In the Netherlands: guidelines on antibiotic prescription
Guidelines focusing on antibiotic prescription have just been published in the Netherlands.
They indicate which practices are recommended, necessary or mandatory. In all cases, the
prescriber is responsible for his own prescription.
End March, the Dutch veterinary authorities published guidelines on the prescription of veterinary
antibiotics. The 56-page document outlines the “recommended, required and mandatory” antibiotic
prescription practices. In contrast to earlier published guidelines (two for food producing animals:
one on streptococcus in piglets, one on dry cow treatment), this is a general prescription document.
Authors of the guidelines recall that application of the guidelines is “under the complete
responsibility of the veterinary practitioner”. In case of discrepancy with recommendations or
legislative constraints, “it is strongly advised to record all details [of the context and reasons for not
following guidelines or legislation] to allow for a better understanding in case of investigation.”
The formularies
The “guide” constantly refers the practitioner to the formularies, which are documents (one
formulary per species) that list the antibiotics of 1st, 2nd and 3rd choice for each indication. However,
for certain indications (or routes of administration), it is possible that no first or third choice exists.
These are specific cases that highlighted the need for a more general, transverse approach.
To prescribe or not to prescribe?
First pillar of recommendations: the approach of prescription, which can be based on a probability
diagnosis or deducted from complementary investigations. In the first case, only first choice
products should be prescribed; second choice products can only be prescribed for individual
animals. In case of group treatment, the prescriber must “necessarily” follow the second option of
bacteriological culture and sensitivity testing. This kind of investigation is mandatory when
prescribing third-choice antibiotics, which must therefore be preceded by the taking of a sample “of
material that has the highest possibility of detecting the causal agent, and the lowest risk of
contamination”. The practitioner is “responsible of the quality of sampling and of interpretation” of
the laboratory results.
The best choice
When choosing an antibiotic substance, the guidelines recommend that the practitioner consults the
formulary of the species concerned, or even the guidelines that already apply. Ideally, he or she
would start with a first-choice product; if the vet opts directly for a second choice antibiotic “it is
strongly advised to justify this choice and record the justification”. Regarding the prescription of
third-choice antibiotics (so-called critically important antibiotics), this should be “limited to an
absolute minimum” and is prohibited for group treatment – unless exceptional circumstances apply.
In any case, prior bacteriological examination is mandatory. The relation with the farmer is also
highlighted, and the prescribing vet is obliged to “leave clear and detailed written instructions” for
farmers administering the treatment. A herd treatment plan should be drawn up by the practitioner
for each of his farmers, and should taken account of the formularies, but “can only mention firstchoice antibiotics”.
Systematic assessment
After carrying out treatment, it is “strongly recommended” to systematically carry out an
assessment, and to keep written records of the findings. If no cure is obtained, this should lead to
“another therapeutic option.” The document recalls that it is also mandatory to notify case of
therapeutic failure to the authorities in view of pharmacovigilance”.
Source:
https://www.kwaliteitdiergeneeskunde.nl/media/default.aspx/emma/org/10859709/richtlijn%20tam
%20definitief.pdf