Knowledge, attitudes and practices of veterinarians on antibiotic use, resistance and its containment in South Africa.

Abstract

The inappropriate use of antibiotics in the veterinary sector has led to antibiotic resistance (ABR), which negatively impacts animal health and welfare and indirectly on human health. Understanding the knowledge, attitudes, and practices on antibiotic use, ABR, and its containment amongst veterinarians is critical to optimize antibiotic use and contain resistance. A quantitative questionnaire based online survey was conducted amongst members of professional veterinary associations. The questionnaire consisted of four sections focusing on socio-demographic characteristics, knowledge, attitudes, and practices (KAP) of participants on antibiotic use, ABR, and its containment in the South African veterinary sector. The Independent t-test, analysis of variance (ANOVA), and Chi-square test were used to establish associations among selected socio-demographic variables and selected KAP parameters. A total of 130 responses were received from 2178 animal health professionals, yielding a response rate of 6 %, with 102 complete responses constituting the final sample size. Self-reported knowledge on antibiotic stewardship, antibiotic resistance mechanisms, and pharmacology was good at 96 (94.1%), 91 (89.2%), and 70 (68.6%), respectively. More than half the respondents (60 [58.8%]) were confident that the veterinary training they received prepared them quite a bit/very much on rational antibiotic use. Most respondents (81 [79.4%]) believed that antibiotics were sometimes prescribed for suspected but not confirmed infections. The majority of the respondents (77 [75.5%]) were quite concerned/very concerned about antibiotic resistant infections, compared to 19 (18.7%) of clients expressing the same concern. Veterinary guidelines for appropriate use of antibiotics were sometimes read by respondents (45 [44.1%]). A little more than half of the veterinarians (54 [52.9%]) often/always discussed antibiotic resistance with their clients. Most respondents identified broadspectrum antibiotics such as amoxicillin-clavulanate and metronidazole as first-line treatment at 62 (60.8%) and 64 (62.7%) respectively. Notably, most of the veterinarians (61 [59.8%]) also lacked an antibiotic stewardship programme at their practice. The cost of diagnostics (90 [88.2%]), time to results of diagnostics (83 [81.4%]), and client expectations of receiving antibiotics (74 [72.5%]) were cited amongst barriers to the implementation of an antibiotic stewardship programme. Place of practice was significantly associated (p=0.004) with possession of knowledge about antibiotic resistance. Veterinarians in urban practice were more knowledgeable about antibiotic resistance than those in rural practice. Place of practice was also significantly associated (p=0.035) with discussions on antibiotic resistance with clients. More veterinarians in rural practice frequently carried out such discussions than their urban counterparts. There is a need for education and training to address gaps in KAP. There is also a need for the development and implementation of antibiotic stewardship programmes in veterinary practice. Cost effective diagnostic tests with shorter turnaround time might assist in achieving such. The programmes might encourage microbiology informed therapy and the use of guidelines for appropriate antibiotic use.