had revealed the difficulties with owner compliance; i.e., incomplete course of the antibiotics, inappropriate follow-ups, and improper care of the sick animals. The majority of practitioners (95%) reported self-prescription of antimicrobials by the owner before presenting the pet(s) to the veterinary clinic, whereas more than half of the respondents (64%) revealed unavailability of antibiogram facilities. Furthermore, a large number (76%) of practitioners stated empirical treatment based on their experience as the main criteria for antimicrobial choice in the absence of timely results from the laboratory. Although non-necessitated use of antimicrobials in clean surgical procedures has been claimed, surprisingly, the majority of pet practitioners (97%) reported their use to reduce the post-operative complications. The use of the highest priority, critically important antimicrobials (HPCIA) listed by the WHO for humans, particularly quinolones and third-generation cephalosporin, also has been reported for different infections. The treatment durations were nearly as per the recommended guidelines issued by the Danish Small Animal Veterinary Association (DSAVA) for different ailments. Analysis using chi-square tests exhibited a significant correlation between less experienced veterinarians (less than 5 years) and prescription of antimicrobials restricted for critically important infections in human medicine. However, there seems to be no association between the experience of the practitioner and the further studied parameters, namely, antimicrobial regimen prescription, weighing the animals before prescription, dose rate calculation, and antimicrobial selection and use after clean surgical operations. The findings suggest periodic awareness campaigns among practitioners regarding the implementation of the official guidelines, the need for systematic surveillance of AMR, awareness among pet owners about antimicrobial resistance, and the importance of rational use of antimicrobials on their pets.
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Affiliation(s)
- Kushal Grakh
- Department of Veterinary Public Health and Epidemiology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar 125004, India
| | - Dinesh Mittal
- Department of Veterinary Public Health and Epidemiology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar 125004, India
- Correspondence:
| | - Tarun Kumar
- Department of Veterinary Clinical Complex (VCC), Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar 125004, India
| | - Swati Thakur
- Department of Veterinary Physiology and Biochemistry, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar 125004, India
| | - Diksha Panwar
- Department of Animal Biotechnology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar 125004, India
| | - Lokender Singh
- Department of Veterinary Physiology and Biochemistry, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar 125004, India
| | - Manesh Kumar
- Department of Veterinary Public Health and Epidemiology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar 125004, India
| | - Naresh Jindal
- Department of Veterinary Public Health and Epidemiology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar 125004, India
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17
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Mudenda S, Mukosha M, Godman B, Fadare J, Malama S, Munyeme M, Hikaambo CN, Kalungia AC, Hamachila A, Kainga H, Bumbangi FN, Daka V, Mfune RL, Mainda G, Mufwambi W, Mpundu P, Kasanga M, Saad SAM, Muma JB. Knowledge, Attitudes, and Practices of Community Pharmacy Professionals on Poultry Antibiotic Dispensing, Use, and Bacterial Antimicrobial Resistance in Zambia: Implications on Antibiotic Stewardship and WHO AWaRe Classification of Antibiotics. Antibiotics (Basel) 2022; 11:1210. [PMID: 36139990 PMCID: PMC9495135 DOI: 10.3390/antibiotics11091210] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Globally, the inappropriate dispensing and use of antibiotics in animals has contributed to the development of bacterial antimicrobial resistance (AMR). In Zambia, there is insufficient information among community pharmacy professionals on antibiotic use (ABU) and AMR in food-producing animals. This study assessed community pharmacy professionals' knowledge, attitudes, and practices regarding poultry antibiotic dispensing, use, and bacterial AMR in the Lusaka district of Zambia. A cross-sectional study was conducted among 178 community pharmacy professionals between February and April 2022 using a semi-structured questionnaire. Data were analyzed using Stata version 17. Of the total participants (n = 178), 51.1% (n = 91) were pharmacists. The most dispensed antibiotic was oxytetracycline, a Watch antibiotic, mainly without prescriptions. Good knowledge of ABU and AMR was associated with work experience for more than one year (p = 0.016), while good practices were associated with male gender (p = 0.039) and work experience of more than one year (p = 0.011). The study found moderate knowledge, positive attitudes, and moderate practices of pharmacy professionals on poultry ABU and AMR. There was high dispensing of poultry antibiotics without prescriptions, which calls for strict implementation of antimicrobial stewardship and surveillance programs in poultry production in Zambia to reduce AMR.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - Moses Mukosha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University College of Medicine, Ado-Ekiti 362103, Nigeria
| | - Sydney Malama
- Department of Biological Sciences, School of Natural Sciences, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - Musso Munyeme
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | | | - Aubrey Chichonyi Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Audrey Hamachila
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Henson Kainga
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Department of Veterinary Epidemiology and Public Health, Faculty of Veterinary Medicine, University of Agriculture and Natural Resources, Lilongwe P.O. Box 219, Malawi
| | - Flavien Nsoni Bumbangi
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- School of Medicine, Eden University, Lusaka P.O. Box 37727, Zambia
| | - Victor Daka
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola P.O. Box 21692, Zambia
| | - Ruth Lindizyani Mfune
- Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola P.O. Box 21692, Zambia
| | - Geoffrey Mainda
- Department of Veterinary Services, Central Veterinary Research Institute, Ministry of Fisheries and Livestock, Lusaka P.O. Box 50060, Zambia
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Prudence Mpundu
- Department of Environmental and Occupational Health, Levy Mwanawasa Medical University, School of Health Sciences, Lusaka P.O. Box 33991, Zambia
| | - Maisa Kasanga
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Shereen Ahmed Mohammed Saad
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, University of Zambia, Lusaka P.O. Box 32379, Zambia
- College of Veterinary Science, University of Bahr El-Ghazal, Wau P.O. Box 10739, South Sudan
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
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18
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Smith SI, Kwaga JK, Ngulukun SS, Adedeji A, Jolaiya TF, Ajayi A, Kabir J. Antibiotic prescription practices amongst veterinarians in Nigeria. Res Vet Sci 2022; 152:219-227. [DOI: 10.1016/j.rvsc.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/19/2022] [Accepted: 07/30/2022] [Indexed: 10/16/2022]
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Kovačević Z, Vidović J, Erdeljan M, Cincović M, Ružić Z, Galić I, Kukurić T, Stojanac N, Horvat O. Veterinary Practitioners' Standpoints and Comprehension towards Antimicrobial Use-Are There Opportunities for Antimicrobial Stewardship Improvement? Antibiotics (Basel) 2022; 11:antibiotics11070867. [PMID: 35884121 PMCID: PMC9311883 DOI: 10.3390/antibiotics11070867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/04/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022] Open
Abstract
The main subject of the research is the assessment of the knowledge, attitudes and behaviors of veterinarians regarding the use of antibiotics (AMU) and antimicrobial resistance (AMR) through a questionnaire conducted among veterinarians in the northern region of Serbia. A total of 62 respondents completed the questionnaire, which represents a response rate of 44.3%. Male veterinarians are less likely to be in the group of veterinarians with insufficient knowledge (p < 0.05). Veterinarians engaged in mixed practice (small and large animals) (p < 0.001) and veterinarians who have over 100 patients per month (p < 0.005) are also less likely to be in the group with insufficient knowledge of antimicrobial resistance. The proportion of those with insufficient knowledge is growing among veterinarians whose source is the Internet (p < 0.01), while the proportion of those with insufficient knowledge about antimicrobial resistance is declining among veterinarians whose source of information is continuous education (p < 0.05). The majority of the respondents (n = 59, 95.2%) completely agreed that AMR is a very big issue in the global health sector right now. Unfortunately, there are crucial gaps in the knowledge and attitudes of the surveyed participants. They do not appear to be aware of the importance of AMU in veterinary medicine and its influence on overall AMR, or the crucial part that non-prescribed antibiotics have in all of it. Positively, many veterinarians use good practice AMU guidelines in their everyday practice and in line with the global trend of AMU reduction, respondents have also decreased their AMU compared to the previous year.
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Affiliation(s)
- Zorana Kovačević
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Jovana Vidović
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Mihajlo Erdeljan
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Marko Cincović
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Zoran Ružić
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
- Correspondence:
| | - Ivan Galić
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Tijana Kukurić
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Nenad Stojanac
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Olga Horvat
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
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20
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Khan X, Lim RHM, Rymer C, Ray P. Fijian Veterinarian and Para-Veterinarians' Behavior, Attitude and Knowledge Toward Antimicrobial Use and Antimicrobial Resistance: A Qualitative Study. Front Vet Sci 2022; 9:898737. [PMID: 35774981 PMCID: PMC9237570 DOI: 10.3389/fvets.2022.898737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global health issue affecting humans and livestock. Reduction in antimicrobial use (AMU) and appropriate use of antimicrobials in livestock production systems have been encouraged. Lack of access to qualified veterinarians, policies regulating AMU and knowledge of AMU and AMR have been identified as drivers of inappropriate AMU behavior in developing countries. Hence, para-veterinarians take a lead role in providing veterinary services to livestock farmers in developing countries. Our previous work found Fijian farmers lack knowledge and understanding of AMU and AMR. However, the attitude, knowledge, and behavior of Fijian veterinary professionals toward AMU and AMR is currently unknown. Therefore, this qualitative study used face-to-face, semi-structured interviews to explore and understand Fijian veterinarian and para-veterinarians' attitude, knowledge, and behavior toward AMU and AMR. A sample of at least ten participants was targeted and recruited from the Central and Western divisions of Viti Levu, Fiji. The Theory of Planned Behavior (TPB) informed the development of the semi-structured interview guide. The interviews were audio-recorded and analyzed using reflexive thematic analysis and deductively using the TPB framework. Our analysis generated three key themes: 1) Antimicrobials prescribed and used based on availability and cost rather than clinical need, 2) Para-veterinarians awareness and knowledge of AMR influence treatment decisions, and 3) Limited resources impede effective consultation and veterinary service delivery. This study demonstrated para-veterinarians (not veterinarians) lacked knowledge and understanding of AMU and AMR. The availability and cost of antimicrobials rather than clinical justification drove antimicrobial prescribing amongst the para-veterinarians. Veterinarians did not visit farms to provide veterinary services; therefore, para-veterinarians provided the veterinary services to the livestock farmers. Lack of human resources, antimicrobials, and physical resources incapacitated veterinary service delivery, where services to farmers' were delayed or not provided at all. Terms of reference for veterinary service delivery and para-veterinarian training framework targeting prescribing, dispensing, use of antimicrobials and risks associated with inappropriate AMU are recommended as part of antimicrobial stewardship (AMS) programmes. Allocation of physical and human resources to Fijian veterinary services should be considered part of AMS programmes to improve veterinary service delivery to livestock farmers and optimize the AMU at the country level.
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Affiliation(s)
- Xavier Khan
- Department of Animal Sciences, School of Agriculture, Policy and Development, University of Reading, Reading, United Kingdom
| | - Rosemary H. M. Lim
- Reading School of Pharmacy, School of Chemistry, Food and Pharmacy, University of Reading, Reading, United Kingdom
- *Correspondence: Rosemary H. M. Lim
| | - Caroline Rymer
- Department of Animal Sciences, School of Agriculture, Policy and Development, University of Reading, Reading, United Kingdom
| | - Partha Ray
- Department of Animal Sciences, School of Agriculture, Policy and Development, University of Reading, Reading, United Kingdom
- Corporate Engagement, The Nature Conservancy, Arlington, VA, United States
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21
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Charlier J, Bartley DJ, Sotiraki S, Martinez-Valladares M, Claerebout E, von Samson-Himmelstjerna G, Thamsborg SM, Hoste H, Morgan ER, Rinaldi L. Anthelmintic resistance in ruminants: challenges and solutions. ADVANCES IN PARASITOLOGY 2022; 115:171-227. [PMID: 35249662 DOI: 10.1016/bs.apar.2021.12.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anthelmintic resistance (AR) is a growing concern for effective parasite control in farmed ruminants globally. Combatting AR will require intensified and integrated research efforts in the development of innovative diagnostic tests to detect helminth infections and AR, sustainable anthelmintic treatment strategies and the development of complementary control approaches such as vaccination and plant-based control. It will also require a better understanding of socio-economic drivers of anthelmintic treatment decisions, in order to support a behavioural shift and develop targeted communication strategies that promote the uptake of evidence-based sustainable solutions. Here, we review the state-of-the-art in these different fields of research activity related to AR in helminths of livestock ruminants in Europe and beyond. We conclude that in the advent of new challenges and solutions emerging from continuing spread of AR and intensified research efforts, respectively, there is a strong need for transnational multi-actor initiatives. These should involve all key stakeholders to develop indicators of infection and sustainable control, set targets and promote good practices to achieve them.
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Affiliation(s)
| | - D J Bartley
- Disease Control, Moredun Research Institute, Penicuik, United Kingdom
| | - S Sotiraki
- Veterinary Research Institute, Hellenic Agricultural Organisation ELGO-DIMITRA, Thessaloniki, Greece
| | - M Martinez-Valladares
- Instituto de Ganadería de Montaña (CSIC-Universidad de León), Departamento de Sanidad Animal, León, Spain
| | - E Claerebout
- Ghent University, Faculty of Veterinary Medicine, Laboratory of Parasitology, Merelbeke, Belgium
| | - G von Samson-Himmelstjerna
- Institute for Parasitology and Tropical Veterinary Medicine, Veterinary Centre for Resistance Research, Freie Universität Berlin, Berlin, Germany
| | - S M Thamsborg
- Veterinary Parasitology, University of Copenhagen, Frederiksberg C, Denmark
| | - H Hoste
- INRAE, UMR 1225 IHAP INRAE/ENVT, Toulouse University, Toulouse, France
| | - E R Morgan
- Institute for Global Food Security, Queen's University Belfast, Belfast, United Kingdom
| | - L Rinaldi
- University of Naples Federico II, Unit of Parasitology and Parasitic Diseases, Department of Veterinary Medicine and Animal Production, CREMOPAR, Napoli, Italy.
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22
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Kalam MA, Rahman MS, Alim MA, Shano S, Afrose S, Jalal FA, Akter S, Khan SA, Islam MM, Uddin MB, Islam A, Magalhães RJS, Hassan MM. Knowledge, Attitudes, and Common Practices of Livestock and Poultry Veterinary Practitioners Regarding the AMU and AMR in Bangladesh. Antibiotics (Basel) 2022; 11:80. [PMID: 35052957 PMCID: PMC8772885 DOI: 10.3390/antibiotics11010080] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/24/2021] [Accepted: 01/04/2022] [Indexed: 01/27/2023] Open
Abstract
Current evidence indicates that more than half of all antimicrobials are used in the animal food-producing sector, which is considered a significant risk factor for the development, spread, and existence of antimicrobial resistance (AMR) pathogens in animals, humans, and the environment. Among other factors, clinical etiology and the level of knowledge, attitudes, and practices (KAP) of veterinarians are thought to be responsible for inappropriate prescriptions in the animal-source protein production sector in lower-resource settings like Bangladesh. We performed this cross-sectional study to assess factors associated with veterinarians' antimicrobial prescription behavior and their KAP on antimicrobial use (AMU) and AMR in Bangladesh. Exploratory and multivariate logistic models were used to describe an association between knowledge, attitudes, and practices of AMU and AMR and demographic characteristics of veterinarians. The results demonstrated that when selecting an antimicrobial, there was no to minimal influence of culture and susceptibility tests and patients' AMU history but moderate to high influence of the farmer's economic condition and drug instructions among the veterinarians. The results also demonstrated that more than half of the veterinarians had correct KAP regarding AMU and AMR, while the rest had moderate or lower levels of KAP. The factor score analysis revealed that age, level of education, years of experience, gender, and previous training on AMU and AMR were the key influencing factors in their level of KAP. Adjusted logistic regression analysis showed that respondents' age, current workplace, and previous training on AMU and AMR had a positive association with increased KAP. Considering the results, it is imperative to include AMR issues on vet curricula, and to provide post-education training, awareness campaigns, easy access to, and dissemination of AMR resources. Increasing the veterinary services to the outreach areas of the country and motivating veterinarians to follow the national AMR guidelines could be some other potential solutions to tackle the over-prescriptions of antimicrobials.
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Affiliation(s)
- Md. Abul Kalam
- Bangladesh Country Office, Helen Keller International, Dhaka 1212, Bangladesh;
| | - Md. Sahidur Rahman
- One Health Center for Research and Action, Akbarshah, Chattogram 4207, Bangladesh;
| | - Md. Abdul Alim
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram 4225, Bangladesh; (M.A.A.); (S.A.K.)
| | - Shahanaj Shano
- Institute of Epidemiology, Disease Control and Research, Dhaka 1212, Bangladesh; (S.S.); (A.I.)
- EcoHealth Alliance, New York, NY 10018, USA
| | - Sharmin Afrose
- Bangladesh Country Office, World Food Programme, Dhaka 1212, Bangladesh;
| | - Faruk Ahmed Jalal
- Handicap International-Humanity & Inclusion, Dhaka 1212, Bangladesh;
| | - Samira Akter
- Department of Anthropology, Jahangirnagar University, Dhaka District, Savar 1212, Bangladesh;
| | - Shahneaz Ali Khan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram 4225, Bangladesh; (M.A.A.); (S.A.K.)
| | - Md. Mazharul Islam
- Department of Animal Resources, Ministry of Municipality and Environment, Doha P.O. Box 35081, Qatar;
| | - Md Bashir Uddin
- Department of Medicine, Sylhet Agricultural University, Sylhet 3100, Bangladesh;
| | - Ariful Islam
- Institute of Epidemiology, Disease Control and Research, Dhaka 1212, Bangladesh; (S.S.); (A.I.)
- EcoHealth Alliance, New York, NY 10018, USA
- Centre for Integrative Ecology, Geelong Campus, School of Life and Environmental Science, Deakin University, Warrnambool, VIC 3216, Australia
| | - Ricardo J. Soares Magalhães
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
- UQ Child Health Research Centre, Children’s Health and Environment Program, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Mohammad Mahmudul Hassan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram 4225, Bangladesh; (M.A.A.); (S.A.K.)
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23
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Vidović J, Stojanović D, Cagnardi P, Kladar N, Horvat O, Ćirković I, Bijelić K, Stojanac N, Kovačević Z. Farm Animal Veterinarians' Knowledge and Attitudes toward Antimicrobial Resistance and Antimicrobial Use in the Republic of Serbia. Antibiotics (Basel) 2022; 11:64. [PMID: 35052941 PMCID: PMC8773276 DOI: 10.3390/antibiotics11010064] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
Antimicrobial resistance (AMR) is considered one of the most prevalent global health issues in both veterinarian and human medicine. This complex problem requires a "One Health" approach with the cooperation of all healthcare sectors, as well as agriculture, finance, and consumers. We conducted a survey with the objective to assess the knowledge and attitudes of farm animal veterinarians toward AMR and antimicrobial use in the Republic of Serbia with a small focus on mastitis therapy. A total of 110 respondents completed the questionnaire, which represents a response rate of 27.3%. The majority of our respondents (n = 102, 92.7%) completely agreed that AMR currently represents severe concern in the health sector. Unfortunately, less than one-third (n = 34, 30.9%) of the respondents had only heard about antimicrobial stewardship. Participants showed a positive attitude toward prudent antimicrobial use and were open to solutions to the AMR crisis. We noticed a certain gap between farm veterinarians' desire to improve and perform better in daily practice, while at the same time feeling like they did not have enough guidance, help, and resources.
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Affiliation(s)
- Jovana Vidović
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Trg Dositeja Obradovica 8, 21000 Novi Sad, Serbia
| | - Dragica Stojanović
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Trg Dositeja Obradovica 8, 21000 Novi Sad, Serbia
| | - Petra Cagnardi
- Department of Veterinary Medicine, Università degli Studi di Milano, 20122 Milan, Italy
| | - Nebojša Kladar
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Olga Horvat
- Department of Pharmacology Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Ivana Ćirković
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - Katarina Bijelić
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Nenad Stojanac
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Trg Dositeja Obradovica 8, 21000 Novi Sad, Serbia
| | - Zorana Kovačević
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Trg Dositeja Obradovica 8, 21000 Novi Sad, Serbia
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